Quality statement 4: Audiological assessment

Quality statement

Adults presenting for the first time with hearing difficulties not caused by impacted earwax or acute infection have an audiological assessment.

Rationale

Audiological assessment, which includes a full history and assessment of hearing and communication needs, can identify any hearing loss and associated difficulties. The audiologist can then advise on management options, which might include the use of hearing aids. Early identification of progressive hearing loss in adults is important because early management can minimise the effect of hearing loss on social interaction, work, family relationships and quality of life.

Quality measures

Structure

a) Evidence of referral pathways in place to ensure adults presenting for the first time with hearing difficulties have an audiological assessment.

Data source: Local data collection, for example, referral criteria and documented, locally agreed pathways.

b) Evidence that healthcare practitioners have training and access to information to enable them to recognise hearing and communication difficulties for which referral for an audiological assessment is needed.

Data source: Local data collection, for example, training records and clinical protocols.

Process

Proportion of adults presenting for the first time with hearing difficulties not caused by impacted earwax or acute infection who have an audiological assessment.

Numerator – the number in the denominator who have an audiological assessment.

Denominator – the number of adults presenting for the first time with hearing difficulties not caused by impacted earwax or acute infection.

Data source: Local data collection, for example, audit of electronic case records.

Outcome

Hearing-specific health-related quality of life for adults presenting with hearing difficulties not caused by impacted earwax or acute infection.

Data source: Local data collections, for example, a patient survey. NHS England's Adult hearing service specifications (2016) include outcome 2 on improvement in service-user-reported quality of life using validated self-reporting tools such as the Glasgow Hearing Aid Benefit Profile (GHABP) or the Client-Orientated Scale of Improvement (COSI).

What the quality statement means for different audiences

Service providers (such as primary care services) ensure that locally agreed referral pathways are in place for adults who present for the first time with hearing difficulties not caused by impacted earwax or acute infection to be referred for an audiological assessment. Service providers also ensure that healthcare practitioners have training and access to information to help them recognise hearing and communication difficulties for which referral for an audiological assessment is needed.

Healthcare professionals (such as GPs and practice or community nurses) arrange an audiological assessment for adults who present for the first time with hearing difficulties after impacted earwax and acute infections, such as otitis externa, have been excluded. This assessment includes a full history and assessment of hearing and communication needs by the audiologist to identify any hearing loss and associated difficulties.

Commissioners (clinical commissioning groups) ensure that the services they commission include audiological assessment for adults with hearing difficulties not caused by impacted earwax or acute infection.

Adults who go to healthcare services for the first time with hearing difficulties have a hearing assessment, unless the hearing problem is caused by a build-up of earwax or an ear infection.

Source guidance

Hearing loss in adults: assessment and management (2018) NICE guideline NG98, recommendation 1.1.1

Equality and diversity considerations

When assessing an adult presenting for the first time with hearing difficulties, healthcare professionals should be aware of the link between hearing loss and mild cognitive impairment, dementia and learning disability. Hearing loss can affect performance in cognitive function tests, which can lead to misdiagnosis. People with mild cognitive impairment, dementia or a learning disability may not be aware of their hearing loss, or may not have the capacity to ask for help. Their families and carers may not consider that hearing loss is a compounding factor given their other health needs. However, hearing loss that is not addressed will significantly affect understanding and social interactions and will exacerbate underlying cognitive difficulties.