Sounding It Out

About Sounding It Out

As a leading manufacturer in the Audiology industry -Signia are passionate about hearing and hearing health. We want to share this passion with you, whatever your level of expertise. In this series-Julia van Huyssteen (Signia’s Head of Audiology, UK & Ireland) will speak with leading figures in the sector about a range of topics including clinical standards, new research, industry developments and also general education around hearing and the link to well-being. Each topic will be covered in 3 bite-sized episodes. Enjoy! We’d love to hear from you about future topics – email us marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland-https://www.signia-pro.com/en-gb/

Publisher

Signia UK & Ireland

Category

health & fitness

Language

en

Explicit

No

First episode

9 Sept 2022

Latest episode

5 Feb 2025

Latest episodes

16 episodes in the feed.

1. 

   5 Feb 2025

   The Impact of Tinnitus and Access to Tinnitus Services

   Signia’s Julia van Huyssteen is again joined by Alex Brooks-Johnson, the CEO of Tinnitus UK (the only charity in the UK dedicated to tinnitus) and Sonja Jones, who runs Cardiff Hearing and sits on the scientific advisory board of Tinnitus UK. The round table discussion from Episode 1 continues, and leads to some more important topics, including the impact of tinnitus on mental health as well as the reality of accessing tinnitus services in the UK. This episode also gives some pointers on actions that individuals can do to prevent tinnitus in those instances where hearing health can be influenced. Lastly, when an individual is already living with tinnitus, helpful tips are given regarding things that may alleviate the experience of tinnitus. Signia and innovation go hand-in-hand, and the same can be said for Signia’s in-build tinnitus therapies! Found within all of their hearing aids, combining advanced sound technology with personalised functionality, Signia’s tinnitus solutions are designed to distract from tinnitus and enhance hearing clarity – improving quality of life for those living with Tinnitus. For more information about Tinnitus UK head to https://tinnitus.org.uk/ (https://tinnitus.org.uk/). For more information about Signia Hearing UK, head to https://www.signia.net/en-gb/tinnitus/therapy/ (https://www.signia.net/en-gb/tinnitus/therapy/) See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

2. 

   3 Feb 2025

   Exploring Tinnitus and Identifying Education Needs

   During this episode, Signia’s Julia van Huyssteen is joined by Alex Brooks-Johnson, the CEO of Tinnitus UK (the only charity in the UK dedicated to tinnitus) and Sonja Jones, who runs Cardiff Hearing and sits on the scientific advisory board of Tinnitus UK. The three of them sit down for a round table discussion that explores what tinnitus is as well as current treatment recommendations. Alex and Sonja talk about their most recent research project, which identifies some training needs for professionals that may come into contact with a person living with tinnitus. Signia and innovation go hand-in-hand, and the same can be said for Signia’s in-build tinnitus therapies! Found within all of their hearing aids, combining advanced sound technology with personalised functionality, Signia’s tinnitus solutions are designed to distract from tinnitus and enhance hearing clarity – improving quality of life for those living with Tinnitus. For more information about Tinnitus UK head to https://tinnitus.org.uk/ (https://tinnitus.org.uk/). For more information about Signia Hearing UK, head to https://www.signia.net/en-gb/tinnitus/therapy/ (https://www.signia.net/en-gb/tinnitus/therapy/) See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

3. 

   8 Jul 2024

   4.2 Exploring Invisible Disabilities and Hearing: A Conversation with Professor Andrew Hugill

   In this episode, Professor Hugill and Julia delve into how invisible disabilities impact hearing experiences, discussing terms like neurodivergence and aural divergence. The conversation explores tinnitus, its effects on musicians, auditory processing disorder (APD), misophonia, diplacusis, and palinacousis. They emphasize the importance of patient-centered care and raising awareness about aural diversity. Check out the Aural Diversity webpage for more information: https://auraldiversity.org/ (https://auraldiversity.org/) EPISODE SUMMARY the second and final episode of 'Sounding It Out’, Series 4, Julia Van Huyssteen, Head of Audiology at Signia UK and Ireland, hosts Professor Andrew Hugill from the University of Leicester to explore beyond the audiogram into various individual experiences of hearing. They delve into conditions like neurodivergence and aural divergence, explaining terms such as tinnitus, auditory processing disorder (APD), misophonia, diplacusis, and palinacousis. Professor Hugill shares personal insights and discusses the complexity each condition brings, especially in musicians. He likens neurodivergence to the difference between operating systems like Windows and Mac. They talk about how often individuals with normal audiograms still struggle to process sound and the potential overlap with other conditions, emphasizing the need for personalized patient care. The importance of raising awareness about these conditions, making reasonable adjustments, and providing appropriate support is underscored. The episode stresses the importance of patient-centered care, acknowledging the unique needs and circumstances of each individual. Listeners are encouraged to visit the Aural Diversity Network website for further information and to revisit previous episodes of the podcast to expand their understanding of hearing health. Finally, the show calls for more dialogue on less-known conditions and invites listeners to suggest future topics to continue raising awareness about aural diversity. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

4. 

   8 Jul 2024

   4.1 Exploring Aural Diversity with Professor Andrew Hugill

   Welcome back to the 'Sounding It Out' podcast, brought to you by Signia UK & Ireland! In this episode, your host Julia Van Huyssteen is joined by Professor Andrew Hugill, Deputy Director at the Institute of Digital Culture at the University of Leicester. Together, they delve into the concept of aural diversity, which acknowledges that everyone hears differently. Professor Hugel shares insights from his vast experience in music, research, and personal journey with hearing issues like autism, severe hearing loss, and Meniere's disease. They discuss the origins of the Aural Diversity Network, the limitations of the traditional audiogram, and how technology can help. Check out the Aural Diversity webpage for more information: https://auraldiversity.org/ (https://auraldiversity.org/) EPISODE SUMMARY In this episode of 'Sounding It Out,' hosted by Julia Van Huyssteen, the podcast focuses on aural diversity and hearing health, featuring guest Professor Andrew Hugill from the University of Leicester. Julia and Professor Hugel, who is also an autistic individual with severe hearing loss, tinnitus, and Meniere's disease, delve into how unique each person's hearing is and how traditional audiology norms based on a limited sample from the 1950s-60s fall short in addressing this diversity. They discuss the concept of aural diversity, the importance of recognizing various hearing experiences, and the founding of the Aural Diversity Network in 2018. Professor Hugel shares his personal journey of dealing with hearing differences and how it led him to create music suitable for people with aural divergences. They touch upon how socio-economic, geographical, and ethnic differences impact hearing and the critical differences in hearing at various life stages, from fetal development to old age. Additionally, the conversation highlights various hearing conditions like sensory-neural and conductive hearing loss, as well as auditory processing disorders and conditions like hyperacusis and tinnitus, emphasizing how these affect people beyond what is measurable by traditional audiological methods. Towards the end, they discuss the role of technology, from hearing aids to cochlear implants, in re-engineering the soundscape for individuals rather than merely correcting hearing loss. The episode concludes by encouraging listeners to broaden their understanding of hearing differences and inviting them to stay tuned for further episodes that will explore specific causes of hearing variations. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

5. 

   4 Sept 2023

   3.3 Dementia & Hearing Loss: The Audiologist Rehabilitative Role

   In this episode, Dr. Barbara Weinstein and Julia talk about the importance of audibility - promoting social interactions and the importance of a ‘patient-centric’ approach when treating individuals with Dementia. You can find out more about Dr Weinstein’s work here (https://www.gc.cuny.edu/people/barbara-weinstein). You can explore more about the disease by looking at the Alzheimer’s website here (https://www.alzheimers.org.uk/or%20by%20visiting%20https://www.dementiauk.org/). See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

6. 

   4 Sept 2023

   3.2 Dementia & Hearing Loss: The Audiologist’s Role

   In this episode, Dr. Barbara Weinstein and Julia talk about the Audiologist’s responsibility when treating individuals with hearing loss and Dementia. The spotlight for this episode surrounds the topic of what Audiologists can do ‘here’ and ‘now’ – highlighting the importance of a multi-disciplinary approach, and any ‘red flags’ that should be included in case-history taking. You can find out more about Dr Weinstein’s work here (https://www.gc.cuny.edu/people/barbara-weinstein). You can explore more about the disease by looking at the Alzheimer’s website here (https://www.alzheimers.org.uk/or%20by%20visiting%20https://www.dementiauk.org/). See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

7. 

   4 Sept 2023

   3.1 Dementia & Hearing Loss: An Introduction

   This is the first episode in a new mini-series, dedicated to exploring Dementia and its links with hearing loss and brain health. We’ve made this series to coincide with Alzheimer’s Awareness month, as we know that many people living with Dementia may also be suffering from hearing problems, as they share very similar characteristics. It is estimated that by 2030, the number of people with Dementia in the UK alone will be more than 1 million, so it’s vital that we (as Audiologists) understand the issues and how support can be offered. Throughout this series, Julia is joined by the internationally acclaimed Dr. Barbara Weinstein. She is an Author in the field of ‘geriatric audiology’ with specific research interests in Dementia and social isolation, person-centered care and quantification of patient reported outcomes. Dr. Weinstein has long advocated for the integration of hearing health into the mainstream, and her research has profound implications at the intersection of audiology, public health and society in general. Throughout the series, we’ll discuss the Audiologist's responsibility in the prevention and treatment of Dementia, asking what we can do at present when looking after a Dementia patient, as well as doing a deeper dive into the Audiologist's rehabilitative role thereafter. In this episode we will be introducing Dementia and looking at how it links to hearing loss & audiology. You can find out more about Dr Weinstein’s work here (https://www.gc.cuny.edu/people/barbara-weinstein). You can explore more about the disease by looking at the Alzheimer’s website here (https://www.alzheimers.org.uk/or%20by%20visiting%20https://www.dementiauk.org/). See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

8. 

