NHS hearing services for deaf children - coronavirus info for professionalsPublished Date: 11 Sep 2020
There are significant changes to all outpatient services to reduce the amount of social contact with members of the public who are more vulnerable to coronavirus. Audiology services have now re-opened to provide face-to-face appointments, but there may be occasions when they are closed due to a local lockdown restrictions. In areas where audiology is closed for face-to-face appointments due to local lockdown, and the child’s audiologist and parents feel that the child needs to be seen, their audiologist will make decisions on a case-by-case basis depending on whether they have facilities, staff and personal protective equipment available, and what the level of COVID-19 risk is locally at the time. Families are advised not to go to the audiology clinic unless they have spoken to their audiologist first and have been asked to attend.
It is likely that all outpatient services will be run differently for the foreseeable future. There will always be a need to see some children in person at some times, but there will be significant efforts to reduce the amount of time and number of visits needed to the audiology clinic. Changes that families are likely to see include:
- Remote support as the first step – with use of telephone, video or email/text to provide help, arrange to post out any supplies needed, complete questionnaires as part of assessing a child’s use and benefit of their hearing devices, and triaging the need to come in for a face-to-face appointment.
- Being asked to stay outside the building in the hospital grounds until you are messaged to be called in for your appointment.
- No, or very limited waiting areas inside the hospital.
- Limiting of one adult attending with each child
- Staff wearing PPE and masks.
- Visitors and patients will be asked to wear a mask on arrival.
- The use of Perspex screens in smaller clinic rooms as a barrier between staff and patients.
Hearing aid repairs
For hearing aid repairs, families should continue to phone, text or email their audiology clinic to find out how to get a repair locally. All audiology services offer a postal repair service. Families should be advised to make sure they remove the battery before putting the hearing aid in the post. If it is safe to do so, the audiology service may also have a box at clinic reception where faulty hearing aids can be left for repair (a friend or family member can drop this off if necessary). Our website features blogs on caring for your child’s hearing aids at home and troubleshooting technology which provides families with hints, tips and resources in this area.
It is sensible for families to make sure they have a supply of batteries in advance and the NHS will continue to supply at least two packets of batteries per hearing aid at any one time. Families should not wait until they have run out to request new ones. Families are advised to call or email their audiology clinic and they will arrange to post new batteries out to them.
In an emergency, families can buy hearing aid batteries from Boots and other chemists, high street hearing aid dispensers or opticians.
New earmoulds for children are being made without impressions when possible. Manufacturers are re-printing moulds (based on stored scans of impressions) where available, adding a small percentage for growth and then posting to the family. Where scans are not available, services may ask families to post in one of their child’s earmoulds at a time (so that they are not without amplification altogether) and a remake can then be made from this. These are not perfect solutions, but are working for some children. Where impressions are considered necessary, services will try and see children in this situation if they possibly can.
NHS and routine surgery
The NHS is carrying out routine (elective) surgery again. Elective surgery includes grommet surgery for glue ear, bone anchored hearing aids and cochlear implant surgery on older children.
Each hospital will make decisions on surgery on a case-by-case basis, taking into account the prioritisation category given to the procedure (see below), whether they have facilities, staff and personal protective equipment available, and what the level of coronavirus risk is locally at the time.
Due to the nature of Ear, Nose and Throat (ENT) surgery, and working in close proximity to the respiratory system, many of the procedures carry significant risk of passing COVID-19 between patients and staff. ENT surgeons have been working hard to identify new ways of carrying out their surgery procedures using PPE and other new protective measures. ENTUK have published guidance on returning to surgery.
Due to a backlog of patients on waiting lists, the risks involved in individual types of surgery, new infection control measures which limit the number of surgeries that can be undertaken in one operating theatre each day, the need to maintain space for emergency surgery, and competition for theatre space with surgeons who look after other health conditions, a prioritisation exercise has been undertaken by the Royal College of Surgeons. Prioritisation goes from 1 (the highest priority – operation needed within 24 hours) to 4 (operation can safely wait more than 3 months):
Priority 2 - procedures to be performed in < 1 months
- Cochlear implantation post-meningitis
Priority 3 - Procedures to be performed in < 3 months
- Other cochlear implantation
Priority 4 - Procedures to be performed in > 3 months
- Grommets for glue ear
If families are given a date for their child’s surgery they will find that there will be additional safety measures put in place. For example, they will be tested for coronavirus beforehand.
It seems likely that children who fall into priority 4 are unlikely to be offered surgery within the next year. Professionals and families will need to work together and consider other options (such as temporary hearing aids if grommet surgery is not possible) and if there is anything else that can be done to the child in the meantime so that they are not disadvantaged by the delay.
Newborn hearing screening
At the current time, hospital-based newborn hearing screening services (which amounts to around 95% of services) continue, with some changes to usual protocols and procedures. Community-based screening is being re-introduced.
The British Academy of Audiology have produced guidance on essential activity, which includes the diagnostic testing of babies who have not passed the newborn hearing screen in both ears.
In practice, some babies have missed their newborn hearing screen. Audiology services were able to see a proportion of babies referred from the newborn hearing screen but were unable to see all of them. Sometimes appointments were offered but families did not feel confident to take them up at the time. Some babies have had their tests deferred until the 8-9 month of age follow up.
The implications of this are:
- There are families whose child’s screening results indicate a concern, but who have not been assessed by an audiologist. This is likely to cause anxiety for many families.
- For children who have missed newborn hearing screening there is a need to ensure plans are in place to follow them up at a later point. There is a risk that some children may fall through the net during this time.
- There may be a significant backlog of referrals for both audiology and education services in some areas.
- There may be a number of children who will be identified as deaf later than would normally be expected. They may subsequently require more intensive early intervention support.