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An Alternative Approach for Detecting Hearing Loss in Adults with Learning Disabilities

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Title: An Alternative Approach for Detecting Hearing Loss in Adults with Learning Disabilities
Language: English
Authors: McShea, Lynzee (ORCID 0000-0002-9699-9140), Giles, Karen (ORCID 0000-0002-4225-6915), Murphy, Ashley, Ling, Jonathan (ORCID 0000-0003-2932-4474)
Source: British Journal of Learning Disabilities. Mar 2022 50(1):66-75.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 10
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Audiology, Auditory Evaluation, Hearing Impairments, Adults, Learning Disabilities, Screening Tests, Referral
DOI: 10.1111/bld.12377
ISSN: 1354-4187
Abstract: Background: Annual health checks in primary care include hearing assessment, though current guidance recommends subjective assessment only. Previous studies suggest this is inadequate and recommend objective alternatives such as hearing screening. This study aimed to assess the feasibility of hearing screening and examine the last recorded annual health check outcome for hearing, for those diagnosed with hearing loss as a result of the screening process. Method: Hearing screening took place in four locations and 75 people with learning disabilities participated. Contact was made with each individual's GP to share results and to request onward referral where indicated. Findings: Wax occlusion prevented screening for 23%. Fifty-seven people completed the screen, and 25 had suspected hearing loss. Of these, 22 people required referral to Audiology to verify their hearing thresholds. Only 13 were actually referred, and 11 individuals underwent assessment in Audiology, resulting in 10 being diagnosed with hearing loss. The most recent annual health check outcomes for hearing were examined for those diagnosed with hearing loss. Of the records we accessed, hearing loss had not been identified or actioned in every case. Conclusions: Hearing screening is shown here to be a suitable method for detecting hearing loss. We recommend changing current annual health check practice to incorporate objective screening. Only 12% of those with suspected hearing loss were known to Audiology services, suggesting a substantial proportion of undetected hearing loss in the community. We found evidence of apparent reluctance around referral and hearing aid fitting and make suggestions for improvement.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1326805
Database: ERIC
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  Value: <anid>AN0155361180;f0401mar.22;2022Feb23.03:20;v2.2.500</anid> <title id="AN0155361180-1">An alternative approach for detecting hearing loss in adults with learning disabilities </title> <p>Accessible Summary: Annual health checks for people with learning disabilities should include a check of hearing. However, this hearing check only involves asking questions about hearing and does not include an actual hearing test.We tested the hearing of people with learning disabilities in the community.We found that some people had hearing problems that had not been picked up at their annual health check.We think the annual health check should be changed to include a hearing test. Background: Annual health checks in primary care include hearing assessment, though current guidance recommends subjective assessment only. Previous studies suggest this is inadequate and recommend objective alternatives such as hearing screening. This study aimed to assess the feasibility of hearing screening and examine the last recorded annual health check outcome for hearing, for those diagnosed with hearing loss as a result of the screening process. Method: Hearing screening took place in four locations and 75 people with learning disabilities participated. Contact was made with each individual's GP to share results and to request onward referral where indicated. Findings: Wax occlusion prevented screening for 23%. Fifty‐seven people completed the screen, and 25 had suspected hearing loss. Of these, 22 people required referral to Audiology to verify their hearing thresholds. Only 13 were actually referred, and 11 individuals underwent assessment in Audiology, resulting in 10 being diagnosed with hearing loss. The most recent annual health check outcomes for hearing were examined for those diagnosed with hearing loss. Of the records we accessed, hearing loss had not been identified or actioned in every case. Conclusions: Hearing screening is shown here to be a suitable method for detecting hearing loss. We recommend changing current annual health check practice to incorporate objective screening. Only 12% of those with suspected hearing loss were known to Audiology services, suggesting a substantial proportion of undetected hearing loss in the community. We found evidence of apparent reluctance around referral and hearing aid fitting and make suggestions for improvement.