   24 Feb 2023

   Using The ‘Earways Pro’ Tool To Address the Earwax Crisis

   This is the final part of a 4 part mini-series about the UK’s earwax crisis. Throughout the series industry experts have been talking about the innovative ways their clinics have for addressing the earwax problem. In this episode, we’re finding out first hand what it’s like using the Earways Pro tool. It’s been put into practice at the Southeastern Health and Social Care Trust. Nora McDonald is the Acting Adult Lead Audiologist at the trust and is Julia’s guest. For more information about Earways Pro head to their website (https://earwaysmedical.com/earway-pro/) Contact Nora at Nora.Macdonald@setrust.hscni.net (mailto:Nora.Macdonald@setrust.hscni.net) Got a topic you think we should be talking about? Get in touch here: marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland, visit their website (https://www.signia-pro.com/en-gb) Sounding it Out by Signia, is produced by Annie Day from Fresh Air Production. FULL TRANSCRIPT [00:00:00] Julia: Hello and welcome back to Sounding It Out, the podcast dedicated to audiology, brought to you by Signia UK and Ireland. I'm Julia van Huyssteen, your host and Head of Audiology at Signa. This is the fourth and final episode of the miniseries about the wax management crisis we are facing here in the UK. All the guests in this mini- series have found new and inventive ways of tackling the issue in their trusts, and are sharing their experiences and expertise with you. Last time we heard from Nicola Phillips, who is the Principal Clinical Scientist and Head of Primary Care Audiology at Swansea Bay University Health Board. Nicola talked to us about how her trust implemented an audiology led primary care earwax removal service. [00:00:52] Nicola: All our patients access primary care audiology through their GP surgeries. In some practices, patients get triaged by the receptionist and book directly into audiology slots, or the wax removal slots. In other practices GPs will triage over the phone and then book them directly into clinics using a shared booking system. [00:01:10] Julia: If you've missed the first three episodes, you can go back and download them for free wherever you get your podcasts. Today, let me introduce you to Nora McDonald, who is the Acting Adult Lead Audiologist at the Southeastern Health and Social Care Trust. She is going to be sharing her experiences of using the Earways Pro Tool. Hello Nora. [00:01:34] Nora: Hi, good morning Julia, thanks for having me. [00:01:38] Julia: Nora, thank you for joining us as guest speaker. Although you've only recently started using the Earways Pro tool, you have some great experiences you can share with us today. Before we start getting into the nitty gritty, where did you first hear about the Ear Earways Pro tool and what about it made you pay attention? [00:01:55] Nora: Our Audiology and ENT manager, Barbara Greg, had noticed it at the 2021 BA conference. We had long ENT waiting lists after covid and more and more patients were presenting to the audiology appointments with obstructive wax. Of course, we're always interested in exploring any wax management options including alternatives for microsuction. [00:02:20] Julia: So it sounds to me like the impact was both on ENT and audiology. Of course that would be something that makes you pay attention to an alternative method that could actually ease the service. Now, what did the ear removal service exactly look like in your trust before introducing the Earways Pro tool? [00:02:39] Nora: So the ENT specialist nurses manage the wax removal service. They manage their own waiting lists, reviewing patients as and when required, and accepting new referrals from audiology or ENT as indicated. The audiology service in our trust works across four individual sites and we don't always run alongside the ENT microsuction nurse. So if we were faced with obstructive wax within an audiology appointment and didn't have access to a nurse to remove it, the majority of patients would've been advised to contact their GP for wax removal locally, provided obviously that they had no contraindications for local management. We tried to limit referrals to the nurse-led microsuction clinics to those who warranted that specialist ENT attention. For example, the atypical ears perforations, mastoid cavities, history of otitis, surgery, collapsing ear canals, et cetera. But obviously due to a combination of the Covid pandemic and the withdrawal of many local GP wax removal services, our ENT waiting list for microsuction was just... grew longer and longer, so it became quite a big problem that we needed to address. [00:03:57] Julia: Wow. I can really see the impact of limited wax removal opportunities across the four sites too. And of course you also limited wax removal opportunities within primary care, so going back to primary care then, what was the GPs and your trusts response together, I guess, to this problem previously? What did you do, was private wax removal and option, and what was the feedback from the patients around these waiting times or potential wax removal at a cost? [00:04:26] Nora: I can't speak too much on behalf of the GPs, but as far as our department is concerned we added as many additional ENT microsuction clinics as possible in an attempt to tackle the waiting list. But of course, we have all the usual staffing and equipment demands. Patients were obviously understandably disappointed to learn of the long waiting list for microsuction within the trust and would explore options on the high street for a quicker alternative. This is obviously not always an accessible option for patients due to the associated costs, and it obviously doesn't sit well with us as NHS audiologists to suggest this as an option. Our department is always re-evaluating and exploring all options, including further wax removal training and equipment for audiologists and we are hopeful that the use of the Earways Pro tool in audiology appointments will reduce the referral rate and lift that pressure of the ENT microsuction waiting lists. [00:05:25] Julia: Understandably yes. And actually, I mean you talk about the waiting lists, but what about any data around, for want of a better word, wasted appointments due to patients presenting with wax? You mentioned earlier, I think in the first answer, that often you were presented with patients with wax and you didn't have access to ENT wax removal. Many of those appointments would of course not be able to be completed. Can you share with us any figures at all? [00:05:53] Nora: Yeah, unfortunately not on that specific area of wasted appointments, I suppose it isn't something we've been able to reliably audit because now that we have the Earways Pro tool, that would involve a huge retrospective study to investigate all the appointments where wax contraindicated a procedure so that's not something we've managed to to reliably assess. [00:06:18] Julia: That makes sense. But I think from the conversation so far, what I hear is that from both the trust perspective the audiology and ENT and from the patient's perspective, it pretty much wasn't everybody's interest to think outside of the box and look at alternative methods, so good on you, really. So at this point, I just think it's important for us to highlight to our listeners that the Earways Pro tool is regulatory approved. It's a medical device and it's for used by trained professionals. Just emphasizing trained professionals. For our listeners benefit at this point, for those who have not seen the tool before or hasn't got any experience with it, shall we attempt to describe more or less what it looks like and how it functions? [00:07:06] Nora: The tool is a slim, handheld single-use device with a small grip handle and a flexible helical head. They come in small, medium, and large. In terms of the circumference of the spiralled head, patients often comment actually when shown it that they've seen similar online to buy. But I do point out, as you've just said, that the Earways Pro tool is medically approved device only to be used by trained professionals and shouldn't be available to purchase online. I tend to highlight the main difference between the Earways Pro tool and similar commonly advertised to purchases that the helical head at the top is a completely open spiral, so that prevents impacting the wax further the same way a cotton bud would. [00:07:54] Julia: Yeah. So with that spiral head the Earways Pro is designed to spiral around the wax and engulf it. And you've mentioned that open-ended tip and then because it's spiralling around the wax, we are not pushing it further into the canal. We're just simply pulling it straight after the ear. So it is very cleverly designed to be safe to use. Now my next question considering that ENT was previously pretty much solely responsible, whether nurses or surgeons or doctors for the wax removal, what was their view or what is their view actually on the Ear Earways Pro? Did they have any training from you or anybody else? Have they actually made an effort to observe you using the tool, considering that they are ENT specialists? Were they positive or were they negative? And have they actually mentioned any impact in their own clinics in terms of waiting times in people coming for wax removal? [00:08:53] Nora: Yeah, so it's our ENT nurses that lead the microsuction waiting lists as opposed to ENT in general. The nurses were very intrigued and supportive. They recognize that the Earways Pro will hopefully enable us to help those more typical layers within an appointment that the patient's already attending and allow them, the EENT nurses, to concentrate back on those patients with the more complex presentations who require their specialist attention or the microsuction procedure. In terms of any impact on their clinics yet? It's still early days. We are definitely seeing it, but I think at this stage, they're just ticking over, absolutely swamped. So at the moment we haven't quite audited. [00:09:40] Julia: So perhaps a follow up session on that for another series, hey. [00:09:45] Nora: Absolutely, yeah. [00:09:46] Julia: So earlier we stressed that the Earways Pro Tool, both yourself and myself, is a regulatory medical device for used by trained professionals. I wonder if you can please talk us through the training that you and your colleagues have had prior to using the Earways Pro tool. What did that training package look? [00:10:06] Nora: So when we were first interested in the Earways Pro Tool, we contacted the distributor, Signia, and they put us in touch with one of their accredited trainers, Chris Cartwright, the Director of Audiology at the Audiology Academy. He kindly visited us in the department in Belfast and did a half day of theoretical training with our audiology team on wax management options and introduced the Earways Pro tool. Because we were new to the device we weren't sure how useful it would prove to be. We had arranged four audiologists to continue onto the hands-on practical training into the afternoon. We had booked a wax removal clinic full of about 16 from our ENT microsuction waiting lists. We used the Airway Pro tool on these patients under Chris's guidance and supervision and he signed us off. And then those four trained audiologists then continued onto the use of the tool within audiology appointments when indicated. And then we ordered them. [00:11:15] Julia: Wow, that is very comprehensive. So what I'm hearing is that you had half a day off of theory really going back to Otoscopy Anatomy and what to look out for when you do wax removal. And then of course you had the follow up in the afternoon with the practical session where you all got to practice. That's great to hear, and goes back to the fact that we talked about, the Earways medical tool is for used by trained professionals. I've heard that there is a learning curve for getting proficient using the Earways Pro tool, even if you are very experienced at looking in ears and taking impressions, and even if you've got experience with wax removal. We hear this about this learning curve. Have you and your team observed this? And how many years would you say it takes for building up confidence and how many years does it take to practice before you feel that you've got the confidence to select the right size, the right type of wax, the right ear, and all of those things? [00:12:11] Nora: Yeah, so there was quite a steep learning curve initially going from theory to real ears in one day. But ears are our bread and butter, and we are well used to spotting contraindications and performing procedures on them whilst employing all the appropriate safety techniques with regards to positioning, bracing, et cetera. As with any of our procedures in audiology, even six months on our learning with the Earways Pro tool hasn't plateaued. No two ears are ever the same and of course, wax can present in many different forms, even in the same patient, on the same ear. We're still learning every time we use it, both in a practical sense of how to manipulate the device, but also by auditing our outcomes in particular, when it tends to be successful and when maybe less so. I couldn't really place a number of ears as per se on it, but our confidence continues to grow with it each time we use it. [00:13:11] Julia: And I think that's the key here, is that each time you use it, your confidence is growing. So with practice doesn't come necessarily perfection as we've just we should have heard from yourself, but it certainly means that your confidence is growing. From your experience so far, you mentioned six months in or so how long does the procedure take, especially when we compare it to alternative wax removal services like microsuction, for example. [00:13:38] Nora: In my experience, the procedure itself, excluding case history only takes a few minutes or so. There have been times where the wax has come out in one solid, lovely plug within a few seconds and others where a lot's come out. And then reviewing the ear after there's even more behind. So we repeat the procedure again with a new tool. Looking at our outcomes so far 50% of procedures took one to two minutes, 38% took over two minutes. And of note, many of those were those that were unsuccessful, so probably involved maybe a repeat attempt or changing the tool size and 12% took under a minute so around a few minutes really. [00:14:25] Julia: Wow. So that really shows us that this is a tool that can be implemented very quickly in an appointment like you mentioned at the start, where you can have a patient that presents with wax, for example, at a direct referral appointment and rather, have to book a separate session with a nurse or asked a nurse to help. You could potentially use the Earways Pro tool for, let's say, two minutes or so which doesn't take that much more because you'd have to take the case history anyways. And then within that same appointment you'd be able to still fit in the rest of the appointment because the Earways Pro only took let's say a couple of minutes or so. So that's really quite impressive. [00:15:04] Nora: Yeah, I think it very often does just take that amount of time and actually when, because some of our staff aren't trained yet, we have some of them if they have too much wax that it's preventing a procedure and they aren't trained on the Earways Pro. I did ask them to book in with one of the people who are trained to give it a go if the patient was interested in giving a go. And actually at the beginning people were booking in a half hour, it was much too long. It was a waste of time. 15 minutes did it. So we changed 15 minutes because in a couple of minutes you know if it's going to work or not. So I think that gives you an idea of how much time it takes. [00:15:47] Julia: Yeah, definitely. So you've mentioned there that some of the staff isn't trained at the moment, but at the BAA you mentioned that actually they are really quite keen to also get trained because they have already started to see the benefit of the Earways Pro tool. Do you have any plans for rolling the training out to the rest of the department too? [00:16:06] Nora: Yeah, so the feedback from the trained staff is really positive. They are relieved to have something in their toolbox to at least reach forward to try to remove obstructive wax, which