Over the last year we published two papers dealing with hearing impairment and what might be relevant for the eye care practitioner. Here we summarise some of the key points outlined in these articles. The complete articles are to be found along with the CET exercise online and it is essential to familiarise yourself with these before undertaking the discussion with your colleague.
- There are more than 11 million people in the UK with some form of hearing loss, or one in six of the population. By 2035, it is estimated that there will be 15.6 million people with hearing loss in the UK - that's one in five
- More than 70% of over 70 year-olds and 40% of over 50 year-olds have some kind of hearing loss
- Around 6.7 million people could benefit from hearing aids
- On average it takes ten years for people to address their hearing loss
Essentially there are two types of hearing loss;
- Conductive – usually localised to the outer and middle ear, a blockage or structural change prevents conduction of the compression wave adequately to the cochlea. Sound is reduced or muffled. Depending on the underlying cause, conductive hearing loss may be reversible.
- Sensorineural – damage to the cochlea or auditory neural pathway preventing adequate transmission of neural signals to the brain. Such loss is permanent.
For this overview I have considered management in three main areas;
- Communication strategies
- Treatment strategies
- Support services
Communication skills
When communicating with a patient with a hearing impairment in eye care practice, the following general points should be considered:
The practitioner should face the patient as much as possible. For times of significant communication, such as during history and symptoms, good lighting on both faces is important
The mouth should be as visible as possible. Some authorities point out that an untrimmed beard or a face covering of any sort may inhibit the interpretation of speech.
The practitioner should always attract attention before starting to speak
Any background noise may significantly reduce the ability of the patient in interpreting the message from the practitioner. This is potentially a problem outside the consulting room, for example at reception or in a pre-examination area.
As with most patients, the use of jargon or technical words (astigmatism, amblyopia and so on) adds to confusion
Specific instructions may be reinforced by being written down
Whole sentences are easier to interpret, though verbosity is best avoided
Complex messages, such as at the summing up of the practitioner’s findings, should be given in short concise bundles (categorisation)
Speech should be slowed down to a steady well-articulated pace of a sensible volume. If speech is too fast it becomes imperceptible, too slow and the natural rhythm is lost making interpretation harder
Though raising volume a little is helpful, shouting or speaking too loudly will actually distort clear speech and may even be painful (for either party!)
The practitioner should ascertain whether the patient has asymmetrical hearing loss and arrange to be seated nearer the side with reduced loss
The practitioner should not be shy or embarrassed to repeat important phrases
Speech can be very effectively reinforced by appropriate body language without any need to resort to specialist sign languages
The practitioner must allow adequate time to allow the patient to respond. It is often forgotten that one has to also listen to a hearing impaired patient
Treatment strategies
- Wax removal
- Cochlear implant
- Hearing aids
Support services
To find out what hearing services are available in any UK area, including access to an audiologist assessment, a good start is to go to www.nhs.uk/Service-Search/Hearing-impairment/LocationSearch/1799
Reading material
Hearing and hearing loss – an eye care practitioner’s guide
Hearing and hearing loss: an eye care practitioner’s guide - part 2
Once you have read through the source material, please attempt the 6 multiple choice questions on the following page.