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Author: admin, 22.11.2013
North Staffordshire Clinical Commission Group (CCG) are considering scrapping providing hearing aids to people with a mild or moderate age-related hearing loss and have asked for local people’s views on the proposals. People have been asked to fill in an online survey or attend public meetings to air their views on the proposals which would save the NHS ?1.2 million per year. According to the CCG’s website, services to children would remain unaffected and those with hearing aids already would not have them taken away. The move to consult with patients comes after a local body, known as a Clinical Commissioning Advisory Group (CCAG), weighed up the costs and benefits of providing hearing aids for people with mild or moderate age-related hearing loss. According to Public Health England’s website, the Portsmouth Scorecard is a method that is adopted by many heath authorities across England to guide the prioritisation of their services. North Staffs decision could have implications nationwide – while they appear to be the first in the UK to consider scrapping the provision of hearing aids for mild or moderate hearing loss, others authorities using the same system could reach the same outcome as part of a drive to cut costs.
2500 people have been identified as having a mild or moderate hearing loss in the North Staffordshire area but millions of people may be affected if the proposals are copied nationwide. Despite this, the vast majority of people considered to have a hearing loss do not use hearing aids. Action on Hearing Loss is a charity that actively encourages people with hearing loss to get hearing aids as soon as possible.
Dr Dave Hughes, a GP and Clinical Accountable Officer for North Staffordshire NHS said: “We think it is vital that we have this conversation with local people and that all interested parties have the opportunity to be fully informed over costs and the clinical needs of patients who do not have severe or profound hearing loss. There is no national clinical guidance on providing hearing aids for age-related hearing loss. Lorraine Gailey, Chief Executive of Hearing Link, a charity that represents deafened people, thinks that health chiefs in North Staffordshire will withdraw their proposals once they have looked at the facts. The connection between hearing loss and mental health conditions is a relatively recent discovery. Dr Frank Lin, an assistant professor at the Johns Hopkins University schools of medicine and public health said earlier in the year that hearing loss contributed to accelerated brain shrinkage in elderly people, which was evident through MRI scans.
Groups representing people with hearing loss are said to be ready for action after a flurry of activity on Friday when the leaders of national charities and local groups agreed to work together. The North Staffordshire CCG are holding meetings on Wednesday 25th June 2-4pm in Newcastle-under-Lyme and on Wednesday 2nd July 6-8pm in Leek.
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As an ex NHS audiologist now living and working in Australia, i cannot understand the mentality of the people who make these decisions now nor could I 13 yrs ago when I left. This is in conflict when increased access to correct listening devices is under review by NHS England itself and the House of Lords Commission.
This CCG is looking short term rather than long term – we already know the NHS is bankrupt and we are all doing what we can to look at costs but not to this detrimental short sighted not thought through and suspect incorrectly evidenced rather than looking at what is currently being reviewed and all recent reports.
That is clearly the decision amking of IDIOTS who know nothing about those who can benefit from hearing aids.
Deaf adults do not always have the adequate support and information regarding using hearing aids, their deafness is a medical issue in today’s clamouring world. I was saddened to discover a close relative, after poor support by the local NHS Audiology service concerning his deafened condition and not getting any benefit from the NHS hearing aids, decided to go private and squandered a few thousand pounds of very hard-earned savings for hearing aids. We had thought, this is 2014, it could not be right that those small plastic covered gadgets could still be costed so much especially as my relative has moderate hearing loss. Just because someone has a lower degree of deafness it doesn’t mean that they have an easier life or that they do not need as much support as severely deaf people. Loneliness and isolation are known factors in both elderly and deaf people, not necessarily associated with the level of hearing loss. It is very short sighted to consider cuts in this area where there is currently a growing need. As far as people not using their hearing aids are concerned … are these people getting proper aftercare?
If the NHS is no longer willing to help individuals with age related hearing loss by providing them with free hearing aids ( which I believe costs the NHS around ?80 each due to having a contract for big orders that makes them cheaper in comparison to private hearing aids which can cost individuals over ?3K each), then the cost of supporting these deafened individuals in terms of the cumulative effects of their inability to access communication and services through lack of medical equipment will rise steeply and ultimately other services will have to dig deeper in their pockets to provide support to these people and where would these cuts end, other NHS cuts will surely follow if this is allowed to happen? My Mum would be affected if the decision to cut hearing aids and stop people who have mild to moderate hearing loss from having hearing aids. It looks like to me, the NHS is trying to spin off audiology onto the private sector and make the general public pay for it much like Specsavers and Boots – I think GPs can actually refer people to Boots or Specsavers for hearing aids.
