Adult Audiology —
Training activity: 4

Details

Assess and manage patients with severe-to-profound hearing loss or deafness

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Principles of patient-centred care
• Communication skills
• Support in work/home life
• Deaf awareness
• Deaf culture
• British Sign Language interpreters
• NHS Accessible Information Standard
• Modifications to hearing aid fitting and earmoulds, and alternatives
• Assistive listening devices
• Counselling and setting of expectations
• Patient centred care, support and joint goal setting
• Cochlear implant or auditory brainstem implant candidacy
• Other support mechanisms
• Local and national guidelines

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the different assessment techniques that are particularly relevant for patients with severe-to-profound hearing loss?
• What adjustments, other than testing, may you need to consider during your appointment? Does the patient need to lipread, do they use sign language, do you need to be aware of how to contact a sign interpreter if needed, or set up speech to text application on a tablet?
• Consider if you need to review information about aided and unaided evoked response audiometry, or specific speech testing procedures.
• What management options beyond hearing aids might be relevant for this group and what tools can you use to help the patient during decision-making?
• Discuss with your training officer any specific protocols or approaches used within your department for this patient group.
• Think about how you might adapt routine assessments and what communication strategies are most effective.
• Consider potential challenges you might face, such as communication barriers or complex device options, and think about how you might approach them.

In action

• How are you approaching the assessment and management of this patient? Why are you doing it this way?
• What decisions are you making as the activity progresses regarding test selection, communication strategies, and management options?
• What aspects of your practice feel intuitive when working with this level of hearing loss, and what requires more conscious effort?
• How effective are your chosen assessment techniques in determining the extent and nature of the severe-to-profound hearing loss? How relevant is this information for the individual’s functional ability to hear and communicate? What information are you not capturing?
• What challenges are you facing in communicating with the patient and understanding their needs?
• What can you learn from the patient’s responses and behaviours as the assessment and management progresses?
• Are there alternative assessment or communication approaches you could be considering if your initial methods are not effective?
• What support or guidance might you need from a qualified clinician during this activity?
• Are you working within your scope of practice when assessing and discussing management options for severe-to-profound hearing loss?

On action

• Begin by summarising the key aspects of the assessment and management process for the patient(s) with severe-to-profound hearing loss or deafness. What specific challenges were presented by the severity of the hearing loss? What communication strategies were most effective or ineffective? What were the key considerations in developing a management plan?
• What skills or knowledge did you develop or improve in assessing and managing this patient group? Were there any unexpected challenges or successes during the activity? What did you learn from these?
• What areas for continued development have been identified as a result of this activity? How can you apply the learning from this activity to your routine practice with patients experiencing severe-to-profound hearing loss or deafness? Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learned. What support or resources might you need to further develop in the areas identified through this reflection?

Beyond action

• How have your experiences in assessing and managing patients with severe-to-profound hearing loss or deafness influenced your approach to other patient groups with different levels of hearing loss?
• Reflecting on similar experiences since this DTA, what common themes or challenges have emerged in your learning? How have you adapted your strategies over time to address these?
• Consider how the skills developed in this activity (e.g., communication strategies, hearing aid technology considerations, counselling techniques) have been transferable to other DTAs or clinical situations you’ve encountered.
• How has your understanding of the long-term needs and support systems for individuals with severe-to-profound hearing loss or deafness evolved since you first engaged with this DTA?
• What actions will you take in the future to further develop your expertise in this area, based on your reflections on these past experiences?

Relevant learning outcomes

#	Outcome
# 1	Outcome Use a range of tests to safely assess the extent and nature of auditory problems in adults, including those with complex aetiologies, complex audiological configurations and comorbidities.
# 2	Outcome Apply shared decision-making to develop an individualised management plan and counselling for adults with hearing loss and other auditory difficulties, taking into account differing cultural and social attitudes to hearing care.
# 3	Outcome Evaluate individual patient outcomes and safely manage a range of routine and complex hearing losses.
# 4	Outcome Practice within their own personal and professional scope, identifying where onward referral is appropriate.