may be preventing their management rather than just giving their apology to the patient and wasting a patient visit and appointment time. It's often successful, the use of the Earways Pro, so within a few minutes we're able to identify the wax, remove it, and move on with our appointment without any need for a return visit or onward referral. It's been used successfully in domiciliary. With bed bound and dementia patients where alternative wax removal options aren't always accessible, it's made it possible to obtain reliable objective testing and take impressions within the same visit and move things along quickly without delay. Which is obviously particularly important for that patient group. So it's been a real positive difference to the department. And we recently asked the team if anyone else was interested in being trained on the Earways proto and everyone volunteered. So that's the plan over the coming months. No one wants to be the one who can't do anything about the wax when faced with obstructive wax. [00:17:23] Julia: Fear of missing out, right, is what it sounds like to me. And you mentioned domiciliary visits and I've heard other trusts also mention going to care homes, with it being very convenient for that and also repair clinics, if somebody comes in for a hearing aid repair and the main problem is that they've got obstructive wax .Due to the time that you've just described two minutes, you could actually fit it into a repair clinic, whereas previously you'd have to send the patient away to use olive oil for a couple of weeks, then book them in with the ENT nurse so you can start to see the applications and the relevance of this tool in an audiology department more and more so as you gain experience using it in different ways. Earways Pro themselves have some data from the US and Canada, the UK and Australia where they included 43 clinicians who did the Earways Pro procedure on 330 ears. And amongst other things, these clinicians have rated the Ear Earways Pro Tool 4.2 out of five for safety. Now, I know that you are relatively new to the tool, but from your experience has there been any incidents that made you worry about its safety at all? [00:18:38] Nora: So we paid particular attention to the case history before the procedure to ensure there's no contraindications. We don't use the Earways pro tool on patients who have any type of otitis, have history of ear surgery including grommets or hearing. We don't use it with patients who have any abnormalities of the pinna or ear canals or malignancies of the ear or temporal bone or patients who have had any radio radiation therapy for the head and neck and we also exercise caution with those on anticoagulants because obviously they have a higher risk of hemorrhage and hematomas. And as with otoscopy and impression taking, we are well used to employing appropriate positioning and brace technique, which is obviously crucial and of course, oscopy is essential before the procedure to note any contraindications and to document the condition of the air canal, after the procedure. Our audits to date indicates that in five ears out of 77, there was a slight redness of the ear canal observed after the procedure. But in the majority cases, there has been no change in otoscopy findings of the ear canal walls after the procedure. We do tend to advise patients to keep their ears dry for a subsequent 48 hours after the use of the tool, just as a precaution to reduce any risk of infection of the newly exposed, potentially vulnerable ear canal skin. And we've not had any reports of post-procedural Otitis to date or anything from my personal experience. The wax usually slides out really easily. But I have had one occasion where when I've gone to remove the tool, I've had a slight kind of friction or almost pull back, which indicated to me that the wax was too stuck. So I just rotated the tool back in the opposite direction and removed it from the ear and advised olive oil and left it at that. So I have just been aware of that feeling what you're doing and being mindful that obviously it shouldn't require any force on your part. It should just slide out once it's been gripped. [00:20:52] Julia: So what I'm hearing from that is that you mentioned five patients, I think, did you say, was it out to 70 or so? 77, yeah, 77 that had slight redness. And I guess you can compare it to any other wax removal technique. Or even impression taking where there will always be a few people that show some slight redness afterwards but as you say, there's been no real complications post-procedure that you are aware of either, that sounds great. So basically the conclusion is here be a good audiologist [00:21:23] Nora: Exactly, it's remembering all the usual safety procedures and precautions that you do anyway in your day-to-day. [00:21:33] Julia: Yes. Exactly. Now you mentioned there that you can tell when the Earways Pro isn't the appropriate tool to do. But what about the patient and in terms of talking to them about using this new way of tackling Earways. I guess it's something quite new to them too. When you look at the tool itself, it is something that you tell them that will be going into the ear. They may feel a little bit worried about this new procedure. I guess counselling is really quite important in terms of making them feel safe and happy for you to go ahead. What are the type of things that you would say to the patient to a, talk them through the procedure and b, put them at rest that that it's okay to do this procedure. [00:22:18] Nora: Yep, so I've obviously mentioned that we've been collecting outcomes on every time we use the Earways Pro, regardless of whether it's successful or not. And one of the things we are obviously very keen to record is comfort. 50% of instances reported no discomfort at all during the procedure. While 50% reported a slight discomfort of which hundred percent characterized the slight discomfort as only momentary, so no one reported discomfort that continued after the procedure, and no patients reported that they had some discomfort rather than slight, was uncomfortable or was painful in our comfort scale. And in the early days, one patient did comment that they weren't physically uncomfortable during the procedure, but they just felt nervous, which is what you were saying there. So I think it is important to be mindful that it can be nerve wracking having someone effectively poke a device into your very sensitive ear. And I personally explain a few things before the procedure. I tend to explain that it's a medically approved tool that I can use to try to remove the wax. And sometimes it works and sometimes it doesn't. Just to give them realistic expectations. I obviously show them the tool and I explain that it may feel deep, often deeper than it actually is. And I explain that we have a strong protective reflex in our ear canals that will make them want to cough. And I sometimes suggest that they keep swallowing repeatedly through that sensation where possible that kind of can sometimes ease that feeling. And I explained that it may feel intrusive and not particularly comfortable, but it should not be painful. And any pain, obviously raise your hand and obviously I check that they're happy to proceed and gain consent, because of course, if they're more comfortable trying an alternative method, that's entirely up to them. So I guess just reassurance. Often, also while doing the procedure so whenever you're rotating the tool, obviously through the air of the ear canal before you hit the wax, you can feel when you do a very slight change in the friction when the tool reaches the wax and you're spiralling into it. So I tend to, at that point, reassure the patient that, okay I've reached the wax now and I just need to get a good grip of it and then we'll just slowly remove it. So just so that they are aware of if they have a change in sensation that I'm explaining why at that point. But they're obviously delighted by the end if it's successful. Oh my goodness. They love to look at it and study it and see what it was. I can't believe I had one patient who asked to take it home. Another patient said she wanted to jump on the weighing scales cause she felt like she'd lost five pounds. So yeah, lots of photos taken of it after it of the patient to show their families. [00:25:24] Julia: Oh, that's so funny actually and you don't tend to get that really with other wax removal techniques. So I guess this is a unique one. In terms of the counselling, what I'm hearing is that it's really important to describe the procedure before, describe the tool to the patient and pretty much the safety mechanisms of the tool, and then describe to them what they may expect in terms of feeling. And then as you're doing it, talking them through the procedures to keep them informed all the way through. And of course the last piece is if there is discomfort, let me know. And then I've heard people say, or check in with the patient, do you mean by discomfort that it's painful or that you feel pressure or that it feels a little bit strange? Or as you said, it may feel a little bit deep. And often when you talk about what this discomfort is that they initially say, "oh, this is uncomfortable". It isn't necessarily pain, it may be one of these other sensations that they weren't expecting. [00:26:18] Nora: Yeah, and also as we do with any procedure is observing the patient. You can see if they scrunch their eyes a little bit, then obviously that's your cue to check in with them because they might not be the most vocal and they might not want to interrupt or complain of course, so it's just reading their cues as well, and constant communication and take it from there. . [00:26:41] Julia: Okay, great. Do you have any data for us? I know you said that retrospective data's quite hard for you to get because obviously you'd have to go back and do a really big study in terms of who you weren't able to see and you had to refer back to the nurses or to the GP. But do you have actually any data for us since you started using Earways on referrals that you managed to avoid because now you've got the Earways Pro tool? [00:27:04] Nora: Yeah so from a total of 77 years, 32% were unsuccessful, 58% were either partially or fully cleared, requiring no onward referral. So out of the documented instances where an odd logical procedure was inhibited by wax, 40% of these instances were preventing PTA or speech testing or some assessment of their audiological hearing threshold. But Earways Pro use enabled continuation of the assessment in 83% of those cases 50% of delayed procedures were, was impression taking. And 66% of those were able to be continued after the Earways Pro tool use. So that hopefully gives you a bit of an idea on the benefit and the ability to continue our procedures because of just being able to reach for this tool prior to impressions or prior to PTA [00:28:07] Julia Those are really crazy numbers and I hope that our listeners will take that on board in terms of how successful this tool has been for your patient pathway and allowing you to carry on with audiological procedures that you would not normally be able to carry on with at all. Staggering numbers, really. What is the perfect patient and the perfect type of wax for the tool to be most effective? I know you've talked about contraindications before, but is there certain things that you look out for when a patient arrives in clinic just in a standard case history that makes you think "I'm gonna try..", or looking into the ear in terms of the ear canal shape and size, looking at the wax, cause we know that Earsways Pro is more effective for certain individuals and wax types. [00:28:50] Nora: So in 56% of the unsuccessful instances, the audiologist felt that the reason was because the wax was too deep. So I think that might be an indication that we need to scream even louder about the impact of cotton bud use. 28% was because it was too soft and it was attributed to it being stuck to the canal wall with another, 8% the reason being unknown. Of the fully cleared wax instances, the texture of the wax was described as firm, in the majority, 63% of cases, the colour was described as a darker brown in 52%, and brown in 26, and a light brown in 21 of the fully cleared instances. In my personal experience, wax would ideally be firm but not dry. And by firm I mean that it isn't too moist or drowning in olive oil as the tool can slip right through that, but also not dry and flaky as it needs to obviously grip onto something and not break apart. I usually get excited when I see a thick smooth, completely occluding plug of darker brown wax that almost hits you in the face when you do otoscopy [00:30:10] Julia: Oh man. You're describing a wax that is usually for us as audiologists, the biggest challenge and to hear you say that you get excited about that is something that I think a lot of listeners wouldn't expect, but you're right. That is exactly the type. But you look into the ear and like you say, you almost can't get the otoscope in because it's that occluded? And you think this is perfect. And then the other flip side to that is we've not really talked about that, but how rewarding it is for us as audiologists to be able to see that wax, and you think, oh, I've got the right size tool here. And you go through the procedure and that plug of wax that jumped out at you physically gets out of the ear in one go. Very rewarding. [00:30:47] Nora: I'm not gonna lie, obviously, I'd rather look in and see a pristine ear, but if I'm going to see wax rather than Oh, the dread, oh my goodness, what am I gonna do? And you're already trying to work through how you're going to break it or break the news or explain the options, which are quite poor that they have or to get the wax removed. It's it great when you see that type of wax that really is obstructing the ear and nice and close and yes, it's very empowering to be able to say, oh, we actually have this tool that we could try and when it's successful, oh it's really is fantastic. And then just being able to move on rather than having to explain options of things that they might have to try and think about doing or consider doing. And it just makes it a lot cleaner and a lot nicer and a much more enjoyable experience for us as audiologists. [00:31:45] Julia: and I've heard other audiologists also say that if they do have other wax removal options available to them, whether that's through ENT or audiologists having microsuction training, they all say that this has got a fantastic place in the toolbox because when you see the right person, the right ear canal, the right ear wax it is a great tool to have in the box to be able to do something about that wax quickly, to be able to move on. So many thanks to you, Nora. It was great to hear about the success you have had with Earways Pro in your trust and there was lots of really rich content for our listeners to process. [00:32:22] Nora: Thanks very much for having me, Julia. [00:32:33] Julia: Many thanks also to my other guests in this series, Frankie Oliver, Mark Newman and Nicola Phillips for sharing their insights. All those episodes are available to you to download from wherever you get your podcasts. If you want to talk to Nora about her experiences, you can find her email on the episode page. I'll end by reminding our listeners of the RNID or Royal National Institute for Deaf People's Campaign priorities. And that is firstly for earwax removal services to be brought back into primary care or community setting. Secondly for the Department of Health and Social Care, NHS England and local health bodies to explore new models for delivering ear wax removal services to make sure people can access timely and appropriate treatment. And thirdly, for the NHS to publish clear information on how people can manage ear wax build up themselves at home. If you found any of what you've heard in these episodes helpful, please tell your colleagues so as many people as possible can share the knowledge. And if there's a topic you think we should be covering, drop us an email to the address on the show page and remember to follow wherever you get your podcasts so you don't miss an episode. This is a Fresh Air production for Signia UK and Ireland, until next time, goodbye. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

