Guidance

9. Audiology

Updated 9 April 2024

Applies to England and Wales

Audiological assessment

Audiological assessment is carried out by a clinical audiologist. This is the process of assessment used to determine the degree and type of hearing loss.

Audiological assessment and follow-up of babies referred by the NHS Newborn Hearing Screening Programme (NHSP) must take place within the timescales specified in the NHSP standards and in line with national guidance.

Audiological protocols and guidance are the responsibility of the British Society of Audiology (BSA). The BSA has a special interest group (SIG) dedicated to electrophysiological aspects of audiology - the BSA Electrophysiology Group.

Audiological services that are responsible for the assessment of immediate referrals from NHSP should participate in a peer-review process of auditory brainstem response (ABR) and in a quality initiative such as Improving Quality in Physiological services (IQIPS).

Entering audiological data into the national IT system

The effectiveness of NHSP (locally and nationally) is judged on key indicators including yield (the number of babies identified), sensitivity (the ability to refer individuals with the target condition), age of identification of hearing loss and age at referral to professional early intervention services.

Data entry into the national IT system is required for all babies referred to audiology from the hearing screen. Details of the data entry requirements are outlined in the Audiology guide which can be found on the resource tile in the national IT system.

The data added translates into key data items that enable reporting of degree and type of hearing loss identified, age at confirmation of permanent childhood hearing impairment (PCHI), the age at which amplification is offered, accepted and fitted, age at referral to early intervention/teacher of the deaf (ToD) services and age at cochlear implantation (CI).

Audiologists’ use of the national IT system

Login for the NHSP national IT system are requested through you’re the NHSP local manager. The NHSP local manager will be able to provide training on the national IT system where required. An audiology user guide is available on the resource tile in the national IT system.

A training version of the national IT system is available. The training system does not require an N3 connection. Login details can be requested via the national IT system helpdesk.

Only genuine patient data must be entered into in the national IT live system and only dummy data in the training system.

The screening helpdesk is available to support any clinical queries, use the email title ‘NHSP - audiology data query’.
For problems entering data or accessing the national IT system please contact:

National hearing screening IT helpdesk

Email S4H.helpdesk@nhs.net

Phone 0845 0130183

For users of the S4H IT system. The helpdesk is open from 7am to 7pm, 365 days a year.

Requirements for audiological data

The audiology data held within the national IT system is crucial and gives the PHE newborn hearing screening team oversite of all babies in England with a PCHI identified by the screening programme or those with a later identified PCHI. Helping us to identify trends through audit and share data that can support plans for children in England. Data is required for each audiology appointment until a PCHI of any degree in either ear is confirmed or ruled out.

Where PCHI is confirmed the record should be updated annually until the child is 5 years of age. Information relating to how to enter audiology data into the national IT system can be found in the SMaRT4Health (S4H) audiology guide on the resource tile in the national IT system.

Consent for audiology data

Parental consent obtained for newborn hearing screening includes consent to screen and consent to share screening and follow-up data for national audit.

Data quality reports

The PHE newborn hearing screening programme monitors the quality and completeness of audiological data. Several audiology data reports are produced on a monthly basis highlighting records that need updating. Further details on how to access these reports, report descriptors and the actions required can be found in the reports guide found on the resource tile within the national IT system.

National hearing screening IT helpdesk

Email S4H.helpdesk@nhs.net

Phone 0845 0130183

For users of the S4H IT system. The helpdesk is open from 7am to 7pm, 365 days a year.

Reviewing and reporting case of later identified PCHI

NHSP providers and associated audiology services must have a local process in place to review any cases of moderate to profound PCHI that were not identified by newborn hearing screening.

A local named individual (preferably a senior clinician in paediatric audiology) should be responsible for coordinating this review and acting on any issues identified. They should liaise closely with the local NHSP clinical lead(s) and local managers. Such a review will help to maintain confidence in the performance of the hearing screening programme as well as identifying any issues with performance of the screening programme and/or referral pathways.

Identifying cases to review

Any child identified with a moderate or worse PCHI in one or both ears who was born in England or was otherwise eligible for newborn hearing screening in England should be reviewed.

These children should have a record on the national IT system. A historic or national search may be required to locate the record using the NHS number. The local manager for NHSP may be required to migrate or share the record into the site and update it.

Carrying out the review and documenting the outcome

A template review form ‘review of case of PCHI not identified by the newborn hearing screen late identified’, can be found on the resources tile of the national IT system and used to record the outcome of such a local review. It can also serve as a report to the national programme team for appropriate cases.

It is not the aim of such a review, nor is it possible, to retrospectively assess whether the screening test gave a ‘correct’ result. In most cases, it is impossible to know for certain whether the hearing loss was present at the time of the screen.

Incident reporting

Any cases where the review identifies that correct protocols were not followed or referrals were not made are reported as a screening incident.

Cases which must be notified to the national programme team

A separate notification to the national programme team is only required when:

• PCHI >=40 dB in both ears and passed the screen (unless there is robust evidence of meningitis or some other causative agent that occurred subsequent to the screen) or
• PCHI >=40 dB in both ears and failed the screen and initial diagnostic ABR reported as satisfactory

If notification is required the ‘review of case of PCHI not identified by the newborn hearing screen late identified’ must be completed and emailed to the screening helpdesk. The title of the email should be ‘notification of later identified PCHI’. No patient identifiers should be used in the file name or the documentation.