</p> <p>Keywords: auditory and speech issues; collaborative practice; communication; health; health screening and genetics; learning (intellectual disabilities)</p> <hd id="AN0155361180-2">INTRODUCTION</hd> <p>Primary care services are recognised as essential in providing health care to people with learning disabilities (Heyman et al., 2004). It is widely accepted that people with learning disabilities have poorer health and greater unmet health needs than the rest of the population. Bauer et al. (2019) provide a summary of some of the key reasons for this, including genetic and social factors, diagnostic overshadowing, inequality and barriers to access, diagnosis and treatment. In an attempt to reduce the inequities faced by people with learning disabilities, annual health checks were recommended by the Disability Rights Commission in 2006 and were introduced by the Department of Health in 2009 (DH, 2009). By offering a yearly assessment and examination of physical health, behaviour and medication within the primary care environment, annual health checks aim for early identification of undetected health conditions, timely diagnosis and treatment (RCGP, n.d.). Some evidence (e.g. Bauer et al., 2019; Byrne et al., 2016) suggests that annual health checks have met these aims for certain health needs. However, there are continued concerns regarding uptake and access (Giles et al., 2019) and variability in implementation, of annual health checks (Chauhan et al., 2012).</p> <p>Hearing is an important component of the annual heath check, as people with learning disabilities are at high risk of hearing loss (RCGP, n.d.). The most commonly used estimate of prevalence is 40% (Emerson et al., 2012), although much of the data is from review of records or interviews, rather than objective assessment (Bent et al., 2015). Bent et al. (2019) provide a comprehensive summary of the three categorisations of hearing loss (conductive, sensorineural or mixed), depending on which part of the ear is affected (conductive—outer or middle ear, sensorineural—inner ear or hearing nerve, mixed—a combination of conductive and sensorineural). Of these configurations, sensorineural loss is thought to be most common in people with learning disabilities and not only occurs more frequently in this group, but also has an earlier onset than for the rest of the population (Bent et al., 2015, 2019).</p> <p>Regardless of the type of hearing loss, living with unmanaged hearing loss has individual and social consequences and can affect the potential and capabilities of an individual (Van Schrojenstein Lantman‐de Valk, 2005). Pryce and Gooberman‐Hill (2012) describe common features of undetected hearing loss such as reduced social engagement, comprehension and communication. These are also associated with a learning disability, and Carvill (2001) highlights the multiplied effect of living with both hearing loss and learning disability. There is plentiful evidence in the literature of the need for increased awareness and treatment of hearing loss in people with learning disabilities, and powerful examples (such as McShea et al., 2014) which highlight the transformations that are possible. The inclusion of hearing in the annual health check should therefore be welcomed.</p> <p>However, there is doubt regarding the effectiveness of the annual health check on the detection and management of hearing loss in its current format. Whilst there is evidence of increased "hearing assessment" as a result of annual health checks cited by some (e.g. Bauer et al., 2019; Lennox et al., 2011), it is unclear what format this assessment takes and therefore whether it is effective. In guidance produced by the Royal College of General Practitioners (RCGP, n.d.), the use of a "whispered voice test" is recommended for use during the annual health check to aid detection of possible hearing loss. McShea (2015a) describes the significant limitations of this recommended test, not only in terms of sensitivity to detecting hearing loss, but also in its application to people with learning disabilities as the test relies on expressive and receptive language skills. There is no additional guidance provided for when the whispered voice test cannot be completed. Most often, hearing ability is determined in an annual health check currently by asking an individual or their caregiver if there are any hearing concerns. Emerson et al. (2013) note that some individuals with learning disabilities find self‐reporting difficult, due to issues around understanding and communication. Where this occurs, the responsibility for reporting may fall to a proxy, such as a caregiver. However, caregivers are known to be unreliable in their ability to detect hearing loss in people they support (McClimens et al., 2015). In one study, caregivers estimated over 70% of individuals they supported had satisfactory hearing, though subsequent testing revealed only 11% actually did (Kerr et al., 2003). Aside from attempting a whispered voice test or questioning a caregiver, primary care practitioners report they are unsure of how else to assess hearing during an annual health check (McShea, 2015a). Therefore, despite suggestions in the literature that more "hearing tests" are being completed during annual health checks (Lennox et al., 2011), if this test is simply a question with a misinformed answer, the assessment becomes tokenistic. Heyman et al. (2004) caution against equating nondetection with absence of a condition (e.g. hearing loss), particularly when the test procedure is sub‐optimal.