9. 

   17 Feb 2023

   Wax Management Crisis: Audiology-Led Primary Care Earwax Removal Service

   Welcome to part 3 of our 4 part mini-series about the UK’s earwax crisis. We’re speaking to industry experts who have come up with innovative ways in their clinics for addressing the earwax problem. In this episode, Julia speaks to Nicola Phillips, who is the Principal Clinical Scientist and Head of Primary Care Audiology at Swansea Bay University Health Board. Nicola and the team have come up with a system that enables patients with hearing, tinnitus or wax problems to be triaged directly to the Audiology Department – which then acts as the first point of contact, freeing up other general practitioners to see patients with more complex health conditions. Nicola would love to share her experiences so email her: nicola.phillips@wales.nhs.uk (mailto:nicola.phillips@wales.nhs.uk) Got a topic you think we should be talking about? Get in touch: marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland, visit their website (https://www.signia-pro.com/en-gb) Sounding it Out by Signia, is produced by Annie Day from Fresh Air Production. Full episode transcript [00:00:00] Julia: Hello and welcome back to Sounding it Out, a podcast dedicated to audiology, brought to you by Signia UK and Ireland. I am Julia van Huyssteen, your host and Head of Audiology at Signia. This is the third episode of a miniseries about the wax management crisis we are facing here in the UK. In 2019, the British Medical Association decided it would no longer be considered part of the core services they were obliged to provide. This has created a postcode lottery for patients suffering from ear wax. We've already spoken to the RNID or the Royal National Institute for Deaf People about their concerns. If you missed that conversation, you can go back and listen for free wherever you get your podcasts. We are also speaking to people in the profession who have come up with some innovative solutions. Last time I spoke to Mark Newman, Head of Audiology at the Barking, Havering and Redbridge University Trust. He has managed to form an agreement with the CCG to fund their earwax management through reimbursement, which allows Mark's trust to have a full audiology lead wax care pathway. [00:01:15] Mark: So sometimes you need to do a little bit of manoeuvring and ensure you're in the right meetings with the right people in order to make effective change. [00:01:23] Julia: If you missed the conversation, you can go back and listen for free. My guest today is Nicola Phillips, who is the Principal Clinical Scientist and Head of Primary Care Audiology at Swansea Bay University Health Board. Nicola, hello. [00:01:41] Nicola: Hello. Thank you for having me, Julia. [00:01:44] Julia: So my first question to you really is about a paper that you co-authored very recently, and that has been published in the BMJ or as it used to be called the British Medical Journal. That's so exciting and congratulations. I'm really pleased for you and this paper details a trial that you've been running at the University Health Board. Can you please give our audience an overview of this paper? [00:02:07] Nicola: Yeah. Thank you Julia. We are delighted to get the first ever primary care audiology publication and myself and the team are very delighted about that. The title of the article is Approved on Healthcare and Practice, an Integration of Audiology Services into Primary Care. So back in 2016, delivering audiology in a primary care setting was set up as a pilot project within the health board. The main aim of the service being enabling patients with hearing, tinnitus or wax problems to be triaged directly to audiology, acting as the first point of contact. And it greatly benefits the patients as they're seeing specialists in hearing care within a matter of weeks, whilst also freeing up important time for GP and practice nurses. And we do see the amount of referrals being sent to ENT in secondary care, which as we know is very costly. [00:02:55] Julia: Thank you very much for that, Nicola. So I was actually lucky enough to come and observe this primary care approach in person a month ago or so, and although the service runs like a well-oiled machine, for the most part, it has taken, as you say, a long time to get to this point. I think you mentioned the start date of being 2016. In your opinion, why do you think it has taken this long? [00:03:18] Nicola: I think, delivering an audiology service within primary care had never been done before. So we needed firstly research, primary care activity, and then start collecting as much data as we possibly could because at that time, there's no data around for us to work with. So we began the project in two of the eight GP clusters. This enabled us to audit the service to access its true potential before expanded further clusters. Once we had the information we needed, we be began to expand to the remaining clusters. The main challenges I feel were, highlighting the service and an audiologist being the best person for patients to see at the first point of contact we needed to educate patients into accessing new healthcare pathways. Patients had always seen a doctor and initially they didn't like the thought of seeing anyone else. So I think getting that message out to patients and educating them in these new patient pathways was really important, I think still is important. We've worked really hard with our comms teams in the health board. We've done some publications in local newspapers, websites, Facebook pages, things like that. Just educate the patients in the new way to access services. I think recruiting new staff as well and training staff was another challenge. It takes a lot to forward thinking, of planning and departments really need to start training staff to take on these roles used in advance. And that that's what we did. We started thinking about this progression then - back in 2016, you have to train the staff over the period of time and it is very timely. The biggest challenge though, I think was acquiring permanent funding. This was a very challenging process indeed. There are lots of board meetings to get these kinds of things passed through the health board, again, forward thinking is a must. Collaborative working using primary care and secondary care funding is how our permanent funding was achieved in June of this year. So I think it's just having that little… you know, thinking out of the box approach where you know, where you're a service in secondary care and primary care, utilize that knowledge of both parts of the health board and really think about how you can achieve the funding from different pots so you don't have to achieve the funding from one pot. It can come from different parts and then all together, you can achieve the funding. So that's something that's worked really well in our health board. I'm not saying that would work for everybody, but it is something that's worked really well for us. [00:05:32] Julia: Wow. That's a very comprehensive answer. Thank you so much Nicola, and so many angles that you would have to consider if you wanted to align with the approach that you and your trust have followed. Certainly some angles I didn't think about was the patient's response and how you had to re-educate them about accessing services not directly from their GPs . That wasn't something I thought about before and a really interesting point. My next question is around the pilot project that you actually have just mentioned in your previous answer. How important do you think a pilot project is in terms of being successful? So do you think this is a vital first step for other trusts to consider if they wanted to have a primary care approach, or do you think they could simply build on the pilot that yourselves did? And maybe just putting together a strong business case purely based on numbers is good enough evidence? [00:06:21] Nicola: Yeah, I think for us it was important cause as I said, it was the first time it had ever happened. There was no previous data available. We were the first audiology department to deliver an actual wax removal service, and a first point of contact service, we had no numbers or data to go on. So we had to collect as much information as a we could. I can remember auditing spreadsheets upon spreadsheets and just looking at it for hours, collecting data in the beginning. It has been done now .We are one of the departments which are leading the way in primary care audiology with our colleagues up in North Wales as well. And we are happy to give any help and advice and support to our colleagues nationally and setting up the services. I think that's something that we are really proud to be an example of. I think it's good to know every area will be different. Geographically some areas are much bigger and more spread apart, which may offer more challenges in setting up audiology services in primary care. But certainly we are happy to give any help or advice and provide any help with data collection wherever we can for our national colleagues. [00:07:21] Julia: Wow, what a fantastic offer. And I hope that our listeners will indeed take you up on that because you've gone through this experience with some really rich information and help that you can share with anybody that's thinking about approaching wax removal or wax management in a primary care fashion like you have. You make me smile when you were talking about the spreadsheets because it's something that I certainly don't have much interest in, but it's absolutely necessary when you do a pilot project like this. Well done you for persevering. You mentioned earlier that you ended, I think the previous question with that, the greatest barrier really was acquiring permanent funding. And I understand - having an NHS background myself, how big a barrier this can be when you start up something new. So for our listeners' sake, which parties are important to involve in this process of getting funding? Who are the key stakeholders that you can approach right from the start and that you should think about and what's the right approach? Is email okay? Is a phone call okay? Is attending a GP meeting Okay? What are the different types of things that we need to consider when we are looking for acquiring permanent funding? [00:08:28] Nicola: Yeah, I know. I think this will differ in different health boards but speaking from our experience, our funding is based on funding from both secondary care and primary care. The clusters, the GP cluster support the service as well as the health board. And this has worked well for us, so how they will be individual in health boards would be the most appropriate way of funding? I think, we set up from the beginning we went with a various that we wanted to gain a very good rapport with our , with our cluster leads, with our practice managers. I think that's paramount in any primary care service. Cause without them on board, you're gonna really struggle in booking in patients and getting the service up and running etc, etc. There's so much that they need to help us with. So it's very collaborative working. And once you've got them on board we do work together. And once you're doing a pilot project, they see the benefits, they see how that’s benefiting their GP time and they see how it's benefiting the patients and therefore they're much more likely to look at funding. So we ask our clusters, every GP cluster, for some funding. And then our health board, the secondary care section met some funding as well. So yeah, we had to come in from a few different pots, but I think it, it worked really well and I think it is a good example of acquiring the funding, so yes that's our experience. I think meetings and any GP cluster meetings. I think any emails, it's always good to send emails cause there's an email trail. But yeah, attending meetings face-to-face and speaking with cluster leads face-to-face or whether it be teams meetings. Now that's always good as well because I think now that's where the rapport really builds up with your colleagues. [00:10:04] Julia: Wow. Just from that answer there, you mentioned earlier forward thinking and the angles that you considered in order to get this funding in working with the GPs and, securing some funding from secondary care as well. Just make me think, almost the cliche saying of don't take no for an answer, if there's a will, there's a way. So again, and your trust. So my next question is, I'm just trying to form a picture here of the setup that you've got within your trust in terms of the audiology department. So obviously you run the primary care side of things, the secondary side of secondary care side of things. How is all of it spread in terms of audiologists what is the setup and the locations that the department functions within? [00:10:46] Nicola: Yeah, so all in all we have approximately 40 staff that's including admin staff as well. We have two main hospital locations and three for the outreach clinics for secondary care activity. And then the primary care service runs over seven further primary care locations. 15 of the 40 staff make up the primary care audiology team. It is, it is a nice working mix. All the primary care audiology team also do a day or two maybe in secondary care as well. So I think from a, from the career aspect, it is a nice way of working. People tend to enjoy it. But yeah, so there's a lot of sites though. So a lot of sites means a lot of clinics. A lot of clinics means a lot of equipment. It is hard keep on top of equipment calibration what's where, what do we need, what stock? So it has those challenges. But we do tend to try and keep on top of it as much as we can. [00:11:33] Julia: Okay, quite a big department with a widespread working very well together. You also mentioned, , in your answer about recruiting staff, because this was a completely new setup, did you have to create completely new positions for the primary care settings? And then also alongside with that, how did the staff respond to this primary care setup? And then also going along with that, whilst we're talking about staff, I guess you mentioned, needing certain qualifications. So does it mean that in order to be able to perform wax management, for example, in primary care, you need to be a certain band? So I guess this question is about recruiting staff. What are the qualifications for being in those positions, and how did the staff respond to this set up. [00:12:16] Nicola: Yeah we did have to create some new positions and these were all included in our business case. The staff were all very positive and it does create new positions and has enabled some members staff to be promoted. So it was excellent to see, these staff progressed and it's lovely that they've been with us many years and progressed through the bands. Our associates carry out the waxing removal. These are generally band fours. However, we do have a couple of band fives carrying out waxing removal, and then all the complex wax removal is carried out by the advanced practitioners who are band seven or eight. So our service is run with what we call a power working model, where you've got a sorted practitioner band four or five working alongside an advanced practitioner, a band seven or eight. They really complement each other. That's quite cost effective as well obviously running the wax removal service because band four can't work alone. So if you will run standalone wax clinics you'd have to employ band fives to do that. But the way our model is set up is quite cost effective as a band four can work alongside one of the advanced practitioners. It works really well as the parallel working model. [00:13:19] Julia: No, it sounds, as you say, it sounds like a really good way of giving people the opportunity to come into new positions, giving people the opportunities to be able to progress. And also, as you say having a cost effective setup, which is also bringing it back to the funding that we talked about earlier, the more cost effective the model that you run, the more, , likely it is that you will acquire funding for this type of approach. The next one then is about the patients, really. How do patients access this audiology, whether primary care or secondary care in your trust. So if you maybe can talk us through a typical audiology patient pathway. So maybe when somebody sees their GP or maybe not even seeing the GP, what the likely outcomes are and how they would end up in either primary care or secondary care in the first instance [00:14:03] Nicola: Yes, all our patients access primary care audiology through their GP surgeries. In some practices, patients get triaged by the receptionist and book directly into audiology slots, or the wax removal slots. In other practices we do triage over the phone and then book them directly to clinics using a shared booking system. So I think that's something that's really to note as well is the booking system of these patients, which can be quite tricky. You do have to have a shared booking system with your GP practices. There are a few different ways of doing that. We generally work from the Vision 360, which is what our GP practices work on and we got a shared booking system then where they can access the booking and we can access the booking and the patient files and write up a little journal on the patient as well. So I think it is quite a big thing to bear in mind when you're setting up these clinics as well. So you do need to have a booking system for the patient that everyone can access. Patients will attend their audiology appointment, then after they're being booked in, they'll be assessed for their reported issues, whether that be for routine wax removal, which will be carried out in a wax removal clinic, or asymmetrical pathology, which should may be dealt with an advanced practice clinic, where all diagnostic testing is available. Once the patient's testing has been completed, the patient will be appropriately managed by the advanced practitioner. So if the patient hasn't been discharged, any onward referrals to ENT or radiology, for MRI scans, will be managed by the advanced practitioner, along with any hearing aid for tinnitus referrals then to secondary care audiology. And so the pathway reduced waiting lists and wait times of patients from many months really, because before we were there, these patients would really be seen in ENT before any asymmetrical pathologies and for any MRI scans. Sitting on an ENT waiting list for many months has dramatically reduced that wait time round for the patient because we are referring them for MRI scans. And then by the time we get to see them... and they only see the ENT consultant if they need to then, if anything has come up on the scan. And when they get to see the ENT consultant, they're seeing them there with full diagnostic testing and audiograms to view, any waxes being removed and obviously their MRI results as well. So it's a much better pathway for the patient and for our ENT colleagues as well. [00:16:13] Julia: Nicola, we've talked a lot about the way that you went about getting the service set up. We've talked about the audiologist's response and the GPs response too, what was the patient's response to this new service delivery model? [00:16:25] Nicola: Initially patients were unsure as they were expecting to see your doctor, but they quickly realised audiologists are the right people to see for their ear and hearing problems. Patients always gave very high scores in any PROMS or PREMs, outcome measures and experience measures that we collect. We carry all those out now on a regular basis. We also audit the service regularly to see, to ensure the patient's needs and the aims of the service continue to be met. I think any opportunity in educating patients, like I mentioned earlier, in the new way of working in the NHS is really useful. Seeing healthcare practitioners in primary care rather than GP is becoming far more common, and I think it's really important to get that message across to patients as well for their expectations. [00:17:07] Julia: So really positive from the patient perspective too. Which wax removal tools do you and your department have in your toolbox, and when would you select a certain tool over another one? [00:17:20] Nicola: Yeah, so obviously our main go to in our wax removal clinics are microsuction. Because obviously with microsuction it doesn't matter the depth of the wax. It is very successful so that is our main go-to. But obviously we have got some manual tools such as Crocs hooks, and now we are using Earways Pro as well. That's in our toolbox. But depending on the type of wax and the depth of the wax, we will decide on what's best to use. [00:17:45] Julia: So a very comprehensive toolbox. You mentioned Earways Pro very briefly then, and this will be my last question actually for you. I know that your team have been collecting some data around the tool, around how long it takes, around the type of wax, around how successful it has been. I think there's some data on safety. Can you please highlight some of the takeaway messages from the data that you and your team have been collecting regarding Earways Pro? [00:18:10] Nicola: Yeah, I think the main take-home message that myself and the team would agree on is it can be a very useful tool. It works better with harder wax, which is in the outer part of the canal, is very quick, very effective, taking only seconds. Patients didn't report any discomfort in the evaluation. It, unfortunately, it's not so useful on soft wax or wax which is deep in the ear canal. So that's why obviously like microsuction, it is better for the those patients. But it is nice to have the Earways Pro there for the type of wax that it is, it does work well on and it does save a lot of time. So yeah we are really happy to have it in our tool box. [00:18:47] Julia: And like you say, thankfully the team that performed the earwax removal, they are fully trained and qualified and experienced, and then identifying the right type of wax for the right tool is of course something that they excel in. So thank you so much. My thanks to you Nicola, for sharing your experiences and your expertise. I have learned a lot and so has our audience too. There's lots of food for thought and of course inspiration and ideas. You said earlier that you are happy to talk to people about your approach and to give some advice. So if you wanted to reach out to Nicola, you can get in touch by email on Nicola.Phillips@wales.nhs.uk. Nicola, once again, thank you to you so much. [00:19:34] Nicola: Thank you Julia. Thank you for inviting me and myself and the team are more than happy sharing experiences and we really are thankful for the opportunity that you've given us today to showcase our service. So thank you. [00:19:55] Julia: In the next episode, I'll be speaking to Nora McDonald, who is the Acting Adult Lead Audiologist at Southeastern Health and Social Care Trust. She'll be talking about using the Earways Pro tool a little bit more. [00:20:07] Nicola: It's very empowering to be able to say, oh we actually have this tool that we could try and when it's successful, oh, it really is fantastic. I usually get excited when I see a thick, smooth, completely occluding plug of darker brown wax that almost hits you in the face when you do otoscopy . [00:20:25] Julia: I'll end by reminding our listeners of the RNID campaign priorities, and that is firstly for ear wax removal services to be brought back into primary care or community settings. Secondly for the Department of Health and Social Care, NHS England and local health bodies to explore new models for delivering earwax removal services to make sure people can access timely and appropriate treatment. And thirdly, for the NHS to publish clear information on how people can manage earwax build-up themselves at home. If you found any of what you've heard today helpful, please tell your colleagues so as many people as possible can share the knowledge. And if there's a topic you think we should be covering, drop us an email to the address on the show page and remember to subscribe wherever you get your podcasts so you don't miss an episode. This is a fresh air production for Signia UK and Ireland. Until next time goodbye. END See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

