Excerpt

Hearing loss is a major public health issue affecting about 9 million people in England. Because age-related hearing loss is the single biggest cause of hearing loss, it is estimated that by 2035 there will be around 13 million people with hearing loss in England – a fifth of the population. Hearing loss ranks second in terms of prevalence of impairment globally and is third for disease burden in England (years lived with disability).

This guideline explores the most urgent questions about referral, assessment and management of hearing loss in adults in order to offer best practice advice. It cannot address the whole topic. One of the issues the guideline committee has encountered when preparing this guideline is that the quality of evidence on which to base recommendations is not high in many areas. There is scope for more robust research in all areas.

This guideline seeks to inform people with hearing difficulties, their families and carers, all healthcare professionals dealing with adults, social care professionals and commissioners of health and social care services about best practice in assessing and managing hearing loss. It is important that audiological care is patient-centred and that people should have the opportunity to make informed decisions about their care and treatment in partnership with their healthcare professionals and this is reflected in the guideline.

Contents

• Guideline committee members
• NGC technical team members
• Co-optees
• Acknowledgements
• 1. Guideline summary
  • 1.1. Full list of recommendations
• 2. Introduction
  • Impact
  • Pathways
  • Causes
  • Summary
• 3. Development of the guideline
  • 3.1. What is a NICE guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Identifying and analysing evidence of effectiveness
  • 4.4. Identifying and analysing evidence of cost effectiveness
  • 4.5. Developing recommendations
• 5. Immediate, urgent and routine referral
  • 5.1. Introduction
  • 5.2. Review question: What are the symptoms and signs that allow early recognition of hearing loss needing immediate or urgent referral to a secondary care specialist?
  • 5.3. Review question: Who should be routinely referred to audiovestibular medicine or ear, nose and throat (ENT) surgery for medical assessment?
• 6. MRI
  • 6.1. Introduction
  • 6.2. Review question: In people who have been referred to secondary care with sensorineural hearing loss, who needs MRI to assess the underlying cause of hearing loss?
• 7. Subgroups
  • 7.1. Introduction
  • 7.2. Review question: Which groups of people are more likely than the general population to miss having hearing loss identified?
• 8. Early versus delayed management of hearing loss
  • 8.1. Introduction
  • 8.2. Review question: What is the clinical and cost effectiveness of early versus delayed management of hearing loss on patient outcomes?
• 9. Communication difficulties and limitations in function
  • 9.1. Introduction
  • 9.2. Review question: What is the clinical and cost effectiveness of communication needs assessment in adults with hearing loss?
• 10. Management of earwax
  • 10.1. Introduction
  • 10.2. Review question: What is the most clinically and cost-effective method of removing earwax?
  • 10.3. Review question: What is the most clinically and cost-effective setting for the identification and treatment of earwax?
• 11. Sudden sensorineural hearing loss (SSNHL)
  • 11.1. Introduction
  • 11.2. Review question: What is the most clinically and cost-effective treatment for idiopathic sudden sensorineural hearing loss (SSNHL)?
  • 11.3. Review question: What is the clinical and cost effectiveness of different routes of administration of steroids (for example oral or intratympanic) in the treatment of sudden sensorineural hearing loss (SSNHL)?
• 12. Information and support
  • 12.1. Introduction
  • 12.2. Review question: What are the information, support and advice needs of people with hearing difficulty and their families and carers?
• 13. Decision tools
  • 13.1. Introduction
  • 13.2. Review question: What is the clinical and cost effectiveness of using patient-centred tools to help patients with hearing loss decide between different management strategies?
• 14. Assistive listening devices
  • 14.1. Introduction
  • 14.2. Review question: What is the clinical and cost effectiveness of assistive listening devices (such as loops) to support communication?
• 15. Hearing aids
  • 15.1. Introduction
  • 15.2. Review question: What is the clinical and cost effectiveness of hearing aids for mild to moderate hearing loss in adults who have been prescribed at least 1 hearing aid?
  • 15.3. Review question: What is the clinical and cost effectiveness of fitting 1 hearing aid compared with fitting 2 hearing aids for people when both ears have an aidable hearing loss?
• 16. Hearing aid microphones and noise reduction algorithms
  • 16.1. Introduction
  • 16.2. Review question: What is the clinical and cost effectiveness of directional versus omnidirectional microphones?
  • 16.3. Review question: What is the clinical and cost effectiveness of noise reduction algorithms?
• 17. Monitoring and follow-up
  • 17.1. Introduction
  • 17.2. Review question 1: What is the most clinically and cost-effective method of delivery of monitoring and follow-up of people with hearing-related communication needs (including those with hearing aids)?
  • 17.3. Review question 2: When should people with hearing-related communication needs (including those with hearing aids) be monitored and followed up?
• 18. Interventions to support the use of hearing aids
  • 18.1. Introduction
  • 18.2. Review question: What is the clinical and cost effectiveness of interventions to support continuing use of hearing aids?
• 19. Reference list
• 20. Acronyms and abbreviations
• 21. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Clinical review protocols
  • Appendix D. Health economic review protocol
  • Appendix E. Clinical study selection
  • Appendix F. Health economic study selection
  • Appendix G. Literature search strategies
  • Appendix H. Clinical evidence tables
  • Appendix I. Health economic evidence tables
  • Appendix J. GRADE tables
  • Appendix K. Forest plots
  • Appendix L. Excluded clinical studies
  • Appendix M. Excluded health economic studies
  • Appendix N. Cost-effectiveness analysis: early versus delayed management of hearing loss
  • Appendix O. Threshold analysis: fitting 1 hearing aid compared with fitting 2 hearing aids
  • Appendix P. Unit costs
  • Appendix Q. Research recommendations
  • Appendix R. Additional information
  • Appendix S. NICE technical team
  • Reference list

Final version

Developed by the National Guideline Centre, hosted by the Royal College of Physicians

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.

Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.