</p> <p>In one study, prevalence of known hearing loss in people with learning disabilities across seven GP practices ranged from 0% to 14%, despite each practice providing annual health checks, and believing these were comprehensive (McShea, 2015a). With the literature suggesting a 40% prevalence of hearing loss for people with learning disabilities (Emerson et al., 2012), this is further evidence that the annual health check for hearing is insufficient in its current format, and alternatives should be considered. One such alternative to tackle under‐diagnosis of hearing loss is objective hearing screening (Janicki & Dalton, 1998; McClimens et al., 2015). This has been implemented successfully for athletes with learning disabilities at Special Olympic events (Hild et al., 2008). However, Special Olympic athletes represent a more able subset of the population of people with learning disabilities; little research has focussed on hearing screening for adults with learning disabilities in the wider population.</p> <p>Objective hearing screening can provide information about an individual's hearing status in minutes. Sometimes referred to as "point of care testing", Giles et al. (2019) describe the potential of such a screening model for use with people with learning disabilities and suggest it as a possible alternative to the current annual health check for hearing. However, the authors identified a general lack of awareness of point of care testing capabilities for hearing loss and recommended further work to explore feasibility and benefit.</p> <p>We therefore created two study aims:</p> <p></p> <ulist> <item> To assess the feasibility of completing objective hearing screening for people with learning disabilities in community locations.</item> <p></p> <item> To examine the most recent annual health check outcome for hearing, for individuals identified with hearing loss as a result of the objective hearing screening process.</item> </ulist> <hd id="AN0155361180-3">METHOD</hd> <p>The hearing screening initiative was part of a wider collaboration between NHS Sunderland CCG, two NHS Foundation Trusts and the University of Sunderland. This partnership trialled "pop‐up clinics" in community locations, utilising point of care technology.</p> <p>Ethical approval was granted by the University of Sunderland in November 2017 (approval reference number 000988), and all participants with learning disabilities were treated with respect and dignity throughout. Four pop‐up clinics took place between January 2018 and May 2019: two in community day centres, one at a health promotion event (held at a local football stadium) and one at a local college for young people with learning disabilities.</p> <hd id="AN0155361180-4">Preparation</hd> <p>Preparation and involvement of carers are important to ensure the success of point of care initiatives (Giles et al., 2019). Therefore, prior to each pop‐up clinic, briefing sessions were completed for prospective volunteers and their support workers, led by the local Learning Disability Health Promotion Team Manager (who is also a Learning Disability Nurse). These sessions were guided by the NHS Health Research Authority's best practice principles (NHS Health Research Authority, 2017). They involved explaining details of the screening tests and obtaining written consent from each participant with learning disabilities. The health promotion event was an open invite to people with learning disabilities across Sunderland, via local contacts and via Sunderland People First (a self‐advocacy group for people with learning disabilities). Participants from the day centres and the college were more opportunistic; simply those who were available on the day of the briefing sessions, and also on the day that the pop‐up clinics were scheduled to take place.</p> <p>Qualified audiologists from one of the local NHS Foundation Trusts completed the objective hearing screens at each pop‐up clinic. They had no prior knowledge of who would be attending for hearing screening and therefore had no opportunity to influence the recruitment of volunteers. They were unaware of the hearing status of volunteers prior to the screening. On one or two occasions, the participant arrived for hearing screening wearing hearing aids, making their hearing status visible. In the interests of inclusivity, these participants were screened in the same way as all other volunteers and their results included in the study up until the point where referral to Audiology was requested. (Referral was requested to verify the suspected hearing loss identified as a result of the screen, and therefore not required for individuals with previously determined hearing loss.)