10. 

    10 Feb 2023

    CCG funded Audiology-led Secondary Care Earwax Removal Service

    This is the second episode of our mini-series looking at the UK’s earwax crises. Across 4 episodes you’ll hear from specialists who have come up with innovative ways of treating patients. In this episode, Julia who is the Head of Audiology for Signia, speaks to Mark Newman, Head of Audiology at the Barking, Havering and Redbridge University Trust. Mark has managed to form an agreement with his CCG to fund their wax management through reimbursement, allowing his trust to have a full Audiology-lead wax care pathway. Got a question for Mark? Email him mark.newman7@NHS.net (mailto:mark.newman7@NHS.net) Got a topic you think we should be talking about? Get in touch here: marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland, visit: https://www.signia-pro.com/en-gb (https://www.signia-pro.com/en-gb) Sounding it Out by Signia, is produced by Annie Day from Fresh Air Production. FULL EPISODE TRANSCRIPT [00:00:00] Julia: Hello and welcome back to Sounding it Out, a podcast dedicated to audiology, brought to you by Signia UK and Ireland. I'm Julia van Huyssteen, your host and Head of Audiology at Signia. This is the second episode of the miniseries about the wax management crisis we are facing here in the UK. As we discussed in the last episode, the situation started to deteriorate in 2019 when the British Medical Association decided it would no longer be considered part of the core services GPs were obliged to provide. It's created a postcode lottery for patients suffering from ear wax, the RNID, or Royal National Institute for Deaf People are concerned that the situation is risking people's hearing health with hearing loss, earache, tinnitus, and dizziness as some of the symptoms. In the last episode, I spoke to Frankie Oliver, audiology advisor at RNID about their worries. [00:01:06] Franki: I don't think we can really overstate the risks that people compose when, they are forced to try and remove wax themselves. People are being forced to do this because private removal is either inaccessible or too expensive or they're just not able to access any care on the NHS . So people are using dangerous methods to try and remove wax, and then this is posing your risk to the really delicate anatomy of the middle ear and therefore posing a risk to someone's hearing. [00:01:34] Julia: If you missed the conversation, you can go back and listen for free. In this mini-series we're speaking to people in the profession who have come up with some innovative solutions. I'm going to be joined by people who have found new and inventive ways of tackling the problem in their trusts and we will draw on that expertise. My first guest is Mark Newman, who is the Head of Audiology at the Barking, Havering and Redbridge University Trust. Hello, Mark. [00:02:06] Mark: Hello, Julia, and thank you for asking me along, [00:02:09] Julia: Mark, you've taken a really fresh approach to tackling earwax management in your trust, can you explain what you've done and why it was needed please? [00:02:18] Mark: As with a lot of audiology departments, we were very frustrated at seeing our patients come through the door for our GP direct access appointments, and also seeing our existing patients where they'd have problems with their hearing aids and we would find wax in the ears and also a lot of our direct access patients are being triaged over the phone by the GPs having a telephone appointment, them being sent through to us with, not even looking in the year. It's always been frustrating thing for us as caring clinicians trying to provide good care for our patients, having to just stop the appointment and send them back to the GP knowing full well, but the services weren't really there to help them. We found that between about 12 and 14% of our patients, although this could vary, were coming in with wax at one point or other. The problem is, as change takes a long time within the NHS , but I was very determined to see this one through seeing these patients in my clinics, I could share with their frustration as to how long this whole process took, and it just wasn't very satisfactory for me as a clinician trying to provide care as well. So what I managed to do was actually negotiate a audiology led wax removal clinic, with a full blessing of the ICBs as they are now, or the CCGs as they were then which was, meant we had a fully funded audiology led wax removal clinic. [00:03:40] Julia: Wow. So my next question then is, of course, going to be how you managed to get this agreement with your CCG, how did you go about conversations and what arguments that you used to justify the cost? [00:03:51] Mark: I was quite lucky because I've only been in this department about four years, but we're doing an awful lot of change and we're trying to make, and just trying to shuffle things around really and make things a bit better for the patient. So during that time I've already managed to get a good line of communication with the CCGs or ICBs as they are now, of course and I was already attending a couple of the meetings, which is quite important to get a foot in the door. It's actually very difficult as this line of management to actually get access to the people who can make the decisions. So sometimes you need to do a little bit of manoeuvring and ensure you're in the right meetings with the right people in order to make effective change. During that, I was able to add the wax removal process to the to the agenda. I'd already done my research. I had all my stats. I had all the kind of quality data to show the need. And of course, on these meetings were representatives from the GPs, so I was able to draw on the GPs frustrations with the management of wax, and they were a very good voice in terms of supporting my cause. And also I asked a few patients just to put a few notes to me so I could quote them as saying look, these are from real life patients. These are their frustrations and their issues. It would alleviate an awful lot of pressure on the primary care. So just through, basically through these meetings, I was able to demonstrate there is a dire need for the wax removal. I was able to demonstrate what we had capacity and I was able to demonstrate, but we would be able to do a good and professional job by taking the wax out. It also helps to clean up the process, as well, so instead of all this boomeranging about, I believe, referred to earlier, it would be like a bit of a one stop shop. Sometimes we were able to take the wax out on the day, but obviously we're all running very busy clinics. So what we'd normally do is ask them to use drops for between week and a half, and then book them into the following week. What we were able to do at that time, keeping things very flexible the timetable helps, I was able to do a hearing test and a, like a DR continuation appointment immediately after taking the wax out, there was a consideration about temporary threshold shifts, but on the flip side, it was like, in terms of patient access and in, in terms of trying to provide that one stop shop model, it was deemed more appropriate, both clinically and for patient convenience to actually do the wax removal and then do the, the appointment soon or soon after. We'd normally have about half an hour gap to allow the patient to go and get a cup of tea, and just reboot for the next part of the appointment. [00:06:25] Julia: So what I'm hearing there is that you were able to, through these conversations and being involved in the meetings that mattered to have a voice, you were able to talk about the benefits for the GPs, the benefits for the patients, the benefits for ENT for your department. So really having a multi-angle approach to demonstrate the benefit of this wax setup that you have. [00:06:47] Mark: That was very important, Julia. So essentially you're trying to demonstrate how obviously the CCGs and the ICBs, they're mostly concerned with money. So when you think about how much money it would cost for the GP to see this patient for the second time, for them to send them on to say an ENT consultant, we don't need ENT consultants taking wax out of people's ears. It's quite ridiculous to be charging that as a consultant outpatient appointment and the cost and time to the patient as well and the , inconvenience of attending multiple clinics multiple times because we feel like, there's an assumption that a lot of our patients are retired with nothing to do on their hands. But of course we see patients from all walks of life and people are very busy nowadays. So it was about actually making clear the savings, but people could find, and that's in cost of saving in time for the GPs in primary care, in the ENT consultations, and of course with us, at least, if they're referred to our servic , then at least we can actually take care of them. The other thing is, the feedback I was getting from the GPs is that they just want to say, this patient has an ear problem, can you please deal with it? We don't really want them coming back and forth. You don't really need to ask for our permission to do this or that or the other. This isn't patient with an ear problem regardless of the cause. It'd be really good if you could just sort it all out, and I think that was a very attractive proposition which I, managed to paint the picture to the ICBs, which allowed them to, , pass this through. And the savings, in terms of the costings, I was putting it roughly against the cost of staff and administration and rooms and so on and so forth. But throughout the NHS we use HRG codes and I was able to adapt that as a template. and the CCGs were quite happy with the cost I came up to, which I couldn't actually reveal obviously, cause that'd be... but yes, it was quite amenable all round. [00:08:46] Julia: Thank you for that, Mark and I'm sure that our listeners will take lots and lots of really good information and advice away from that because there's many steps to, the answer that you've just talked me through. I'm interested though, how long has the service been going, the audiology led wax service, and you talk about all the steps that you had to go through, when did you start the process with your CCGs? How long did the whole thing take? [00:09:10] Mark: So the whole thing probably took about a year and a half. Maybe a little bit longer. It wasn't easy it was just a huge amount of persistence. There were several points where you felt you were just banging your head against the wall. There were several times where me and my deputy thought, we are really trying this and not getting anywhere. We could just open up a private wax removal business ourself and then retire in our fifties, I think given the amount of people coming through our doors with wax, however, it did take about year and a half really. It has to be signed off by contracts. It has to be signed off by finance, by the senior management here, the senior management over in the CCGs and ICBs. And there was a few other bits and pieces. So our actual wax removal service has been going on for nearly two years now. I think we kicked it off in, January of 2020. We had a few mock test clinics, going back to say, October the year before. We were also quite keen to make sure we gave a quality service and to give assurance to, other audiologists in the department, but also the ENT and our senior management. So as such, we did a few test ears under the, under the care of the ENT. A lot of audiologists had already incidentally been taking wax out for nine or 10 years or longer. But we thought just to go through a kind of a reassurance and kind of a clinical assurance program with ENT we demonstrated before and after pictures talk through any complications on how we'd manage them, and they were quite happy to sign off on that. [00:10:48] Julia: Great success so far with your audiology led wax clinic. You mentioned earlier that there were times where you were banging your head against the wall. Can you share some additional examples too, with our listeners, of the main barriers that you faced during this lengthy process, you mentioned a year and a half, and maybe give them some advice, some practical advice on how to overcome these, because no doubt if somebody's listening to this podcast, episode and they are thinking about following in your footsteps or your example, so to speak, they would want to have some shortcuts because you've already been through the process. [00:11:24] Mark: Oh yeah, sometimes it's a little bit difficult to create any obvious shortcuts, but for certain you need to highlight and illustrate the problem, which is, known, but also you've gotta provide the right solution. So getting that strong voice, both from your patients, from yourselves, from the GPs, all helps. You really have to demonstrate your vision, though. Sell that idea. You need to demonstrate to your management that you've got the capacity. You need to demonstrate how money will be saved. Again, managers listen when you tell them that they're going to save money, if you say, Okay, we do a quick audit of your ENT clinics, how many of these referrals have been just for wax removal? Your ENT consultants could be doing something much more worthwhile with their time. We can take on that work with the caveat of course, but we are doing the more straightforward work and leaving the more complex stuff to the ENT. [00:12:20] Julia: Just out of interest, was there any surprises along the way in terms of barriers, any strange protocols or procedures or questions that you were not expecting? I'll give you an example, of a particular trust that was interested in trialling the Earways Pro tool, which we'll talk about a little bit later, and they, health and safety picked up on the fact that within their booths they have carpet on the floor, and of course we know that audiologically, when we perform a hearing test, we don't want many reflective surfaces. So that was a little bit of a surprise to them. Have you had anything strange, like that pop up in your experience? [00:12:54] Mark: As a, as audiologists, I think we're used to all these like little random things, that do pop up from time to time. Certainly the carpeted rooms would be an issue, thankfully, we've got a mixture of both carpeted rooms with the booths and more kind of straightforward clinic rooms with Lino. We'd already got or procured a kind of a dentist chair type thing. Really, you just have to make sure that your communications are good. You would be surprised that the number of people who come out the woodwork when these things, go into production, as it were, one of the things we had to make sure, for example, but all the data was being collected efficiently from our clinics. That meant talking with the guys who pull the information off the back of Auditbase, for example, and ensuring that they match that against the HRG codes. So you're trying to get finance guys to talk to the data guys and come up with solution, but works for everyone. And then there's always little sort bits and pieces. Make sure you've got your infection control guidelines done and dusted. Make sure you've got your SOPs in place. Make sure you communicate widely with ENT and the team. To ensure that you are getting the right sort of patients. So we spent a lot of time just refining our, referral criteria. [00:14:16] Julia: So Mark, you mentioned earlier about the DMO one. In real life. , how did you manage expectations in terms of delivering , the hearing test within six weeks? [00:14:27] Mark: So this is actually quite a big thing. As we know, we are held to account on both our DMO one, which is our diagnostic pathway. Which means we have to see patients within six weeks and our RTT referral to treat, which is the 18 week