Managing hearing loss in primary care

McShea, Lynzee

doi:10.7748/ldp.18.10.18.s19

Cited by 6 publications

(13 citation statements)

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“…The World Health Organisation (2018b) states that people with disabilities have the same type of general healthcare needs as the general population, but they face a range of barriers in accessing the health and rehabilitation services they need. These barriers include prohibitive costs, limited availability of services, physical barriers like inaccessible premises (World Health Organisation, 2018b), inadequate skills and knowledge from healthcare professionals (Ali et al, 2013; Aulagnier et al, 2005; Evenhuis et al, 2001; Kerr et al, 2003; McShea, 2015; Slater et al, 2019), communication issues impacting the understanding of risks and treatment plans, healthcare professionals' inattention to the impact on daily activities, time and resource shortage during consultations, behavioural and attitudinal barriers (Marks et al, 2019; Slater et al, 2019), diagnostic overshadowing where behaviours or symptoms of hearing loss are falsely attributed to the person's intellectual disability (Carvill, 2001), or their complaints, signs and symptoms are not recognised or taken seriously, by their guardians, sports coaches or even by their health professionals (Andersson et al, 2013; McCracken et al, 2011; McShea, 2015; Purcell et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

“…And even with proper training, underdiagnosing remains a problem in people with intellectual disability (Ali et al, 2013; Evenhuis et al, 2001; Kerr et al, 2003). More importantly, there is evidence that even if diagnoses are made, many health professionals do not acknowledge the need for management, and the problem may be underestimated, misinterpreted or even ignored because of barriers regarding behaviour, nonverbal and verbal communication, cost, time and resources (McCracken et al, 2011; McShea, 2015; Purcell et al, 1999; Slater et al, 2019). Carvill (2001) stated that the relationship between intellectual disability and hearing loss is multiplicative rather than additive.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of 10 years of ear and hearing screening in people with intellectual disability in Europe: A multicentre study

Willems

Berlaer²,

Maes

et al. 2021

Research Intellect Disabil

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Background Undetected ear and hearing problems negatively impact the quality of life of people with intellectual disability. Methods This multicentre retrospective study describes the outcome of 10 years of ear and hearing screening in athletes with intellectual disability in seven European countries. The screening was conducted by a trained team using a strictly standardised protocol. Results Of 15,363 screened athletes with intellectual disability, more than half (58.7%) needed referral for ear and/or hearing problems, ranging from 51.7% (<20 years old) to 81.4% (≥60 years old). The most commonly detected conditions were excessive/impacted earwax (40.3%), middle ear problems (30.1%) and hearing loss (27.0%), with significant differences between age groups and countries. Discussion This study demonstrates an increased risk of ear and hearing problems in people with intellectual disability as compared to the general population. Considering the unawareness and impact of these problems, it is highly recommended to organise systematic screening. Follow‐up for diagnostic elaboration, therapeutic management and long‐term guidance should be provided.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of 10 years of ear and hearing screening in people with intellectual disability in Europe: A multicentre study

Willems

Berlaer²,

Maes

et al. 2021

Research Intellect Disabil

View full text Add to dashboard Cite

show abstract

“…78% (7/9) of these individuals were described as having satisfactory hearing at their most recent annual health check, whilst 22% (2/9) had hearing concerns documented, but no action taken. Although it is a positive finding that some hearing concerns have been identified, without onward referral the annual health check is reduced to a “box ticking exercise” (McShea, 2015a).…”

Section: Discussionmentioning

confidence: 99%

“…In one study, caregivers estimated over 70% of individuals they supported had satisfactory hearing, though subsequent testing revealed only 11% actually did (Kerr et al., 2003). Aside from attempting a whispered voice test or questioning a caregiver, primary care practitioners report they are unsure of how else to assess hearing during an annual health check (McShea, 2015a). Therefore, despite suggestions in the literature that more “hearing tests” are being completed during annual health checks (Lennox et al., 2011), if this test is simply a question with a misinformed answer, the assessment becomes tokenistic.…”

Section: Introductionmentioning

confidence: 99%

An alternative approach for detecting hearing loss in adults with learning disabilities