The NHS was privatised by the ConDem government in their recent Health and Social Care Act, it just hasn’t been reported. The British Academy of Audiology (BAA), the UKs largest professional body representing over 2000 professionals working in the field of hearing and balance would like to make it clear we condemn any such proposals that would prevent a hearing impaired person accessing a hearing aid free at the point of care.
Enter your email address to follow this blog and receive notifications of new posts by email. The findings of this case study are consistent with the research that supports the use of slower compression times when fitting traditional compression circuitry hearing aids to patients with ANSD. Auditory neuropathy (AN) is a term used to describe a type of hearing disorder in which outer hair cell function (the cochlear amplifier) is normal; however, there is a disruption in afferent conduction along the auditory neural pathway.
Accordingly, hearing aids are of limited use for patients with ANSD.1,11 Patients with ANSD have temporal perception difficulties that can make speech difficult to understand.

Several studies have demonstrated that the use of non-linear amplitude compression hearing aid circuitry, such as WDRC, which tend to utilize fast compression attack and release times, actually reduces the amplitude fluctuation of the spectral envelope of speech (Figure 1). Research utilizing speech perception scores and psychophysical results supports the use of linear circuitry and other innovative signal processing schemes to improve speech understanding for patients with ANSD. At age 3 months, the child was fitted with Phonak Maxx 411 behind-the-ear (BTE) hearing aids, with limited use. The child has consistently attended individual auditory-based speech therapy for the past year. Recorded CID W-22 words were presented at 60 dBHL via a Grason-Stadler GSI-61 audiometer through soundfield speakers. Comparison of word recognition scores across the three trials (Table 1) demonstrates that the aided condition that utilized the slower compression times provided a significant increase in word understanding ability when compared to either the unaided or the aided condition utilizing the faster compression times. This case study was originally presented at the Starkey First Pediatric Symposium in September 2010.
A 42-year-old man presents with a suprasellar mass, shown on the post-contrast T1-weighted MRI shown here. A 25-year-old man presents with progressive bilateral hearing loss, tinnitus, and neck pain.
Using a scoring system known as the Portsmouth Scorecard, they decided that providing certain hearing aids was not an effective use of NHS resources and now threaten a service, available across the UK since 1948, with decommissioning.
Members of North Staffordshire’s Clinical Priorities Group took into account factors such as cost, benefit to patients, strength of evidence and prevention of future illnesses to end up with a score. Research undertaken by Action on Hearing Loss found that 10 million people in the UK have some kind of hearing loss and 9.2 million of those fall into the mild or moderate category. Hearing certain speech sounds becomes impossible which in turn makes speech muffled and unintelligible. They have an online hearing test which will advise users to see their GP if any hearing loss is detected. The removal of this, a NHS provision, is unprecedented and we are deeply concerned that there will be further cuts to come. Hearing aids offer a lifeline to many, especially older people with hearing loss who would otherwise be sat at home alone unable to communicate with the outside world. She has a profound hearing loss herself and recently her husband was fitted with his first pair of hearing aids. Don’t forget to follow the site on Twitter and Facebook, and check out our supporters on the right-hand side of this site or click here.
Recent reports including the recent Sick of It report, demonstrate poor health due to poor COMMUNICATION. This would undoubtedly be the thin end of the wedge, eventually resulting solely in private provision of hearing aids, coupled with the traditional private sector rip-off prices. The social repercussions of dealing with all this isolation and loneliness will amount to a lot more than the cost of supporting hearing loss in the first place.
We at the BAA are working hard with our colleagues to ensure the CCG will be furnished with enough evidence to help them understand the real impact of such proposals. Slowing down the compression rates can have a positive impact on speech perception; however, more research is needed to investigate how these modifications affect the patient in everyday listening situations. Spirakis, AuD, is clinical coordinator for audiology at All Children’s Hospital, Tampa, Fla. Current hearing aid technology doesn’t address enhancing the temporal envelope of the speech signal to compensate for temporal processing deficits associated with ANSD. This reduction of the amplitude fluctuations in the spectral envelope can make it more difficult to perceive these much-needed temporal cues. Spectrographs of speech sample demonstrating the effects of compression rate on the amplitude of the spectral envelope. One method proposed was to filter out low frequency signals or shift them to the high frequency ranges via frequency transposition. The subject of this case study is a 6-year-old child who was diagnosed with bilateral ANSD shortly after birth.