pathway. One problem we had with try and obviously deliver the service within six weeks to include the wax removal was that we might see them at week three, which is not too shabby, but by the time we actually got them in, , and spent a week and a half actually doing the oil and the drops or whatever we'd recommend, , we were really pushing the six week margin. As such, I was able to negotiate an exemption from the DMO one for these patients, which meant that in a similar manner to a surgeon having to see, , a patient and saying look, yes, you are very much suitable for, say, knee surgery, for example, I want to get your heart rate sorted out first, or we'd like you to lose two or three stone to make it more beneficial to you in the long run and to save the, any kind of clinical complications  when we're operating, I was able to use a similar mechanism to say, we're gonna we can't pause the DMO 1 , but they're actually exempt from the DMO one now because we have demonstrated that we are unable to complete the hearing test due to the wax being present. This in fact meant that we were able to see them, let's say week three, identified the wax and we're able then to take the wax out and then continue the testing and continue the direct referral appointment, but without having to worry about actually get them getting them in within the six weeks. We did try, for the most part, most of our patients get seen within that six weeks, but obviously with annual leave and sickness and so forth, it was just nice to have that little bit of, head room so that if we did go over the six weeks, we wouldn't actually suffer any consequences for that. This meant that the actual service was actually viable, because obviously if we had to do everything within six weeks, that would make it very challenging to deliver that. So this was actually quite a critical point. Getting those patients exempt meant we was able to deliver the service, without any dire consequences of running over the six weeks. [00:16:35] Julia: So kudos to you for making it all happen, and I am sure that there's many listeners that will take inspiration from your advice. Just out of interest how big is your department and how many audiologists are delivering this audiology led wax service? And did you have a certain selection criterion that you use to select these audiologists? Do they have the, have a certain band or training? [00:16:59] Mark: So we are not the biggest department in the world, but we also would just , have a kind of high volume of patients through. We had about three or four audiologists delivering the service, and obviously people come and go. So we had the plan in place to do a continual training. A lot of audiologists had been taken wax out previously in different trusts. And coincidentally, I had met my deputy Jonathan about a year and a half before I joined the department at a wax removal training session. So we made sure all of our audiologists had some relevant wax removal training. Made sure that was all up to date, made sure they were confident, made sure we had ENT review our work, review our techniques and are happy with that we could provide a safe service and were confident in using the equipment. In terms of banding, we'd be band six or above and it just make sure they had some relevant training. We'd obviously have a little bit of a couple of sessions sitting in with them. We'd do a little portfolio again just to run past me and the deputy and also ENT to ensure that everybody's happy and that the audiologists are comfort and they feel safe doing the doing the clinics. [00:18:11] Julia: And whilst we're on the topic of audiologists, I wonder how they've responded to this audiology led wax removal service. Was there any objections before? Was there anything in particular that they liked or disliked about this new service? Did you have to do lots of convincing for the audiologist within the department in terms of the value to the department all? [00:18:33] Mark: So the audiologists found this an absolutely fantastic idea and they were so happy when it is actually implemented. We all had massive frustrations with trying to see these patients and we really want to help them and sometimes, we'd allowed extra time in our appointments, because we found that a lot of patients had a lot to say. We forget that at the time this was being launched was all coming out of like post covid and all this sort of thing, and our patients have had a horrible time and then a massive wait to see the GP and then to actually look in their ears and see wax it's so frustrating. So it was really nice to be able to provide this service for them. We sat down with the whole department, we went through the criteria we took on board any suggestions or ideas, that they had as a group, which was fabulous. because it just, , posed a few questions maybe we hadn't thought about and that just goes to show the importance of kind of involving the team as a, as a wider decision making process. [00:19:30] Julia: So yeah, it's important to get the buy-in from the team too, and that we can see that because you've had that. They are happy with how the service runs at the moment. I'm just interested also to see or hear whether you've had to create any extra capacity for your wax removal clinic. So I'm thinking did you have to recruit any extra staff? Did you have to think about your, mentioned earlier that you had some rooms that was already suitable for it, but did you have to find some additional clinics in the diary. So how did that all work in terms of capacity? [00:20:03] Mark: Capacity is often an issue across the audiology world as we're often forgotten about until too late and then we are shoved in some basement or random part of the hospital, which is certainly the same for us. However, we are quite lucky in as much as, a lot of the audiologists we had working, myself included, were very keen to do the wax removal clinics. We managed to find a bit of space in a suitable room. Capacity is an issue. We ultimately want to get to a direct access wax removal clinic, so the GPs can refer directly electronically from seeing the patient in front of them straight into our wax removal clinic against a certain criteria. But that is pending. [00:20:47] Julia: And also alongside whilst we are talking about patients, what is the feedback from the patients on this service? [00:20:54] Mark: So the service is available to all of our patients, primarily coming through the GP direct access route. Cause obviously they're the guys who really need the help most urgently, it might be worth picking up on the whole DMO one thing in a minute, but certainly we try and see as many of the patients as we can and also our existing patients who might come in for a retube or say that actually my hearing aid's not working. We check the hearing aid, everything's working with hearing aid. We're look in their ears and obviously it's block full of wax. We get those guys in as well. The criteria is probably quite universal, but it's, we are only gonna do the bread and butter things, so any patients with any complex issues. We'd still go and see ENT. We gotta keep everything safe for the patient and ourselves as Audiologists. So I, we go through a brief history, make sure there's no ear pain, discharge, perforations, any operations, any kind of unilateral losses, history of epilepsy. Just straightforward stuff like making sure they can keep their head still, and if they're able to get in and out of a chair. Because we might need to make the dentist chair, we have just rise up and down to ensure we can get a good view of the ears in terms of the patient feedback. Patients have been genuinely really grateful, but we're able to do it. Unfortunately, we are here too often, but we have some quite bad experiences. Our patients have had from either the nurses or GPs try and take the wax out or unfortunately third party providers as well. They haven't always had the the best experience and they really did seem quite comfortable coming back to see us. Obviously we spent that time with doing all the history in the DR and it's nice to have that sense of continuation and we might not see them for the DR but we do the DAC, but we try and book them back with the same person they initially saw, if at all possible, just for that continuity. So they're finding it really useful and not only the patients, but also the the relatives of the patients the husbands and wives and the, sons and daughters who are finding it very useful as we can start the audiological process of helping them with their hearing problems. [00:23:14] Julia: So all in all, really positive. I think you've got some stats for us about the number of patients that you were able to prevent being discharged back to their GPs because of your audiology led wax clinic. Can you share some of those with our audience? [00:23:28] Mark: Certainly, so we do run this about every two months or so. I haven't quite had the time recently to do the October and November ones and I didn't want to just make it up, but we did actually see 98 patients between August and September of this year in 2022, which was brilliant because it stopped nearly a hundred patients from having to go back to their GP and just all that extra time, if you think a hundred appointments in primary care say half of them going to ENT and all the wait time and you start doing the maths and you'll see it's actually been a really valuable service, which I'm very happy and proud to provide. [00:24:06] Julia: That's a staggering numbers really, if you think about it. Just as a out of interest, which wax removal tools do you and your department have in the toolbox and when would you select a certain tool over another. [00:24:19] Mark: So we use a kind of a range of different tools within our arsenal for wax removal. Most of our audiologists, myself included, grew up I suppose with micro suction which is our first port of call. We also have various pulsing machines. I'm not too sure we can mention brands on here, but several are available and some are a little bit better than others which are handy for certain types of wax. We do obviously say to our patients, do use oil. But sometimes they're either they either forget or occasionally they go, oh yeah, put it in this morning for you and didn't quite get the assignment on doing it for the week or so. So rather depends on the situation that presents in clinic, micro suction is our first port of call. We also use the micro pulsing water, if that's indicated, but we've also started using the Earway Pro, which is a kind of a helical wax removal tool, which we've used with varying degrees of success. It does lend itself to getting us out of a little bit of trouble. I've used it a few times myself for certain patients and yeah, had some good results with it. Last time I used it, I think I managed to get a partial removal, which was gonna be very difficult with micro suction, but that revealed a little bit of softer wax behind it, which I was unable to take out , much, much easier. Yeah, certainly a very good tool in our wax removal arsenal and we're certainly looking at expanding the use of this to our home visit service as which shows potential there. This is pending a little bit of a clinical review. Because obviously the patients we see in their own homes tend to be those with slightly more difficulties or additional clinical issues, which may prevent them from being, having their wax taken out in the first place, but certainly something we're looking to explore. [00:26:11] Julia: Thank you very much. And just for our listeners sake, in our last episode in this series, we will have a little bit more from a guest that has been using the Earways Pro tool for quite some time. So we'll have some more information on that for you too. Mark, and this is my final question for you, you mentioned earlier that when you want to make a big change like this, you need to show that there will be some money savings and that there will also be some capacity improvements. Are you able to share with our listeners some of the cost and time savings that you've had before you've changed over and compare it to how the current service works. [00:26:49] Mark: It's a little bit of a tricky one. So obviously all this went into my kind of initial presentations to the CCG as it was then. I obviously didn't have the figures for how much does a, an appointment cost in a GP surgery because that can vary, although I did give it a bit of a Google of course, and of course we know, that the outpatient appointment for ENTs between about 120 to 180 pounds or something thereabouts, depending on the situation and the scenario. And just the, it was the cost of time really to the primary care and to ENT. And I think it was just a commonly held frustration, but we wasn't doing the right thing for the patient. I think the CCG understood, but since they made those changes, it put massive pressure on primary care and of course massive frustration for the patients. They just want their wax out. They'll go to their GP in good faith thinking they can take it out. And they get told no, and then they get to refer to ENT and ENT say no, and then they just go round and round in circles. So I think presenting a good solid case, good solid idea, backed by actual figures and facts, that you can do this job and do it well. I think, they weren't so worried about me demonstrating the actual costs to them within the primary care service, but certainly I could just say, look, we could do this for a modest modest fee. And they were more than happy to do that with the all the other considerations taken on board. [00:28:18] Julia: Many thanks to you, Mark, for sharing your experiences and expertise. I've thoroughly enjoyed our conversation and I've learned a lot. I conclude that it takes fresh ideas, guts, determination, perseverance, and resilience to get a CCG funded audiology, wax removal clinic, and clearly you have all of those. Well done and long may you, your department and your patients benefit. [00:28:42] Mark: Oh, thank you, Julia. [00:28:43] Julia: If you are interested in any further information from Mark, you can contact him on mark.newman7@NHS.net. In the next episode, I'll be speaking to Nicola Phillips, the Principal Clinical Scientist and Head of Primary Care Audiology at Swansea Bay University Health Board. She'll be talking about a trial that the Health Board have been doing since 2016. [00:29:07] Nicola: All our patients access primary care audiology through their GP surgeries. In some practices, patients get triaged by the receptionist and book directly into audiology slots or the wax removal slots. In other practices, GPs will triage over the phone and then book them directly into clinics using a shared booking system. Julia I'll end by reminding our listeners of the RNID campaign's priorities, and that is firstly for ear wax removal services to be brought back into primary care or community settings. Secondly, for the Department of Health and Social Care, NHS England and local health bodies to explore new models for delivering ear wax removal services to make sure people can access timely and appropriate treatment. And thirdly, for the NHS to publish clear information on how people can manage ear wax build-up themselves at home. If you found any of what you've heard in these episodes helpful, please tell your colleagues so as many people as possible can share the knowledge. And if there's a topic you think we should be covering, drop us an email to the address on the show page and remember to follow wherever you get your podcast so you don't miss an episode. This is a Fresh Air production for Signia UK and Ireland. Until next time, goodbye. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

