Adult Hearing Screening Conference: Can we afford to wait any longer?
Following the National Screening Committee’s rejection of the introduction of an adult screening programme in January 2016 The Ear Foundation and Action on Hearing Loss convened this conference to ensure that the debate remains current and in the public domain. The programme was designed to consider the potential benefits of early identification of age related hearing loss and the challenges presented by the implementation of an adult screening programme. Issues of social, emotional and mental health benefits were considered in addition to potential cost benefits to both individuals and the state.
In respect of the HAFM project we were particularly interested in the presentations regarding social, emotional and mental health issues as access to music plays a key role in these areas. Of particular relevance was the presentation by Susan Thompson and Dr Nicola Wright in raising the importance of ensuring that any screening was followed by appropriate and successful care pathways. Ensuring that interventions are able to meet the needs of the individuals is necessary and this includes managing their expectations of the current technologies available. Hearing aid technology is designed to amplify speech, not music so this further supports our aim to better understand the music listening experiences of hearing aid users to inform the development of potential post screen pathways. The importance of improving the quality of life for all individuals with all levels of deafness lies at the heart of The Action Plan on Hearing Loss which was presented by Fiona Carragher. Music is a key factor in many individuals’ quality of life.
The conference was opened by Professor Adrian Davis, OBE and chaired throughout the day by Brian Lamb, OBE. Both spoke very passionately about the issues and importance of detecting hearing loss as early as possible to limit the potential difficulties it brings.
Chris Wood, Health Policy Manager for Action on Hearing loss provided the rationale and supporting evidence for early identification. He summarised research that has highlighted significant decreases in reported quality of life for those with a degenerative hearing loss including difficulties in communication that lead to increased social isolation, reduced self-confidence; nearly double the incidence of depression and an increased impact of dementia. Hearing loss was also reported to reduce access to health and social care, families and friends and lead to increased difficulties and satisfaction in the work place. He was also keen to dispel the notion that many people with hearing aids do not use them citing recent data which indicates that 90% of those provided with hearing aid use them the majority of the time.
Jon Day, Clinical Director for Audiology at Betsi Calwaladr University Health Board Wales presented the reasons given by the National Screening Committee for rejecting the proposal to introduce adult hearing screening. The committee considered there was insufficient evidence to indicate that such a programme would be of benefit to individuals in the long term or cost effective primarily because of the social stigma associated with hearing aid use and the level of non-use of the technology. In particular the lack of evidence generated through randomised controlled trails (RCT) was cited. RCT are considered to be the gold standard to demonstrate effectiveness of interventions in medical research. However the use of RCTs in the context of hearing aid use raises significant ethical issues as Brian Lamb Brian raised towards the end of the day –he suggested that it would not be appropriate to ask a person who would benefit from wearing a HAs not to do so.
This was followed by an informative contextual presentation by Susan Thompson, a council member of the Institute of Health Promotion and Education and Dr Nicola Wright, Course and Deputy Course Leaders respectively for the Graduate Entry Level Nursing course at the University of Nottingham who discussed the main challenges for any health screening programme. This includes ensuring that any screening programme is followed by appropriate care pathways and that expectations of the screening are managed effectively. They also discussed the importance of ensuring the sensitivity and specificity of the screening so limiting the identification of false positive and false negative results. Finally they raised the important issue of cost effectiveness.
Soren Hougard, Secretary General for the European Hearing Instrument Manufacturers Association presented the case that the cost of not implementing an adult hearing screening programme would far outweigh the cost of implementing one. He discussed the impact of hearing loss on productivity and employability citing evidence collected in Denmark. He provided figures that indicate the reduced tax revenue as a consequence of hearing loss far exceeded the cost of identifying and providing the appropriate technology and support for those with hearing loss. Importantly he also drew attention to the increased comorbidities that occur with hearing loss and that hearing aids have been demonstrated to have a significant impact on the rate of cognitive decline with old aged and particularly for those diagnosed with dementia.
Dr Sue Archbold, CEO of the Ear Foundation supported this argument. She suggested that the arguments presented for not introducing an adult screening programme: the lack of RCT evidence; the notion that adults frequently do not use hearing aids when they are provided and the additional pressures it would lead to on audiology services should not prevail. She suggested that recent work and publications indicated that tackling hearing loss is a “major public health issue” and that early identification is key to addressing it.
The Deputy Chief Scientific Officer for NHS England Fiona Carragher set out the remit of The Action Plan on Hearing Loss for which the Chief Scientific Officer (CSO) Professor Sue Hill OBE is ultimately responsible. The CSO’s role is to provide the clinical leadership, system oversight and stakeholder management in the delivery of the plan which requires:
…a coordinated effort across all the stakeholders, patients, clinicians, the health and care system, the third sector and wider government to co-produce a commissioning framework that will inform the NHS. The aim of the plan is to improve the quality of life and services for people with all levels of deafness.
The plan is available to download here.
The final speaker of the morning was Jim Fitzpatrick, MP Chair of the All Party Parliamentary Group on Deafness (APPGD) who described the role of the group in raising awareness of the issues amongst other parliamentarians.
The afternoon focused on more detailed and personal consideration of the issues associated with hearing loss. Carol Riggs presented a very eloquent reflection of her own experience with a congenital deteriorating hearing loss. She has recently been fitted with a cochlear implant following many years of hearing aid use. She feels strongly that society needs to have a more open and positive attitude to hearing loss that includes an adult screening programme.
The subsequent presentations discussed the outcomes of four different projects examining aspects of potential screening pathways. Zheng Ng, researcher at TEF presented results of a survey in which the views of adults’ with age related hearing loss on the implementation of an adult hearing screening programme. 76% of the 188 participants were in favour of such a scheme. Dr Sheetal Athalye, audiologist TEF described existing screening tools that are available through various different initiatives whilst Professor Adrian Davis and Dr Jagit Sethi presented the findings from a recent project designed using a small scale RCT, that aimed to stream line the process of screening and fitting hearing aids. The findings indicated that the screen and fit pathway they established is highly efficient and indicates a cost effective route for implementing an adult screening programme. The final project undertaken by Krishan Ramdoo has developed smartphone technology ear care (e.g. wax removal) and hearing screening which is both portable and cheap and therefore again potentially cost effective.
The afternoon ended with contributions from Stephen Lloyd, ex MP and formally chair of APPGD and Lillian Greenwood MP for Nottingham adding their voices to the support the launch of a report Adult Hearing Screening Conference: Can we afford to wait any longer? compiled by Brian Lamb OBE and Dr Sue Archbold.
The report is available to download from The Ear Foundation here
This conference was attended by Jackie Salter.