Hearing aid services in Ireland

[incus]

I would be very interested to know what is happening with hearing aid services in Ireland. Obviously there has been MHAS in England and the equivalents in Scotland Wales (and I guess Northern Ireland though I am a bit vague about that) but havent heard any news from the South.

Is there access to DSP aids in the public sector? Are they available at the same prices as in the UK? Has there been a move to modernise protocols and patient journeys either from the centre, or by staff on the ground?

[Dayalan]

Hi All,
I would post my reply next Monday 7th March 2005.
Dayalan

Originally Posted by incus

I would be very interested to know what is happening with hearing aid services in Ireland. Obviously there has been MHAS in England and the equivalents in Scotland Wales (and I guess Northern Ireland though I am a bit vague about that) but havent heard any news from the South.

Is there access to DSP aids in the public sector? Are they available at the same prices as in the UK? Has there been a move to modernise protocols and patient journeys either from the centre, or by staff on the ground?

[Ali]

Originally Posted by Dayalan

Hi All,
I would post my reply next Monday 7th March 2005.
Dayalan

I look forward to it with great anticipation. It will be interesting to hear what is occurring in Ireland.

[Dayalan]

Two years ago, we did a pilot project with three Widex digital hearing instruments and three Oticon Hearing Instruments. No modernization has taken place for hearing instruments that can be compared to MHAS. Only in the last five years hearing instruement testing systems have been put in place! Although some of us have developed adequate testing facility, the vast majority do not have standardized audiometric rooms.

The DSP hearing aids will soon be available but only to children. The decision to include adults has not been taken yet.

Tallagh, Limerick, Sligo, Donegal, Tullamore, Portlaoise, Clonmel, Kilkenny and Waterford have new sound rooms for audiometry in the community care services.

Community Care services in the South Eastern Health Region has advanced audiology facilties. Of the four counties in the South East, Clonmel, Kilkenny and Waterford have new audiology facilities for the community services. Wexford will be getting one in the near future. We have facilities for video otoscopy, immittance, otoacoustic emissions, real ear measurement, VRA, Two room audiomteric testing in each of these counties. GSI Tympstar ver II, GSI 61 with HF option, DP Echoport Plus, VERIFIT, Audioscan, Frye 6500 CX, NOAH Link and a host of portable clinical audiologic equipement are available at each of the county clinics.

Burgess and the Irish agent for IAC have built our sound rooms.

Evoked potentials (both AUDERA and MASTER systems are available) including ASSR in available in Waterford Regional Hospital. The audiological scientist in the community care does the ASSR in the operating room. The audiologist in the Hospital and the audiological scientist in the community service work together with excellent support from the ENT surgeons.

We are working hard to bring some science into community audiological service in Ireland. Drs Richard Seewald, Charles Berlin, Gary Rance and Jack Katz have visited us in the recent past and condcuted workshops in different areas of audiology.

We have been discussing about hearing aid modernization and have had some training for the staff. In March Siemens is organizing one day workshop for the new hearing instruments included in the new tender. Other agencies will be doing similar training in the coming months.

Dayalan

[incus]

Thank you - interesting
Sounds very positive on equipment and rooms.

The DSP hearing aids will soon be available but only to children. The decision to include adults has not been taken yet.

It seems odd to exclude adults from DSP aids. The results from MHAS in England show dramatically the huge extra use benefit and satisfaction from the new servce - part from better service, part from DSP aids. With bulk purchase prices in UK are now very low.

In practical terms could ‘they’ stop you fitting them to adults?

However most of the benefit in MHAS has come from the modernised protocols and patient journeys. I am convinced that to do a good job audiologists should be routinely doing REMs to verify fittings and using a validated outcome measure (eg Glasgow HABP or COSI). It is disheartening to see many departments in UK going backwards and abandoning these changes. I'd actually say this is unprofessional.

Good that you are bringing in experts. Manufacturers can be useful in training but they give a narrow view, very focussed on the technology. It is also worth remembering that some have also been hostile to REM in the past ('our hearing aids don't need it'), and they are not really interested in outcome measures etc

[Ali]

Originally Posted by incus

Manufacturers can be useful in training but they give a narrow view, very focussed on the technology.

This is very true. Patients can often be forgotten behind all the technology!

[theresapitt]

Joining the discussion a little late but as a fellow Irish Scientist I should point out that all the Scientists in the late 1980s had access to hearing aid test boxes if they requested them, so the Paediatric services always had that facility - Dayalan is exaggerating about no test boxes being available until 5 years ago in Ireland. I even did DSL REM fittings back in 1993!

Also, the accommodation was quite good in the early 1990s and waiting lists were quite good too, until the whole service was relocated to a different branch of the Health Service. In the longer term this may be beneficial, in terms of service integration with related services etc. In the short to medium term this added hugely to accommodation problems and waiting lists. Political considerations are always prioritised here!!
My accommodation is now far worse than it was in 1990 but due to be upgraded soon.
In the shorter term, Dayalan neglected to mention that there are huge waiting lists in some areas for Audiology appointments despite the much higher-tech services now available; in fact, the waiting lists have hardly ever been longer as in UK. Therefore, there is still insufficient time/staff for all the optimal services to be provided fully.
And with digital aids which are now going to be made available to all customers (new adults and some review fittings too), the usual back-to-front procedure of awarding a tender with no clear idea about the amount of training to be allocated, and ignoring the clear requirement for specific time and procedures to be followed by all people in the National service (not towing the company line) is no surprise. We should learn from UK experience but probably won't!
Some of us try to follow best practice but it will not be universally encouraged I suspect. Amazing how many people are expected to blindly accept manufacturer's software without question. Experience with the GB series aids showed that.

[Dayalan]

In January 2000 when I was planning my move to Ireland, I was told by a firm that manufactures OAE equipment that only one system was available in the entire Republic of Ireland. Although that was a shock for me, I was happy to move to the South Eastern Ireland because it was Waterford Regional Hospital that had the system. Now we have a new hearing centre just 200 metres from the Hospital Audiology Services and thanks mainly to the ENT surgeons who have supported us and helped us to get a new Hearing Centre.

I was requested to use an ordinary room in Kilkenny that was in a building at the centre of town. We still do not have a bus station in Kilkenny! The buses parked right in fron of this building and were idling and I was expected to test hearing of babies! Sure, the move to the Health Service caused some distruption to the above condictions. But now we have a double walled sound suite with VRA facilities. No one did VRA earlier to 2000 in the Republic of Ireland.

The Government gave money to buy equipment when we moved from NRB to the Health Boards. I think that was a real boost that allowed us to buy OAEs for every centre. It also allowed every centre to have a hearing instrument test system. We had no evoked potential system in the NRB. Now every scientitst has one.

We do have a waiting list that was caused by we having no accomodation when we were building our sound rooms. Many of us live in our relatives' home until we get our own home. When its finished we will be all living in our own home. I think we will get over the short term troubles.

[theresapitt]

I think the topic was hearing aid services in the whole country, not diagnostics and not in one specific area. In those terms, the services and more particularly the waiting lists have in general disimproved for those receiving the services, regardless of instrumentation. Quality of current adult hearing aids is also lower than it was many years ago, and now it seems adults will not be eligible for digital aids for another 2 years at least.

A key marker of the effectiveness of paediatric aid services is age at identification and fitting and again in this area, there has been a considerable deterioration from 1994 to 2004 according to nationwide audited data. This has yet to be addressed in a meaningful nationwide approach rather than in a local, piecemeal way.