11. 

    3 Feb 2023

    Is the UK Facing a Wax Management Crisis?

    In episode 1 of this mini-series, Julia is joined by Frankie Oliver, Audiology Advisor at RNID to talk in more detail about their brand-new report from the national RNID charity (Royal National Institute For Deaf People) which outlines that people’s hearing health is at risk due to the axing of wax services in UK primary care provisions. Not only do these changes to primary care provisions potentially put people’s health at risk, but Covid has also had a real knock-on effect for wax management across the board - and the Audiology industry is now desperately trying to play catch up. Please find full episode transcript below. Head to the RNID website to find out more about the report here (https://rnid.org.uk/wp-content/uploads/2022/11/Ear-Wax-Report-FINAL.pdf). Find out about their ear wax removal campaign here (https://rnid.org.uk/get-involved/campaign-with-us/ear-wax-removal-campaign/). Contact the RNID on Twitter (https://twitter.com/RNID) and Facebook (https://en-gb.facebook.com/rnid/) and on Instagram (https://www.instagram.com/rnid_uk/?hl=en) If you haven’t already, don’t forget to follow on your regular podcast app and remember to tell your friends and colleagues so they don’t miss the conversations. Got a topic you think we should be talking about? Get in touch here: marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland, visit: www.signia-pro.com (https://www.signia-pro.com/en-gb/) Sounding it Out by Signia, is produced by Annie Day from Fresh Air Production. See omnystudio.com/listener (omnystudio.com/listener) for privacy information. FULL EPISODE TRANSCRIPT [00:00:00] Julia: Hello and welcome back to Sounding It Out, a podcast dedicated to audiology and hearing health, brought to you by Signa UK and Ireland. I'm Julia van Huyssteen, your host, and I'm delighted to be back with four new episodes. I'm the head of audiology at Signa UK and Ireland and hearing health is something I am passionate about. These podcasts are Signia neutral so that everybody with an interest in hearing health or audiology can benefit. If you're just discovering this series, we've already talked to legendary audiologist, Dr. Gus Mueller about hearing aid fitting standards. You can go back and download those previous episodes for free wherever you get your podcasts from and remember to follow so you don't miss any future episodes. In this mini-series, we are discussing the wax management crisis we are facing here in the UK. It coincides with a brand new report from the RNID or Royal National Institute for Deaf People that was published in December 2022 and this report warns that people's hearing health is at risk due to the axing of wax services. For background, the situation started to deteriorate in 2019 when the British Medical Association decided it would no longer be considered part of the core services GPs were obliged to provide. Data from 2020 shows that as many as 60% of patients that started direct audiology treatment did not complete their pathways. And of course, Covid had a real knock on effect for wax management and as an industry we are desperately trying to play catch up. Accessing ear wax management through the NHS is also a postcode lottery and many individuals are accessing private wax removal at a cost. Some people told RNID they were quoted up to £400 for private removal. Many people shared their experiences with RNID including Paul Clark. He lost his hearing through meningitis when he was a child. He used to get ear wax professionally removed but the service was stopped during the pandemic. These are his words voiced by someone else. [00:02:24] Paul Clark:  I lost my balance and fell. I hit the ground really hard and thought I'd broken my arm. My balance issues were due to the build-up of earwax. So I contacted the GP who checked my ears. He gave me two options to either go private or go on a waiting list with the health trust. I thought about going privately, but it was too costly. I experienced a lot of discomfort and it had a severe effect on my communication with others. Eventually, I got an appointment, but it took over a year [00:02:58] Julia: Later in the series, I'm going to be joined by three inspirational guests who have found new and inventive ways of tackling the problem in their trusts, and we will draw on that expertise. But first I'm joined by Frankie Oliver, Audiology Advisor at RNID to talk in more detail about their freshly published study. Frankie a warm welcome and thank you for joining us. [00:03:22] Franki: Hi, Julia. Thanks for having me. [00:03:24] Julia: Firstly, would you mind telling us who the RNID is for those listeners who may not have heard about the RNID before? [00:03:31] Franki: RNID is the national charity, supporting people who are deaf have hearing loss or Tinnitus. There are 12 million people in the UK who are deaf or have hearing loss and RNID is here to make society more inclusive for everyone, provide support and information and to fund world class research [00:03:49] Julia: A well worthy course, thank you, Frankie. And I know that RNID's campaign regarding wax management in the UK has been ongoing for some time. Maybe even since the BMA's decision. Could you ever have imagined the impact this decision would have, and therefore, why is this campaign so important? [00:04:06] Franki: Yeah, we were receiving inquiries about earwax removal for some time prior to the Covid Pandemic, but this has really become a major issue. After the first lockdown in 2020, the number of inquiries we received just increased significantly with more and more people telling us they were unable to get ear wax removed on the NHS and were concerned about what to do, and then our concerns were then confirmed in an answer to a written parliamentary question in September, 2020, which stated that wax removal was no longer a core service. And then this sort of kickstarted our work into this properly. I think as an audiologist, the potential impact that this decision could have, having been in clinic and had somebody with earwax and been unable help them or take an impression, for example, doesn't necessarily surprise me, but the scale of it is something that really does still surprise me at the moment. I think the fact that it's such a national issue is really concerning and it just also highlights with what we hear every day from people why this campaign is so important. The impact that this decision is having on people's day-to-day life is something that is probably something I couldn't have imagined. [00:05:17] Julia: I completely agree with you. We hear the conversations all around us. We hear it in audiology departments, we hear it in GP surgeries, we hear it even amongst private dispensers, so it is a very loud conversation and I think you're right, the numbers that this study shows really truly shows us the impact. So for me then talking about numbers it really makes sense to use data, to highlight the issue because we can talk about it amongst ourselves, but numbers is so powerful because we know that research gets taken a lot more seriously when you have good and representative numbers and good methodology. So on that note then, can you talk us through the survey a little bit more? Maybe how long it took, how many people participated, how you went about conducting. [00:06:01] Franki: You're right. The data to highlight the issue is so important, because we can talk about it among ourselves, and I think anybody in the audiology space in the UK knows it's an issue, but in order to make change and to get it taken seriously at a higher level, you need the data to back it up. So we surveyed over 1400 adults between May and July of 2022, and all of them had reported having an issue in getting wax removed. We asked what advice they were given, what symptoms they experienced, whether they tried to remove wax themselves, and then what happened as a result, and then just the overall impact this was having on them to build a really strong picture of why this issue is so important. [00:06:40] Julia: Wow, that really is a very large sample size, and as we've both just said, really important and a very good representative of these individuals with earwax. Now your campaign has a very strong message, namely that people are risking their hearing. Very important due to the axing of earwax services. Now, that's a really strong wording, and I know why you've chosen it, but can you explain to our listeners why you felt to to use this strong wording? [00:07:09] Franki: Yes, it is strong wording, but I don't think, and we had some time to think about how we wanted to stress this and I don't think we can really overstate the risks that people can pose when they are forced to try and remove wax themselves. We know that people do put things in their ears that they're not supposed to, and there's not much we can really do about that other than providing very good advice and public health messaging. But the problem is when people are being forced to insert objects into their ears that they shouldn't when they're faced with no other option. People are being forced to do this because private removal is either inaccessible or too expensive or they're just not able to access any care on the NHS. So people are using dangerous methods to try and remove wax. And then this is posing a risk to the really delicate anatomy of the middle ear and therefore posing a risk to someone's hearing. So that's why we went with this quite strong message. I think there's also the concern that in the context of getting people to look at health issues on a whole, wax is often something that's, if you're not in the audiology space and you don't how important it is, it's often something that is regarded as a bit of a joke or something that's just a bit, it's just not very nice. Not something that many people would consider as quite a serious issue unless it's happened to them or, it's happened to somebody they know and so they don't understand why it's so important. So I think that's why we went with that quite strong message. We want it to be taken seriously and we also want people to be aware that there is a risk if people are being forced to remove wax themselves by often quite dangerous methods. [00:08:48] Julia: No completely agree with you. Think in order for people to take notice, we have to take these strong messages and to make people listen up. Because ultimately that is what we are trying to achieve with this campaign, and with this report is we want people, we almost want to shake people awake and say, listen, this is how big the problem is. You are risking your hearing, by not providing wax renewal services through the NHS. You've got some interesting numbers as well in terms of the people who answered your survey, I think you mentioned that 73% of the people actually had earwax buildup. 73% of people or respondents with earwax buildup experienced hearing loss and 37% experienced tinnitus. So this just drives that message home about the risk to your hearing by, not being able to access wax service. One of the questions in the survey was around private wax removal, and you've already mentioned it and referenced it. I mentioned in my introduction that some people were quoted 400 pounds for private wax removal. From your research can you share with our listeners how much on average private wax removal costs? And actually, alongside with that, how many survey respondents said they, that they couldn't afford private wax removal? [00:10:03] Franki: So yes, private removal is often for many people the only thing that's suggested to them and cost for this can range from 50 to a hundred pounds. And that's either for one ear or for both ears. It's likely that we could see this cost increase as costs are generally increasing in the UK and around 26% of our survey respondents said that this was unaffordable and then they could not afford to get wax removed privately and this was especially a problem for people who have recurrent ear wax buildup, especially hearing aid wearers because they are more at risk and then they need ear wax removed regularly. So I think it's also important to state that it's not necessarily a one-off cost of 50 to a hundred pounds, sometimes people can need wax of around three to four times a year. It's much higher than that one-off cost if they have to have it removed regularly as well, which makes it even more unaffordable for some people. [00:10:58] Julia: Understandably so that's high numbers of people that almost have no way of getting the ear wax out of their ears. So considering that, then, considering the cost of private wax removal and the long waiting list, if you can access it through the NHS, you already said people resorted doing dangerous things. Have you got some examples of what people reported in the survey, things that they've tried or whether they've tried and what they thought about the results? [00:11:23] Franki: Yes, many respondents attempted to remove earwax themselves. But around two thirds of them said that they didn't actually feel confident removing wax themselves, which I think is quite worrying. And then the methods that people described, fortunately lots of people used eardrops, which is what's recommended, but we had a lot of dangerous methods reported to us. People described using hair clips, paperclips, toothpicks, cotton buds, and in some cases Hopi ear candles, which we know are very dangerous. And the advice to not put anything in your ear that's smaller than your elbow is so true here. And it was as an audiologist, reading through all of these different responses. It was really worrying to, basically see what people were being forced to do. [00:12:10] Julia: I hear you. And as you were going through those examples, hair clips, paperclips, toothpicks, these are, very dangerous for somebody that doesn't understand the anatomy of the ear like you and I do as audiologists so you can understand why it's so dangerous. Can you also then share some of the answers that you obtained on what people thought about it? Let's say they did try a hair clip, or let's say they did try a tooth thicker, a cotton bud. I wouldn't even talk about Hopi candles. What they thought about the results when they did try it? [00:12:40] Franki: So yeah, when you look at that list of methods, it does make you shudder a little bit. And when we look at what actually happens after people try to remove wax themselves, and a lot of the time people are being advised to do this. It's the kind of the first line of treatment. Now one in 10 of people who said they tried to remove wax themselves said that they caused themselves injury or that their symptoms got worse. So sometimes it's even required medical attention. So things like perforated eardrum, bleeding, ear infections and even foreign bodies were reported to us. And then while obviously that's really concerning, it's also important to look at whether this is something that's effective and only 20% of respondents said that their symptoms went away. And then 55% noticed no change at all. So I think this is important to consider when this is the kind of the first line of treatment and pre-treatment, ear wax softeners, like eardrops can be really helpful in removal. But I don't think they can be considered something that's going to completely solve the problem for everyone and this data kind of serves to highlight that. [00:13:43] Julia: And the reality is the 20% of responders that said their symptoms actually went away, would've actually used the safer methods. And you already mentioned the eardrops for that. But we both know that's a very long-term treatment often, and it's something that has to be administered on a daily basis. You've got to remember to do it, you've got to remember to keep it up. So actually, although it might be a solution for only 20% of the respondents, it actually meant the symptoms went away. So that brings me back to our message or your message of the RNID saying people are risking their hearing. It brings them back to the point. Now in terms of why people or what people told you about their experiences, I know you have a couple of people that you might be able to tell us or share their stories with us. Is that okay? Can you share some stories with our audience? [00:14:31] Franki: Yeah we have got a few stories and lots of people were, very open in telling us about their experiences. One that sort of stuck out to me in that it's not as, shocking in the sense that fortunately there was no injury or anything. But I think it just, it highlights that what was once quite a simple process has now become much more drawn out. So one person told us that they were previously able to just call the GP practice say that they had wax, were advised to use eardrops, and then was able to book an appointment with the nurse within two weeks, say. Their experience now has taken them a significantly longer length of time, and it's partly because there's additional and probably unnecessary barriers in getting to that removal appointment. So they mentioned having to see a GP twice before being able to see a nurse. And this just seems like a huge waste of not only the patient's time, but also GP time when we know that services are stretched at the moment, I think they said that the experience now took them maybe 10 or more weeks, and this was over the period of Christmas time, which meant that they had those 10 weeks of potentially having symptoms, meaning that they were unable to communicate with family and friends. And I think that's quite...while it's not a story that talked about damage to the ear, and obviously we want to highlight those stories of unsafe practice, but also just the fact that, what was once quite a simple and straightforward thing to deal with is now much harder. And that was a running theme throughout the results that we received. I think other important impacts to highlight were on people's mental health as well. So we had someone saying that actually made them feel scared to leave the house. Because of a loss of independence, because they were unable to hear people, which I think is just, it's just awful that someone's being forced to experience that. And I think we also had somebody say that because they were unable to hear because of wax and they were unable to get an appointment, they actually had to take time off work, which again, is another, a huge impact on somebody's kind of day-to-day life. So yeah, those are some of the stories that we experienced and all were very kind of big themes of impacts on just being able live day to day. [00:16:44] Julia: So yes, understandably if you have got a hearing loss, for example, because of ear wax or if you're experiencing tinnitus because of ear wax, we're not just talking about the hearing symptoms here, we are talking about the wider impact on somebody's mental health, and as you mentioned, the example of somebody that wasn't able to work. So we are really talking about very profound impacts here. And therefore, going back to our message risking your hearing health, but taking that even further into your mental health and your general wellbeing too. So on that note then, my last question for you now is really a result of the interview that we have or the conversation actually that we've had up until this point, and that is, what is the RNID hoping to achieve in a nutshell, just summarize for us, what is the RNID hoping to achieve from this campaign? What are the main things that you are calling for? [00:17:33] Franki: Most importantly, we want earwax removal, to be fully funded on the NHS and in line with NICE guidelines, which calls for earwax removal to be provided in primary and community settings for people who have a clinical need. Another theme that we found through our research was that advice people are being given. It's not totally clear or consistent, so we'd like the NHS to publish this advice and make it available not only to patients, but also professionals and healthcare staff as well. And then finally, we completely understand that the system is very stretched at the moment. And then asking a GP practice to provide something that they're currently not getting funding for it's not necessarily the only option and I think there's lots of options to explore and I know that there's pilots going on at the moment of various different ways that this can be delivered. So is going back to primary care, the only answer, probably not. So we want the Department of Health and Social Care, NHS England, local health authorities, to look at different ways that this could be delivered and different models of delivery. Something that could be delivered in pharmacy settings. Is it something that could be delivered in audiology settings? And then once we get the information from these pilots to then share this with other health authorities, really explore different and innovative ways that we can offer this service. Because the most important thing is that people have access to timely, safe, and appropriate services on the NHS. [00:18:58] Julia: Brilliant answer. Thank you so much for that, Frankie, and thank you for sharing the details of the report. I was aware of the wax management crisis, but this piece of work really drives the wider impact home. The RNID is a well-respected voice in our industry, and now we need to ask ourselves, what do we do with this data? The three priorities that the RNID are calling for and highlights the problem and makes it a pressing and urgent conversation for primary care, the Department of Health and Social Care and NHS England. So let's have that conversation. You can find out more about the research and indeed the invaluable work from the RNID by looking at their website and social feeds. All details are on the episode page. In the next episode, I'll be speaking to Mark Newman, who is the Head of Audiology at the Barking, Havering and Redbridge University Trust, who has come up with a really fresh approach to ear wax removal. [00:20:01] Mark: So what I managed to do was actually negotiate a audiology lead wax removal clinic with a full blessing of the ICBs as they are now, or the CCGs as they were then, which was meant we had a fully funded, audiology led wax removal clinic. So sometimes you need to do a little bit of manoeuvring and ensure you're in the right meetings with the right people in order to make effective change. [00:20:23] Julia: If you found any of what you've heard today helpful, please tell your colleagues so as many people as possible can share the knowledge. And if there is a topic you think we should be covering, drop us an email to the address on the show page. Remember to follow wherever you get your podcasts so you don't miss an episode. This is a Fresh Air Production for Signia UK and Ireland. Until next time. Goodbye and goodbye, Frankie. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

