AQP audiology providers 2018-2019
50 and under - > ENT OPD Referral
51 - 54 -> RCHT Direct Audiology
55 and over -> AQP Audiology if fit criteria
Specsavers Hearcare, Scrivens Ltd, Alistair Kinsey, Royal Cornwall Hospital, University Hospital Plymouth and Northern Devon Healthcare Trust all offer AQP audiology services both from fixed locations and at home.
The Outside Clinic solely provides AQP audiology services on a domiciliary basis.
Domiciliary provision is only available if deemed necessary by the GP practice on referral
AQP audiology referral criteria:
- Over 55s with routine age-related hearing loss
- Referral should only be made following examination of the ears and evidenced in the referral that they are clear from wax and the appearance of the ear drum is normal. The patient will be sent away without a hearing assessment if this criteria is not met.
- Referrals must be made via the electronic referral service. Any referrals made direct to the providers will be rejected
- Please comment if the patient has moderate or severe learning disabilities as non-standard equipment may be needed
- Please state if the person requires a domiciliary visit
Exclusions for AQP (routine) audiology service
If any of the following criteria are evident at the time of referral, the patient should be referred to the Ear, Nose and Throat (ENT) department and not to the routine adult (AQP) hearing service.
- Sudden loss or sudden deterioration of hearing (sudden = within 72 hours), unilateral or bilateral, should be sent to A&E or Urgent Care ENT clinic within 24 hours. Due to the variety of causes of sudden hearing loss, the treatment timescale should be decided locally by the medical team. Prompt treatment may increase the likelihood of recovery.
- Altered sensation or numbness in the face or observed facial droop.
- Persistent pain affecting either ear, which is intrusive and which has not resolved as a result of prescribed treatment. (As a general guideline, this includes pain in or around the ear, lasting a week or more in recent months).
- History of discharge (other than wax) from either ear within the last 90 days, which has not resolved or responded to prescribed treatment, or which is recurrent.
- Rapid loss or rapid deterioration of hearing (rapid = 90 days or less).
- Fluctuating hearing loss, other than associated with colds.
- Hyperacusis(An intolerance to everyday sounds that causes significant distress and impairment in social, occupational recreational and other day to day activities).
Tinnitus, which is persistent and which:
- is unilateral or asymmetrical
- is pulsatile
- distressing lasting more than 5 minutes at a time
- has significantly changed in nature, may be leading to sleep disturbance or be associated with symptoms of depression or anxiety
Adults with other types of tinnitus or known documented tinnitus, which have had an ENT review in past, may be directly referred to Audiology where they can be assessed and referred on if appropriate.
- Abnormal auditory perceptions (dysacuses)
- Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds; possibly having problems with sound localization, or difficulty following complex auditory directions
- Vertigo which has not fully resolved or which is recurrent. (Vertigo is classically described as a hallucination of movement, but here includes any dizziness or imbalance that may indicate otological, neurological or medical conditions17). BAA – Service Quality Committee
- Complete or partial obstruction of the external auditory canal preventing full examination of the eardrum. If any wax is obscuring the view of the eardrum, the GP surgery should either arrange wax removal before making a referral to Audiology, or refer to an Audiology service which offers wax removal.
- Abnormal appearance of the outer ear and/or the eardrum (Examples include: inflammation of the external auditory canal, perforated eardrum, active discharge, eardrum retraction, abnormal bony or skin growths, swelling of the outer ear or blood in the ear canal).
If the following information is available at the time of the referral, then it constitutes an exclusion to the AQP audiology service and referral to ENT should be considered: You do not need to conduct these tests in order to refer.
- Unilateral flat tympanogram, regardless of the associated level of hearing loss
- Conductive hearing loss,defined as 20 dB or greater average air-bone gap over three of the following frequencies: 500, 1000, 2000, 3000 or 4000 Hz. A lesser conductive hearing loss in the presence of bilateral middle ear effusion may be referred at the discretion of the Audiologist.
- Unilateral or asymmetrical sensorineural hearing loss, defined as a difference between the left and right bone conduction thresholds (masked as appropriate) of 20 dB or greater at two or more adjacent frequencies: 500, 1000, 2000, 4000 or 8000Hz. (Other frequencies may be included at the discretion of the Audiologist) . In the absence of recordable bone conduction thresholds, air conduction thresholds should be considered instead.
- Evidence of deterioration of hearing by comparison with an audiogram taken in the last 24 months, defined as a deterioration of 15 dB or more in bone conduction threshold readings at two or more of the following frequencies: 500, 1000, 2000, 3000 or 4000 Hz. In the absence of recordable bone conduction thresholds, air conduction thresholds should be considered instead.
- Any other unusual presenting features at the discretion of the referrer, or according to the requirements of the service to which the adult is being referred.
Red flag – refer to on-call ENT Senior House Officer the same day
Sudden onset sensorineural hearing loss (defined as within 1 week)If sudden onset sensorineural hearing loss is suspected, the on call ENT SHO will arrange an urgent audiogram and ENT follow up. It is recommended that the referrer prescribes a 7-day course of Prednisolone 40mg OD, to start as soon as possible.
Sudden onset conductive hearing loss is often due to middle ear effusion and does not require referral to ENT. If the conductive hearing loss persists >6weeks then refer according to the guidance above
- In order to define sensorineural hearing loss please carry out Webers & Rinne’s tests using a 512Hz tuning fork
- A video on how to perform these tests can be found at: https://www.youtube.com/watch?v=RVH4K4EcsiA
- Information on interpreting the findings can be found at:http://www.gpnotebook.co.uk/simplepage.cfm?ID=355794960&linkID=35956&cook=yes
Next Review 5/6/20
GP Sifter Janine Glazier
Contributors Dr Shipra Rao
Version No. 1.1