A prospective evaluation of direct referral to audiology departments for hearing aids

Abstract

It has been suggested that a proportion of individuals with a hearing impairment can be fitted with a hearing aid without being otolaryngologically assessed. Such assessments are deemed advisable: (a) to identify otological pathology that might require management and (b) because surgery can be a viable alternative in those with a conductive impairment.The aim of this study was to prospectively study individuals referred to an Otolaryngology Department in a teaching hospital to assess how technicians, at a direct referral clinic for the provision of a hearing aid, could screen to identify those meriting an otolaryngological opinion. Two hundred and forty-eight patients were evaluated by technicians using strict audiometric and tympanometric criteria. One hundred and twenty-five patients (50 per cent) failed these criteria and were referred to an otologist. The remaining 123 (50 per cent) were managed by technicians but were subsequently reviewed for the purpose of this study by an otologist and their management assessed. In only two patients (one per cent) was it thought that the initial management would have been different if seen by an otologist. Alternative criteria for deciding suitability for management by technicians were applied. The inclusion of tympanometry was essential to avoid missing middle ear pathology.

Shared care for hearing complaints: guideline effects on patient flow

“…A number of studies have confirmed the safety of this direct referral system [7,12]. The number of persons in need of further examination or treatment varied from 3% to 16% [7,12,13].…”

“…In this system, hearingimpaired persons are referred by the GP, either to an ENT specialist or directly to audiology services where the technicians use guidelines as a safety mechanism [11]. A number of studies have confirmed the safety of this direct referral system [7,12]. The number of persons in need of further examination or treatment varied from 3% to 16% [7,12,13].…”

“…The hearing aid dispenser fits the hearing aids, followed by a check and ultimately an approval of the hearing aids by the prescriber. Considering that only a small proportion of hearing‐impaired adults might need management other than hearing aid fitting it has been suggested that not all hearing‐impaired persons need to be seen by an ENT specialist or Audiological Centre [7]. Therefore, increasing attention has been directed towards shared care in hearing aid provision.…”

Decision‐Analytic Modeling to Assist Decision Making in Organizational Innovation: The Case of Shared Care in Hearing Aid Provision

“…As only a small proportion of hearingimpaired adults require management other than hearing aids, it is advocated that not all persons with hearing complaints need to be examined by an ear nose throat (ENT) specialist or audiological center (AC) (Swan and Browning 1994). Increasing attention is paid to shared care initiatives in hearing aid provision, including direct hearing aid provision by private dispensers.…”

Potential barriers and facilitators for implementation of an integrated care pathway for hearing-impaired persons: an exploratory survey among patients and professionals

“…It has been suggested that a proportion of hearing-impaired individuals can safely be fitted with a hearing aid without medical care [9-12]. These individuals are defined as clients throughout the present study.…”