</p> <hd id="AN0155361180-5">Screening rationale</hd> <p>Each hearing screen was carried out using a three‐step process:</p> <p></p> <ulist> <item> . Otoscopy (using a Welch Allyn 3.5v diagnostic otoscope)—to perform a visual inspection of the ear canal and eardrum.</item> <p></p> <item> . Tympanometry (using an Interacoustics Titan, with a standard screening protocol)—to assess the status of the middle ear.</item> <p></p> <item> . Transient Evoked Oto Acoustic Emissions (TEOAE; using an Interacoustics Titan, with a standard diagnostic protocol)—a screening tool to assess the function of the outer hair cells of the cochlea in the inner ear, generating a "clear response" or "no clear response" result.</item> </ulist> <p>The Titan is a handheld, portable device and can be customised with modules to suit assessment requirements, meaning both tympanometry and TEOAE assessment could be completed using a single device. This device is frequently used in routine practice in UK audiology departments.</p> <p>Steps 2 and 3 were only completed if the preceding step indicated it was clinically appropriate. For example, the screen was stopped in an individual ear if otorrhoea (discharge) or significant wax occlusion was noted upon otoscopy and TEOAE assessment was not performed if tympanometry suggested impedance of sound transmission to the inner ear (e.g. due to otitis media with effusion). If such findings were noted in only one of the participant's ears, the screen was still completed in their other ear. If it was possible to complete all three steps in both ears, the maximum test time was less than 5 min per person. Individuals were required to sit relatively still and quiet during each step, but no other active participation was required.</p> <p>Otoscopy and TEOAE assessment were completed in a similar manner to that of McClimens et al. (2015). These authors elected not to perform tympanometry prior to TEOAE; however, we included this step to ensure normal middle ear function prior to assessment of the cochlea, in order to reduce the number of false‐positive "no clear response" TEOAE results caused by possible conductive components.</p> <p>Steps 1 and 2 in our screening process therefore provided an opportunity to identify possible outer and middle ear causes for hearing loss such as significant wax occlusion, or eardrum perforations (conductive hearing losses), whilst step 3 (TEOAE assessment) assessed outer hair cell function in the inner ear. A no clear response recorded during TEOAE assessment highlighted the possibility of sensorineural hearing loss. As with other hearing screening programmes (e.g. Hild et al., 2008), individuals would not be diagnosed with sensorineural hearing loss on the basis of no clear response on TEOAE assessment, but rather a hearing loss would be "suspected" and the individual would be recommended to undergo more detailed audiological assessment to confirm hearing thresholds.</p> <p>Upon completion of the hearing screen, results were sent to the individual's GP for information, including recommendations for treatment (e.g. wax removal) or onward referral. Referral to the local hospital Ear, Nose and Throat (ENT) department would be requested in cases of discovery of ear pathology, such as eardrum perforations or cholesteatomas. Audiology referral was requested for those where a clear TEOAE response was not recorded in both ears, in order to verify suspected hearing loss by completing a diagnostic hearing assessment in audiology (Figure 1).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/F04/01mar22/bld12377-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bld12377-fig-0001.jpg" title="1 A summary of the screening pathway followed" /> </p> <p></p> <p>While conductive hearing losses are often reversible or temporary, sensorineural hearing losses are usually permanent and incurable (only "managed" with hearing aids). The focus of this study is therefore on the individuals who reached step 3 (TEOAE assessment) and did not have a clear response in both ears. It is this group who are most likely to have sensorineural hearing loss, which is the most common type of hearing loss in people with learning disabilities (Bent et al. 2019; Hild et al., 2008) and yet the type least likely to be detected (McShea, 2015a). However, in all cases where onward referral was recommended, a member of the local Community Learning Disability Health Promotion Team was assigned to facilitate communication between the individual, their family / support team and their GP.</p> <hd id="AN0155361180-7">Outcomes</hd> <p>The feasibility of completing hearing screening was determined by running the pop‐up clinics as described above and calculating how many of the volunteers were able to comply with the three‐step process. This would determine the acceptability of hearing screening to this population. For those able to undergo TEOAE assessment, a comparison between the prevalence of suspected hearing loss found and the prevalence expected according to the literature also provided evidence of value/feasibility.