12. 

    24 Jan 2023

    Coming Up On Season Two...

    Coming soon - Sounding it Out is back for a second series and this time we’re discussing the wax management crisis here the UK. The Royal National Institute for the Deaf is so concerned they’ve issued a report warning that people’s hearing health is at risk due to the axing of wax services. Over the next 4 episodes, join Julia van Huyssteen as she hears not only what the main issues are but also get some amazing tried and tested ideas of how to tackle the challenge. Hear from inspirational guests who share Julia’s passion for audiology who have come up with really creative ways of helping patients in their health trusts. We hear about some amazing new tools, some advice on overcoming the inevitable obstacles as well as how patients have responded to their changes. If you haven’t already, don’t forget to follow on your regular podcast app and remember to tell your friends and colleagues so they don’t miss the conversations. Got a topic you think we should be talking about? Get in touch here: marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland, visit: https://www.signia-pro.com/en-gb/ (https://www.signia-pro.com/en-gb/) Sounding it Out by Signia, is produced by Annie Day from Fresh Air Production. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

13. 

    12 Oct 2022

    Hearing Fitting Standards: Verification

    This is the 3rd and final episode of the mini series dedicated to hearing aid fitting standards. In these podcasts we’ve been reflecting on the Audiology profession’s commitment to providing evidence-based clinical practises that lead to optimal patient outcomes. Julia van Huyssteen is joined once again by Dr Gus Mueller, a US based consultant for WSAudiology and Founder of the American Academy of Audiology. In this episode, we mostly talk about hearing aid verification including using a validated fitting formula, the application of AutoREMS and In-Situ Audiometry and we also discuss how much fine tuning is allowed after performing verification. Read more about Gus: www.gusmueller.net (http://www.gusmueller.net) Sounding It Out has been produced by Annie Day. A Fresh Air Production for Signia. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

14. 

    12 Oct 2022

    Hearing Fitting Standards: Pre-fitting and Assessment Considerations

    This is the 2nd episode of the miniseries dedicated to hearing aid fitting standards. In these podcasts we’re reflecting on the Audiology profession’s commitment to providing evidence-based clinical practises that lead to optimal patient outcomes. Julia van Huyssteen is joined once again by Dr Gus Mueller, a US based consultant for WSAudiology and Founder of the American Academy of Audiology. In this episode we talk about pre-fitting considerations including ‘self assessment pre-fitting questionnaires’, ‘uncomfortable loudness levels’, speech recognition tests and ‘speech in noise’ tests.  We discuss why they are important, what factors to consider when choosing the test for the patient in front of you and how to incorporate the results into your hearing aid fitting. Read more about Gus: www.gusmueller.net (http://www.gusmueller.net) Sounding It Out has been produced by Annie Day. A Fresh Air Production for Signia. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

15. 

    12 Oct 2022

    Hearing Fitting Standards: Why are they important?

    We believe that fitting a hearing aid/s correctly is so important that we’re dedicating the first podcast series to it. We’ll ask why we are still having the conversation about Hearing Aid fitting standards in 2022? We will reflect on the Audiology profession’s commitment to providing evidence-based clinical practises that lead to optimal patient outcomes. Standard of practice documents outline basic services that audiologists are expected to include in the provision of quality healthcare. They reflect the values and priorities of the profession, providing direction for professional practice and a framework for the evaluation of practice. Standards of practice are prepared by subject matter experts, based on available evidence, peer-reviewed and subject to periodic updating.  The UK currently has Audiology protocols in place, which has recommendations, leaving room for interpretation from time to time. To discuss Audiology Hearing Aid fitting standards, Julia van Huyssteen is joined by Dr. Gus Mueller who has extensive expertise in the sector: He is a consultant for WSAudiology and Contributing Editor for AudiologyOnline. He is also a Founder of the American Academy of Audiology and co-author of 12 books on hearing aids and hearing aid fitting, including the recent three-volume Modern Hearing Aids series, and the clinical text on Speech Mapping and Probe Microphone Measures. Gus is the co-founder of the popular website www.earTunes.com (https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.eartunes.com%2F&data=05%7C01%7Cjulia.vanhuyssteen%40signia-hearing.com%7Cc74833d472a94e4de71608da4fbc7496%7C1a41b96d457d41ac94ef22d1901a7556%7C0%7C0%7C637909968351515380%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=wOCRUeHLs70iqjIGLMjoFz853TcBTyN52dnqZmkvIUE%3D&reserved=0) www.gusmueller.net (https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.gusmueller.net%2F&data=05%7C01%7Cjulia.vanhuyssteen%40signia-hearing.com%7Cc74833d472a94e4de71608da4fbc7496%7C1a41b96d457d41ac94ef22d1901a7556%7C0%7C0%7C637909968351515380%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=dsNy%2BP00BeHDjK9U4BAaIcdYe2QTVseYmLhFyw3f8YI%3D&reserved=0) In this first episode Julia and Gus talk about the relevance of hearing fitting standards and how it differs from recommendations. Sounding It Out has been produced by Annie Day. A Fresh Air Production for Signia. See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

16. 

    9 Sept 2022

    Sounding It Out Trailer

    As a leading manufacturer in the Audiology industry Signia are passionate about hearing and hearing health. We want to share this passion with you, whatever your level of expertise. In this series Julia van Huyssteen (Signia’s Head of Audiology, UK & Ireland) will speak with leading figures in the sector about a range of topics including clinical standards, new research, industry developments and also general education around hearing and the link to well-being. Enjoy! We’d love to hear from you about future topics – email us marketing.uk@signia-hearing.com (mailto:marketing.uk@signia-hearing.com) For more information about Signia UK and Ireland: visit: https://www.signia-pro.com/en-gb/ See omnystudio.com/listener (https://omnystudio.com/listener) for privacy information.

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