McShea

Giles

Murphy

et al. 2021

Brit J Learn Disabil

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Accessible Summary Annual health checks for people with learning disabilities should include a check of hearing. However, this hearing check only involves asking questions about hearing and does not include an actual hearing test. We tested the hearing of people with learning disabilities in the community. We found that some people had hearing problems that had not been picked up at their annual health check. We think the annual health check should be changed to include a hearing test. Abstract BackgroundAnnual health checks in primary care include hearing assessment, though current guidance recommends subjective assessment only. Previous studies suggest this is inadequate and recommend objective alternatives such as hearing screening. This study aimed to assess the feasibility of hearing screening and examine the last recorded annual health check outcome for hearing, for those diagnosed with hearing loss as a result of the screening process. MethodHearing screening took place in four locations and 75 people with learning disabilities participated. Contact was made with each individual's GP to share results and to request onward referral where indicated. FindingsWax occlusion prevented screening for 23%. Fifty‐seven people completed the screen, and 25 had suspected hearing loss. Of these, 22 people required referral to Audiology to verify their hearing thresholds. Only 13 were actually referred, and 11 individuals underwent assessment in Audiology, resulting in 10 being diagnosed with hearing loss. The most recent annual health check outcomes for hearing were examined for those diagnosed with hearing loss. Of the records we accessed, hearing loss had not been identified or actioned in every case. ConclusionsHearing 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 known to Audiology services, suggesting a substantial proportion of undetected hearing loss in the community. We found evidence of apparent reluctance around referral and hearing aid fitting and make suggestions for improvement.

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“…Bent et al () and McShea () identified concerns about the assessment of hearing loss within the health check. Despite hearing loss having a greater prevalence within the learning disability population, estimated at 40% (Carvill 2001) and being included in the health check, detection rates remain low.…”

Section: Introductionmentioning

confidence: 99%

Can point‐of‐care testing improve access to diagnostic screening and testing for people with learning disabilities? Exploring perspectives to improve access and equity

Giles¹,

Ling²,

Gordon³

2019

Brit J Learn Disabil

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Funding information NHS England Chief Scientific Office Accessible summary• People with learning disabilities, like everyone else, need to have their health checked, but this can sometimes be difficult.• We asked people with learning disabilities and the people who look after them what they thought about how they have blood tests done or their hearing checked.• We found out the things that make it a positive experience.• We learnt that people with learning disabilities and the people who look after them thought point-of-care testing would be a good idea.• We learnt what things they thought should be put in place to make this type of testing work well for them. AbstractBackground: People with learning disabilities have an increased risk of diabetes, cardiovascular disease and hearing loss. This study explored service users' and health professionals' perspectives and experiences of adopting minimally invasive diagnostic and screening devices, known as point-of-care testing (POCT) as a means of improving access and engagement. Materials and Methods:Focus groups and semi-structured interviews were undertaken with attendees at a nonhealthcare day centre, specialist learning disability clinical network and national leads as well as researchers into learning disability and point-of-care issues. Thematic analysis of the data was undertaken.Results: There was a lack of awareness and experience of POCT across the users and health professionals. Despite this, on seeing the devices and discussing application there was strong support and acceptability across all participants for their use so long as individual needs were addressed. There was no consistent sense of where this testing should be done but support for the flexibility this could provide in terms of nonmedicalised locations and individual needs. Strategies for success included the use of specific adjustments such as the presence of a known carer, pretesting information in an appropriate format and taking into account each individual's preferences. Conclusions:POCT is considered a viable and useful method for improving access to testing for people with learning disabilities. Adoption barriers in implementation identified as specific to the field of learning disabilities included lack of POCT | 29 GILES Et aL. | CON CLUS IONThis evaluation has taken the first steps to explore the feasibility and acceptability of point-of-care testing for people with learning disabilities. Point-of-care testing was described as having the potential to enable access to a range of diagnostics for people with a learning disability; however, this needs to be with some adjustments. It has the potential to widen this access through both the uptake and ability to perform screening as well as increasing flexibility in where these could be undertaken.The findings raise questions and opportunities about how and where POCT could be used. Whilst the context of this study was about health checks and access to health assessments, our findings provide information that could be used to further explore...

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Managing hearing loss in primary care

Cited by 6 publications

References 0 publications

Outcome of 10 years of ear and hearing screening in people with intellectual disability in Europe: A multicentre study

Outcome of 10 years of ear and hearing screening in people with intellectual disability in Europe: A multicentre study

An alternative approach for detecting hearing loss in adults with learning disabilities

Can point‐of‐care testing improve access to diagnostic screening and testing for people with learning disabilities? Exploring perspectives to improve access and equity

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