Audiology (adult)

Overview

There are several options for audiology referrals across BNSSG that are summarised on this page.

AQP (Any Qualified Provider) Services 

These services are for patients with non-complex hearing loss aged 18 years and over. Please note exclusions apply.

Patients can either self-refer or be referred by their GP practice via eRS.

Self-referral for audiology is only in place with the community providers, it doesn’t include UHBW.

Non- AQP (secondary care) Services

These services are based in secondary care (St Michaels and Southmead Hospital - although both are run by UHBW) and are a stand alone service in eRS. They will accept referrals that are excluded from AQP providers such as:

• patients aged 16 and 17 years old
• patients with unilateral hearing loss (if no red flags)
• patients with tinnitus - bilateral or unilateral (if no red flags) - see the Tinnitus page for details.

Exclusions:  active discharging ears, pulsatile tinnitus, otalgia. 

Childrens Audiology (aged under 16)

Please see the Audiology (paediatric) page.

Hearing problems

Please see the Hearing problems page for advice on Rinne and Webber tests and further information on chronic tympanic membrane perforation, eustachian tube dysfunction and otitis media with effusion.

Red Flags

Acute sensorineural hearing loss requires urgent assessment. If this is suspected then refer to the ENT HOT clinic. Sometimes high dose steroids are also advised in these cases.

Indications for 2WW referral include:

• Unexplained unilateral serous otitis media/ effusion in a patient aged over 18.

• Referred otalgia as a symptom of laryngeal or pharyngeal malignancy.

AQP Services

AQP services are available for all adults (18 years and over) with non-complex hearing loss. The 4 local providers across BNSSG are (please note that NOT all locations offer NHS funded audiology - this list details the locations included) : 

• Outside Clinic (Only see housebound patients in their own homes or a care home. They don't have public access premises)
• Scrivens
• Specsavers
• UHBW - St Michaels. Services are available at the following locations - Clevedon, Cossham, Nailsea, Portishead, St Michael's Hospital, SBCH, Southmead Hospital, Stockwood, Thornbury, Weston General Hospital, Yate.
• Hidden Hearing (29/03/2022 - No Longer providing any NHS care. Patients previously seen by Hidden Hearing should be directed to Scrivens for aftercare)

Exclusions to Referral to AQP Audiology

History:

• Persistent pain affecting either ear (defined as earache lasting more than 7 days in the past 90 days before appointment)

• History of discharge other than wax from either ear within the last 90 days

• Sudden loss or sudden deterioration of hearing (sudden = within 7 days, in which case send to A&E or Urgent Care ENT clinic)

• Unilateral hearing loss

• Rapid loss or rapid deterioration of hearing (rapid = 90 days or less)

• Fluctuating hearing loss, other than associated with colds

• Unilateral or asymmetrical, or pulsatile or distressing tinnitus lasting more than 5 minutes at a time

• Troublesome tinnitus which may lead to sleep disturbance or be associated with symptoms of anxiety or depression

• Abnormal auditory perceptions (dysacuses)

• Vertigo (Vertigo is classically described hallucination of movement, but here includes dizziness, swaying or floating sensations that may indication otological, neurological or medical conditions).

• Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds; possible having problems with sound localisation, or difficulty following complex auditory directions.

• Altered sensation or numbness in the face or observed facial droop.

• Most patients with bilateral tinnitus do not need a referral and can be managed in primary care (please see Tinnitus page on Remedy).  If a referral is required, please note that it would need to be to non-AQP Audiology and will not be accepted unless the patient has had an initial ENT review first.  

Ear examination:

• Complete or partial obstruction of the external auditory canal preventing proper examination of the eardrum and/or proper taking of an aural impression

• Abnormal appearance of the outer ear and/or the eardrum (e.g. inflammation of the external auditory canal, perforated eardrum, active discharge)

 Age:

• Patients aged 16 - 18 can only be referred to secondary care services

Self - referral

In August 2022 BNSSG ICB decided that patients would be able to self-refer to any of the community audiology providers (not UHBW) listed in the above section, without the need for a referral from their GP. This was due to a fall in referrals during the earlier years of the COVID-19 pandemic and is designed to makes things easier for providers, patients and for primary care.

This is in keeping with current arrangements in the vast majority of ICBs in the South West of England. This arrangement will continue until the start of 2023/24 and will then be reviewed., 

Patients who self-refer but have exclusions will be directed back to their GP practice.

Referral via eRS

Referral to audiology for adults aged 16 and over is available via eRS. Please use the generic referral form. (available in EMIS - referrals should not specify a provider so that patients can be offered choice).

Referrals should state that ears have been checked and wax occlusion excluded. If a patient attends a provider with complete or partial wax occlusion preventing assessment, the provider is not required to offer wax care and may discharge the patient back to primary care. 

See Ear wax and microsuction page.

There is also a BNSSG ICB self care leaflet for patients with ear wax. 

Domiciliary Audiology

All providers are required to offer domiciliary care, although the preference should be for patients to be referred to The Outside Clinic, who specialise in this service at home. This will be provided only if the referral specifies the patient is housebound, and patients who are not housebound should be directed to use one of the alternative providers.

Non- AQP (secondary care) Service

Secondary care (non- AQP) audiology services can be used both for patients with non-complex hearing problems as well as for some patients who do not meet criteria for AQP services. i.e. Bilateral tinnitus, 16/17 years olds, unilateral hearing loss.

Secondary care services are available at locations across BNSSG:

• St Michaels Hospital
• Southmead Hospital
• Weston General Hospital
• Clevedon, Cossham, Nailsea, Portishead, SBCH, Stockwood, Thornbury, Yate.

Referral is available via eRS. Please use the generic referral form. (available in EMIS) or submit a referral letter requesting non-AQP audiology.

Referrals should state that ears have been checked and wax occlusion excluded

These referrals will be checked by the BNSSG Referral Service and may be returned or directed to ENT services if not appropriate for audiology.

Broken/ lost hearing aids/ batteries

For any maintenance problems with hearing aids patients should be advised to contact the original provider if this is within 3 years of fitting. This includes lost hearing aids and replacement batteries. There should be no need for a GP referral.

Patients who have moved from out of area will need a new referral for maintenance / replacement. As will any maintenance for hearing aids supplied more than 3 years ago.

Resources

Blocked ears leaflet - NHS BNSSG ICB

The Outside Clinic provide audiology assessments for home-bound patients (as do all other providers). Please see the attached guides to the service and how to refer on e-RS:

Choosing Outside Clinic on eRS

Outside Clinic Home Visiting Hearing Care

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.