Newborn Hearing Screening
Since 2006 the UK has implemented a comprehensive screening program for neonatal deafness known as the NHSP, Newborn Hearing Screening Programme.
For healthy newborns, the screening process typically begins with an Otoacoustic Emissions (OAE) test. If the baby has a ‘no clear response’ in one or both ears after two OAE attempts, an Automated Auditory Brainstem Response (AABR) test is administered. A clear response in both ears during the AABR leads to discharge; otherwise, the baby is referred to an audiologist for further evaluation. Following NHSP referral, all babies should have been seen by audiology by age 4 weeks, or gestational age 44 weeks (UK Government, 2021). Further testing should be completed by 8 weeks corrected age.
Babies admitted to a Neonatal Intensive Care Unit (NICU) are automatically considered at higher risk for hearing loss. These infants all undergo an AABR test, because it is more sensitive to the types of hearing loss associated with prematurity or other medical complications.
Newborns with specific conditions are directly referred to audiology without going through the standard screening process. This includes babies with confirmed congenital cytomegalovirus (cCMV), microtia, external ear canal atresia, neonatal bacterial meningitis, or those with programmable ventriculo-peritoneal (PVP) shunts.
Presbycusis
The UK government does not recommend national adult hearing screening despite there being widespread support for such. Presbycusis is typically only detected when an individual seeks advice – typically from their GP - due to noticeable hearing difficulties. It is possible patients would seek direct advice from a private provider.
Patient and healthcare professional pathways
All NHS services, including audiology assessments and hearing aids are provided free of charge to the patient. The primary care physicians (General Practitioners) - also free to access- are often the first point of contact for patients experiencing hearing difficulties. They may perform initial assessments and, if necessary, refer patients to audiology services for further evaluation.refers a patient to an audiology clinic -most of which are based in an NHS hospital. Once referred onto an NHS pathway, audiologists carry out comprehensive hearing assessments, which typically includes pure-tone audiometry, speech audiometry, and other diagnostic tests to determine the degree and type of hearing loss. Based on these results, audiologists can prescribe hearing aids, assist with fitting and customization, and provide ongoing support to ensure the effectiveness of the devices. In the NHS, audiologists do not sell hearing aids; there is no conflict of interest. Private audiologists carry out assessments and sell hearing aids...
The Any Qualified Provider (AQP) system is an NHS contract that allows patients over 55 years old with no ENT referable criteria in their hearing loss to choose from a range of licensed providers for some conditions. The AQP system aims to improve quality and give patients more choice, while also balancing that choice with continuity of care.
Although exact workforce figures for audiologists do not exist, there are estimated to be 3000 NHS and 1500 private audiologists/hearing dispensers in the UK. In 2018, 6123 clinical scientists were registered with the Health and Care Professions Council. Waiting times vary for services. The aim is for wait to be <6 weeks.
Cochlear implants
In the UK, hearing aids and cochlear implants are covered by the National Health Service (NHS), however private options are also available. Cochlear Implant services are separate services from Audiology (although the teams may be located within the same hospital). Referrals typically come from GP or Audiology services and are made when a patient fits the NICE (2019) cochlear implant criteria (thresholds >80dbHL at 2 or more frequencies from 500Hz - 4kHz). Generally, children are offered bilateral implantation, and adults are offered unilateral implantation.
NHS options: Cochlear implants coverage includes the cost of the implant surgery, the device itself, and the required post-operative care.
Private Options: There is an ever-increasing number of patients who choose to obtain these devices privately to avoid wait times and to increase available options. Private health insurance may cover some of these costs, but coverage varies depending on the policy.
Around 1,260 people are implanted each year in England. The updated NICE guidance broadens the indications and is expected to increase the number to 2,150 people implanted per year from 2024-25.
Quality of care
The provision of audiological care through the NHS in the UK is generally considered excellent, with the caveat that waiting times can be long and choices of hearing technology are limited. Areas for improvement include decreasing waiting times, direct access to audiology rather it access being via primary care services (GP). Wales has successfully now implemented such a service.
