Published on 15 April 2021
Annual health checks for people with learning disabilities should include objective hearing assessment, health experts say.
Current guidance on hearing assessment during an annual health check focusses on subjective assessment only, which previous research has shown to be ineffective. Alternatives, such as objective hearing screening have been recommended.
Researchers at our University have been working in collaboration with colleagues across two local NHS Foundations Trusts, with the support from NHS Sunderland Clinical Commissioning Group.
Audiologists screened the hearing of people with learning disabilities in the community and found that some adults had hearing issues that had not been identified previously, despite annual health checks taking place.
Lead researcher Karen Giles Principal Lecturer at the University’s Faculty of Health Sciences and Wellbeing, said: “We think the annual health check should be changed to include objective hearing assessment.
“There is cultural apathy towards hearing loss, understanding of symptoms in adults with learning disabilities and recognised anxieties about health interventions which often prevents this ‘vulnerable’ group from seeking treatment.
“Our study aimed to assess the feasibility of hearing screening and, using a pop-up clinic model and hand-held screening devices, examine the last recorded annual health check outcome for hearing, for those diagnosed with hearing loss as a result of the screening process.”
The collaborative research group organised hearing screening in four locations at pop-up clinics across the city and saw 75 people with learning disabilities taking part. Contact was made with each individual's GP to share results and to request onward referral where indicated.
While wax build-up prevented screening for 23% of the participants, 57 people completed the screen, and 25 had suspected hearing loss.
Of these, 22 people required referral to Audiology to verify their hearing thresholds. Thirteen were actually referred, and 11 individuals attended assessment in Audiology, resulting in 10 being diagnosed with hearing loss.
The most recent annual health check outcomes for hearing were also examined for those diagnosed with hearing loss. Of the records the team accessed, hearing loss had not been identified or actioned in every case.
Karen says: “Hearing screening is shown here to be a suitable method for detecting hearing loss. We recommend changing current annual health check practice to incorporate objective screening. Only 12% of those with suspected hearing loss were already known to Audiology services, suggesting a substantial proportion of undetected hearing loss in the community. Inclusion of hearing screening in the annual health check aims to raise awareness and increase knowledge, leading to better outcomes.”
Dr Lynzee McShea, a Senior Clinical Scientist in Audiology at South Tyneside and Sunderland NHS Foundation Trust was the Audiology lead for this project. She says: “Around 40% of all adults with learning disabilities are thought to be living with hearing loss, but much of this remains undiagnosed and therefore unmanaged. A number of barriers exist around referral to Audiology services and misconceptions about the testing and treatments available. It is assumed that people with learning disabilities cannot have their hearing tested or will not benefit from wearing hearing aids but this is not the case. As a result of this research, we have successfully fitted several individuals with hearing aids so far, which has improved their communication abilities and their quality of life.”
Ashley Murphy, Learning Disability and Autism Primary Care Programme Manager for Sunderland CCG and Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, worked as part of the collaborative group and organised the pop-up clinics.
She said: “I have continued to be concerned about the amount of people who have either full wax occlusion in their ears or undiagnosed hearing loss. In some cases the hearing loss can lead to distress in the individual who cannot self-report and depend on health services to successfully identify unmet health needs and then provide a solution. The point of care model of working is the system that can help do this.”
Sidebar - Point of Care Testing (POCT)
Previous studies at the University of Sunderland have highlighted growing concerns about the health of those with learning disabilities, which researchers say could be improved if more use was made of medical testing technology which is carried out close to where the patient is receiving care.
The study, conducted on behalf of NHS England, evaluated whether the use of Point of Care Testing (POCT) could improve access to healthcare and treatment for people with a learning disability. People with learning disabilities have a significantly lower life expectancy than the general population and are at higher risk of certain diseases including diabetes, hearing loss, cardiovascular disease and obesity.
POCT is medical testing at or near the site of a patient by specially trained healthcare professionals, typically involving blood and/or urine testing. The goal is to collect the specimen, usually through the use of advanced portable and handheld instruments, which are less invasive than traditional methods such as intravenous injections – and get accurate results in a very short period of time that can be presented to the patient quickly, and often on the same day as their appointment.
Hearing screening can also be completed quickly and successfully using POCT via automatic handheld machines. Information about the outer, middle and inner ear can be collected within a couple of minutes, without
any response needed from the person taking part.
The team of university researchers evaluated the experiences of key stakeholders using POCT including Clinical Commissioning Groups (CCG), NHS England, and learning disability national leads, audiologists, GPs and nurses with a special interest in learning disability.
The study found a general lack of awareness of POCT, and lack of knowledge about its availability and potential. However, all stakeholders believed there was a strong case to adopt POCT, particularly in primary care, to support access to diagnostics for people with learning disabilities. It was also felt to be less stressful for both service users as well as clinicians and could provide fresh objective evidence as part of health checking.
For further information on this study, go to https://doi.org/10.1111/bld.12377
McShea, Lynzee, Giles, Karen, Murphy, A and Ling, Jonathan (2021) An alternative approach for detecting hearing loss in adults with learning disabilities. British Journal of Learning Disabilities.