Adult Audiology —
Training activity: 9

Details

Create management plans for a patient with complex audiological presentations, including:

• Single-sided deafness and significant asymmetrical hearing loss (≥30dB difference on four-frequency average)
• Flat, “cookie bite” and reverse-sloping hearing loss
• Steeply-sloping hearing loss
• Hearing difficulties with a normal audiogram
• Suspected non-organic hearing loss
• Progressive hearing loss

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
• Bilateral or unilateral hearing aids and/or modifications to their settings
• Validation of hearing aid fittings using objective methods
• CROS or BiCROS hearing aids
• Alternative and assistive listening devices
• Counselling and setting of expectations, based on published evidence
• Use of interpreters where required
• Local and national guidelines, and international best practice
• Onward referral for auditory implants or other appropriate services

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 various management options for each of these complex audiological presentations (e.g., bone-anchored hearing aids for single-sided deafness, counselling for hearing difficulties with a normal audiogram)?
• Consider reviewing the evidence base for management options beyond hearing aid technology.
• Discuss with your training officer the different approaches used in your department.
• What challenges do you foresee in creating effective and patient-centred management plans for these complex cases?
• Think about the importance of counselling and addressing patient expectations.
• What do you already know about managing these complex audiological profiles?
• Consider potential challenges in patient compliance and how to address them.
• Think about how to incorporate shared decision-making into the planning process.

In action

• How are you synthesising the assessment findings to develop a comprehensive management plan for this patient with a complex audiological presentation? What specific management strategies are you considering?
• What decisions are you making regarding hearing aid technology, assistive listening devices, counselling approaches, and referral pathways?
• How are you involving the patient in the shared decision-making process to create a patient-centred management plan?
• Are you finding it challenging to integrate the diverse assessment information into a coherent management strategy?
• What factors are you considering when prioritising different management options?
• What can you learn from the patient’s reactions and preferences regarding the proposed management plan?
• Are there alternative management approaches you should consider if the initial plan does not align with the patient’s needs or preferences?
• What further information or evidence might you need to support your management recommendations?
• Are you ensuring that the management plan is realistic, achievable, and within the scope of audiological practice?

On action

• Describe the key components of the management plan you developed for the patient with the complex audiological presentation. What specific challenges in the hearing profile influenced your management decisions? What factors beyond the audiogram did you consider when creating the plan? What were the potential benefits and limitations of the proposed management strategies?
• What new approaches or considerations did you learn about in developing management plans for complex cases? Were there any surprising aspects or innovative solutions you considered? What did you learn from these? How did your understanding of the patient’s needs and the diagnostic findings shape the management plan? How does this experience contribute to your ability to develop holistic and effective management strategies?
• What areas for continued development in creating management plans for complex audiological presentations have been identified? How will you apply the insights gained to future management planning for similar cases? What specific actions will you take to enhance your skills in this area, such as reviewing relevant literature or discussing cases with experienced colleagues? What resources or mentorship would be valuable for your ongoing development?

Beyond action

• Reflecting on the various management plans you have created for complex cases, what key considerations have become central to your planning process?
• How have these experiences highlighted the importance of individualised management and shared decision-making when addressing complex audiological needs?
• Can you identify specific management strategies (e.g., different types of hearing aids, assistive listening devices, counselling approaches) that you have become more adept at recommending and explaining as a result of this DTA?
• How has your understanding of when onward referral is necessary for patients with complex presentations developed over time?
• What future learning or case studies will you explore to further enhance your ability to create effective management plans for complex audiological presentations?

Relevant learning outcomes

#	Outcome
# 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.