Press notice

NICE issues guidance on hearing aids

The National Institute for Clinical Excellence has today issued its guidance on hearing aid technology to the NHS.

NICE is aware of the Modernising Hearing Aids First Wave Projects in England, which will look in depth at the benefits and costs of digital hearing aids. The results of these projects will be taken into account when the Institute reviews its guidance in 2002.

Until these first wave projects have reported, the Institute recommends that the full range of analogue hearing aids in the current NHS range should be made available at NHS audiology centres with a presumption that the more sophisticated analogue aids will confer more benefit than the basic linear aids and that the NHS (purchasing & supplies branch) should review the current NHS range of analogue aids against the full range of analogue aids available

The Institute's guidance has been circulated to all heads of audiology departments in England and Wales and consultant ENT surgeons.

Andrew Dillon, Chief Executive of NICE said: “Hearing aid technology is evolving rapidly and it is important that individual patients get the right aid for their degree of hearing loss. The NHS has been very conservative in its prescribing, typically offering the most basic linear aid. NICE believes that the current NHS hearing aid range should be fully exploited while the digital projects are underway.”

Ends

Notes for Editors

1. A hearing aid is an electronic device consisting of a microphone, an electronic amplifier, a loudspeaker and a battery. The microphone receives sound that is enhanced by the amplifier. A number of techniques or features exist which can help ensure that desired signals (e.g. human speech) can be heard but that in doing this that the already loud sounds are not made even louder. These features include AGC, compression regimes (WDRC, multi-channel compression) and directional microphones.

2. It is estimated that in England and Wales some 8.1 million individuals currently have a hearing impairment. There are 2.8 million who have an impairment of 45 decibels or more, in both ears, which is the average level that prompts a referral for further care.

3. In England and Wales, approximately 1.4 million people are using prescribed hearing aids. It is estimated that 1 in 10 of the adult population could benefit from NHS hearing aid services. About 500,000 aids are provided every year and 1 in 3 of these is for a new patient. Digitally programmable and ‘true' digital aids are not routinely available from the NHS range however there are the Modernising Hearing Aids First Wave Projects in England, which will look in depth at the benefits and costs of digital hearing aids

4. In 1997, the cost of providing hearing aids within the NHS was estimated at around £50 million per annum, of which £25 million was for the aids themselves. At an approximate average cost of £90 per patient (for the fitting of a new or replacement device), the NHS (at 1999 costs) is one of the least expensive services of its kind in Europe.

5. NICE has issued the following guidance on the prescription of hearing aids for individuals with hearing impairment: - Please note this should be read in conjunction with the full guidance

  • The full range of analogue hearing aids in the current NHS range should be available at all NHS audiology centres and the device offered to an individual patient should:
    • be based on a careful matching of the device to need
    • be based on patient choice (including function and design)
    • include binaural (both ears) fitting where indicated.
    • assume that the more sophisticated analogue aids will provide more benefit than the basic linear aids.

  • The NHS purchasing & supplies agency should review the existing NHS range of analogue aids against the full range of analogue aids currently available.
  • There is not enough robust scientific evidence to support the nationwide introduction of digital hearing aids at this time. However evidence regarding the benefits of digital devices when compared to both a) the current NHS range and b) to more sophisticated analogue devices, is expected to be available when research projects that are underway in the UK end. These projects include an NHS evaluation of digital aids In England. There are a number of projects including the Modernising Hearing Aids First Wave Project.
  • The general provision of more advanced hearing aids is only one aspect of the potential for improvement of hearing aid services. Other important areas that require action are:
    • a better identification of individual user needs and matching of devices to those needs, particularly in children;
    • more time spent on the provision of information and advice, routine follow-up and review in the use of prescribed devices;
    • a reduction in waiting times for audiology services.

6. Health professionals are expected to take the guidance fully into account when exercising their clinical judgement about the circumstances in which it is appropriate to prescribe specific hearing aids for individual patients. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

7. The National Institute for Clinical Excellence (NICE) is a part of the NHS. Part of its work is technology appraisals. That is we use a team of experts to produce guidance for both the NHS and patients on medicines, medical equipment and clinical procedures based on evidence of clinical and cost effectiveness. Each appraisal takes around 12 months to complete and involves the manufacturers of the technology, patient groups and professional organisations.

8. NICE follows an transparent and well structured process for its technology appraisals, which gives appropriate groups (patients professionals and manufacturers) with the opportunity to submit evidence, to comment on draft conclusions and to appeal, if required, to a panel of those independent of the original judgement. Its task is to assess the evidence of all the clinical and other health related benefits of an intervention. This will include impact on quality of life, relief of pain or disability as well as any impact on likely length of life; to estimate the associated costs and to reach a judgement as to whether, on balance, the intervention can be recommended.

9. An appeal was made against the guidance on hearing aids. An appeal panel heard the appeal, which was not upheld.

10. As a part of the Institute's appraisal process the Appraisal Committee produces a Final Appraisal Determination (FAD). The FAD is then considered by the Institute's Guidance Executive who use it as the basis for producing the Guidance to the NHS. The Institute then makes the Guidance available to all interested parties, initially on a confidential basis. They then have 10 working days to lodge an appeal against the guidance if they wish to. The document Appeal Against Guidance to the NHS on a New or Existing Technology - Guidance for Appellants provides more detail on the process and provides guidance for appellants.

Appeals are a part of the Institute's process that are used in the production of the final guidance for the NHS & patients. If an appeal is lodged an independent panel hears it.

11. NICE promotes clinical and cost effectiveness through its technology appraisals, clinical guidelines and audit tools. NICE supports the work of those who make the complex treatment decisions - doctors, nurses, and other health professionals. The needs of the patient are central to NICE's work, and the Institute has forged strong links with patient groups and representatives.

12. NICE appraises new and existing health technologies, as selected by the Department of Health and the National Assembly for Wales and advises the NHS on how these technologies can best be used. It is also responsible for the production of national clinical guidelines, promoting best practice throughout the NHS. To support and assess the implementation of such guidelines, NICE will produce audit tools for use in the clinical setting.

13. Copies of the full guidance and information for patients are available on the NICE web site (www.nice.org.uk).