Many children in Ireland with hearing problems are diagnosed late and can be left waiting up to five years for adequate intervention, a new report has shown.
According to the HSE National Audiology Review, which has just been published, there are ‘serious shortcomings in many audiology services in Ireland'.
"At its most bleak, the perception is that audiology services are not to the required standard, with access issues, poor information, inadequate staffing levels, poor infrastructure and waiting times that have reached unacceptable levels...Many audiology services in Ireland are substandard," the review found.
It was carried out by the National Audiology Review Group, which was headed by UK audiology expert, Prof John Bamford. It began its work in September 2009 and met on 12 occasions, through to October 2010. Its task was to examine the services currently provided to children and adults nationwide and make recommendations for a national plan for these services, which would address any current inadequacies and inconsistencies.
The group emphasised that hearing problems that are not identified or are not addressed in a timely manner ‘impact directly on communication ability, constrain development in children, lead to limitations in everyday activities and restrict personal and social participation'.
Between 3,000 and 4,500 pre-school and school age children at any one time will have a permanent hearing impairment. Meanwhile, temporary childhood hearing impairment due to ‘glue ear' is widespread, with an 80% prevalence rate between birth and seven years.
Around 3% of children aged two to four have a hearing loss due to glue ear more than 50% of the time. The surgical insertion of grommets usually benefits such children.
The review noted that this condition is the most common reason for GP visits in childhood ‘and sorting out those for whom surgical intervention is warranted from those for whom it is not represents a major burden on audiology and ENT (ear nose throat) services'.
The group acknowledged that it was impressed by the dedication of many existing staff, who must often work under difficult conditions.
"In some areas, there are good examples of multidisciplinary teams working together for the benefit of patients."
However, despite an average annual investment by the HSE of €11.3 million, audiology services ‘represent poor value for taxpayer's money'. For example:
-The average age of intervention for permanent congenital hearing loss is two years for children with severe and profound hearing loss and five years for children with moderate hearing loss
-Access to good, authoritative audiological assessment and intervention is patchy at best and non-existent in some areas
-Children requiring cochlear implants have to wait longer than is optimal for surgery
-Children's earmould services are often slow, inadequate or even non-existent in some areas
-Modern digital signal processing hearing aids are not yet universal for HSE clients.
Meanwhile, the review also found that waiting times for adults requiring audiological assessment or hearing aids are also ‘unacceptably long'.
The review makes a number of recommendations to improve audiology services, including reorganising services in each of the four HSE regions and a ‘root and branch restructuring of audiology careers in Ireland'. Currently, audiologists cannot be trained in Ireland.
It also calls for an urgent ‘workforce planning exercise' of audiology staff. It has estimated that current staff members ‘should be more than doubled to meet need, but with a different, more effective skills mix than is found at present'.
Estimated staffing requirements include the introduction of an additional 23.5 assistant audiologists and an extra 38.9 postgraduate level audiology staff.
Meanwhile, all hearing aids issued by the HSE should be modern, good quality digital signal processing aids. The use of ‘in-the-ear' hearing aids should be phased out.
The group also recommended the introduction of a universal national programme of newborn hearing screening. This would ensure all newborns had their hearing screened shortly after birth. Once implemented, the hearing test currently carried out at eight months - known as the infant distraction test - should be discontinued.
Prof Bamford acknowledged that in mid-2010, the HSE agreed to fund the first phase of a newborn hearing screening programme and this is due to start this month in some maternity hospital in the south.
"This is an encouraging start, but we can only be satisfied when all births are covered," he commented.