Audiograms (taken in August 2010 and September 2009, respectively) demonstrating variable responses to puretone stimuli. Audiograms obtained utilizing behavioral assessment techniques have demonstrated variable responses to puretone stimuli for both ears (Figure 2). ABR evaluations demonstrated a dys-synchronous response bilaterally to both click and tone burst stimuli. The child was fitted binaurally with Starkey 5 Series iQ 11 BTE hearing aids coupled to soft material earmolds with a small vent. Electroacoustic equipment met manufacturers’ and the current ANSI standards for this equipment. Comparison of rarefaction and condensation polarities for click stimuli demonstrated in the subject’s ABR. Comparison of alternating, rarefaction, and condensation polarities for 500 Hz tone burst stimuli demonstrated in the subject’s ABR.
There was a visible difference in the child’s demeanor between the second and third trials, when the compression times went from the slower parameters to the faster compression times.

This additional information may provide insight when selecting hearing aid circuitry for patients with ANSD. Guidelines for Identification and Management of Infants and Young Children with Auditory Neuropathy Spectrum Disorder; 2008. Auditory neuropathy: a report on three cases with early onsets and major neonatal illnesses.
Effect of envelope enhancement on speech perception in individuals with auditory neuropathy. Suprathreshold processing deficits due to desynchronous neural activites in auditory neuropathy. Perception of envelope-enhanced speech in the presence of noise by individuals with auditory neuropathy.
Auditory Neuropathy Spectrum Disorder and Hearing Aids: Rethinking Fitting Strategies Hearing Review. If the score is below a set threshold, then the service may be recommended for decommissioning.
Under the rules being proposed in North Staffordshire, several million people would now not qualify for hearing aids. Withdrawal from social situations is often a result and contributes to strong feelings of isolation. That revision never took place leaving the door open, in the absence of national rules, for local Clinical Commissioning Groups to withdraw hearing aid services if they see fit. If the NHS wants to save money, they should focus attention on recovering the hearing aids which are issued but not used. I am profoundly deaf, but I remember those tears ago when I first got my hearing aids as a moderately deaf person, just how much of a god send my hearing aids are to me. There are many optometrists around like vision express, boots, Specsavers etc that did not even exist like 10-15 years ago! As we professionals know , mild to moderate hearing loss does not equate to mild to moderate problems and the degree of disability caused by hearing loss cannot be quantified by the degree of hearing loss. Note the decrease in amplitude and increase in noise present in the “fast response” compared to the enhanced amplitudes of “slow response” for a speech sample.
Birth history was significant for induced labor with Cesarean delivery and included a 6–day NICU stay due to breathing difficulties and oxygen use for an unknown number of days. Repeated measures of ipsilateral middle ear muscle reflexes have demonstrated absent reflexes in both ears at 500 to 4000 Hz. In addition, there is an inversion of the cochlear microphonic beyond stimuli onset bilaterally when comparing rarefaction and condensation polarities (Figure 3) for the click stimuli and for tone burst stimuli (Figure 4).
The hearing aids were programmed for a flat 35 dBHL hearing loss, based on the hearing loss utilized to program the previous set of Phonak Una M hearing aids, which were well tolerated by the child.
Word recognition scores (WRS) were obtained in the sound booth with the child seated in the speech pathologist’s lap, at a 0° azimuth from the soundfield speaker. Although not statistically significant, it is interesting to note that the unaided condition provided an improved score (12%) when compared to the aided condition utilizing the faster compression times.
During the first two trials, the child was quick to respond, used a normal speech volume, and was very confident in her responses.
So in essence what is important though is the patient voice comes across loud and clear to commissioners that they oppose these proposals. Adjusting the release time for compression to a slower rate allows for greater amplitude differences in the temporal modulations. Distortion product otoacoustic emissions (DPOAEs) were not measured until after the child had worn hearing aids for a year and, when evaluated, were absent bilaterally for all test frequencies. A 25-word list was utilized to determine word recognition ability and three examiners recorded the child’s responses to the stimuli.
In the last trial, List 3-D (1) was utilized and the child was aided with the Starkey hearing aids with manufacturer default compression parameters (attack time 20 msec, release time 2000 msec). During the last trial, when the compression rates were faster, the child became very pensive, spoke much quieter, was slower to respond to stimuli, and appeared very unsure of her responses.
These enhanced amplitude differences help provide salient cues for consonant and vowel perception. When the child turned 5 years old and started kindergarten, the Phonak Una M hearing aids were reintroduced and the child has worn them on a full-time basis. The prescribed manufacturer’s default settings for kneepoint and compression ratios remained constant between the two aided trials. Value For Money (VFM) and Return Of Investment (ROI) requires improvement to the follow up on how to get best use from assisted hearing devices to finely retune to enhance sounds we process. Responses were recorded as correct if determined so by at least two of the three examiners.
Its that area of service which is lacking, is a huge void in many audiology units and as a result many aids remain in their boxes instead of of providing essential benefits.

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