Having worked for many years with people who have hearing and balance disorders and having a significant family history of hearing loss, I understand the impact hearing difficulties can have on communication affecting family life, education, work and mental health. Tackling this issue has been something of a passion. So chairing the development of the new National Institute for Health and Care Excellence (NICE) guideline: Hearing loss in adults was an exciting challenge.
Hearing loss is common; figures from 2015 indicate that about 9 million people in England were affected by hearing loss. It is estimated that by 2035 this number will grow to more than 13 million people.
The guideline aims to improve the quality of care for adults with hearing loss. It provides the best advice for healthcare staff about effective management of hearing difficulties in primary and community care, including care within local audiology services. It also gives guidance on appropriate referrals to specialist services.
The majority of people with hearing difficulties can be effectively managed within primary and community care.
Build-up of earwax is an example of a problem that is treatable in primary care. This can lead to temporary hearing loss, can adversely affect the performance of hearing aids, and can prevent adequate clinical examination. This can cause delays in investigations and management. The committee recognised the importance of prompt and effective earwax removal, and recommended that earwax should be removed within primary or community care. Evidence to support the method of removal was limited to irrigation, but the advice given should ensure prompt care for this problem, and we hope that our research recommendation will guide future care.
Hearing loss has a significant effect on quality of life. Evidence shows that people wait on average 10 years before they seek help. When they eventually do 30 to 45% of those reporting hearing loss are not referred for hearing assessment by their GP.
Delay in care negatively affects quality of life and reduces the benefit from using hearing aids because older people can find it more difficult to adapt to using the devices. Too often people are not given hearing aids for mild but debilitating losses or only given one hearing aid when both ears are affected, presumably to reduce expenditure. The guideline recommends early care for hearing loss and also recommends hearing aids in both ears when needed. The research undertaken for the guideline found that it was cost effective, as well as clinically effective, to provide hearing aids early and to provide two hearing aids as required. Our recommendations in this respect should make a real change.
With an ageing population it is important that practitioners are aware of the high prevalence of hearing loss and its association with dementia. Hearing loss and cognitive decline can present in the same way and tests for dementia can be misinterpreted if hearing loss is a factor. That is why NICE recommends that services consider referring those with suspected or diagnosed dementia for a hearing assessment and to consider an assessment every 2 years if they have not previously been diagnosed with hearing loss.
The need for follow up, monitoring, and aftercare was found to be important to support continuing hearing aid use. The guideline recommendations on these aspects of care should make a significant difference to those with hearing aids.
Simple communication strategies can make a big difference in health and social care settings. Prompt assessment and robust audiological care can improve the quality of life for those affected. It is also important that those who need additional medical investigation or treatment receive that at the correct time. People need to know that hearing loss is treatable and that treatment is effective. I hope this NICE guideline will make a real change for the better.