</p> <p>As the hearing screen is not a diagnostic assessment itself, referral was required to the local audiology department for those with suspected sensorineural hearing loss, to conclusively determine hearing levels. This was necessary, not only to confirm screen results (and therefore provide further evidence of feasibility), but also to provide proof of hearing loss prior to examination of annual health check records. Completing assessment in audiology would also provide supplementary data regarding ease of referral and audiological outcomes (such as hearing aid uptake and the need for onward referral).</p> <p>For those with confirmed hearing loss, primary care records were accessed to determine whether an annual health check had been completed within the 12 months prior to screening, and if so, what the hearing result of that health check was. By retrospectively viewing annual health check records for individuals with confirmed hearing loss, this would allow examination of the "success" of annual health checking, in detecting hearing loss.</p> <hd id="AN0155361180-8">RESULTS</hd> <p>Seventy‐five people with learning disabilities (38 females, 37 males) volunteered in total and all complied with the screening process. No individuals withdrew their participation prior to or during screening.</p> <hd id="AN0155361180-9">Screen fails at Steps 1 and 2</hd> <p>Of the total group, 24% (<emph>n</emph> = 18) were unable to progress to Step 3 (Table 1). For most, this was due to significant wax occlusion (<emph>n</emph> = 17). Wax removal facilities were unavailable on the day, and so the screen was stopped at Step 1 for these volunteers. Recommendations were made to these individuals' GPs to facilitate wax removal, with the offer of a reattempt at screening following this. Follow‐up data for these individuals are not included in this study.</p> <p>1 TableSummary of hearing screen outcomes per location and overall total</p> <p> <ephtml> <table><thead valign="top"><tr><th align="left" /><th align="left">Day centre 1</th><th align="left">Day centre 2</th><th align="left">Health Event</th><th align="left">College</th><th align="left">Total</th></tr></thead><tbody><tr><td align="left">Individuals assessed</td><td align="char" char=".">9</td><td align="char" char=".">8</td><td align="char" char=".">31</td><td align="char" char=".">27</td><td align="left">75 (38 females, 37 males)</td></tr><tr><td align="left">Wax prevented screening</td><td align="char" char=".">2</td><td align="char" char=".">3</td><td align="char" char=".">4</td><td align="char" char=".">8</td><td align="left">17 (23%)(10 females, 7 males)</td></tr><tr><td align="left">Tympanometry result prevented screening</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td align="left">1 (1%)(1 male)</td></tr><tr><td align="left">Clear response TEOAE</td><td align="char" char=".">1</td><td align="char" char=".">3</td><td align="char" char=".">12</td><td align="char" char=".">16</td><td align="left">32 (43%)(16 females, 16 males)</td></tr><tr><td align="left">No clear response TEOAE</td><td align="char" char=".">6</td><td align="char" char=".">2</td><td align="char" char=".">14</td><td align="char" char=".">3</td><td align="left">25 (33%)(12 females, 13 males)</td></tr></tbody></table> </ephtml> </p> <p>For one individual, the hearing screen ended at Step 2, due to an abnormal tympanometry result. In this case, the individual had ventilation tubes (T‐tubes) inserted into both eardrums and tympanometry suggested these were blocked and not functioning optimally. A recommendation was made to this individual's GP to make a referral to the local hospital Ear, Nose and Throat department for reassessment. It is not known by the authors if this recommendation was followed.</p> <hd id="AN0155361180-10">Step 3</hd> <p>Fifty‐seven people (28 females, 29 males) progressed to TEOAE assessment (Step 3). Of these, 32 (56%) had a clear response in both ears and were therefore deemed to have satisfactory hearing levels. Twenty‐five (12 females, 13 males) did not have a clear response in both ears (44%). Therefore, the prevalence of estimated sensorineural hearing loss in this study group could range from 44% to 57% (assuming the screen could have been completed fully for the 18 individuals unable to progress to Step 3 and that all 18 had no clear TEOAE responses in both ears).</p> <p>Similar numbers of females and males were noted at each stage of the screening process (Table 1). The average age of all participants involved in the pop‐up clinics was 28 years (range 15–77 years). Table 2 presents a comparison of the mean ages of participants who underwent TEOAE assessment. As age is known to affect hearing, we wanted to determine whether this influenced the screen results. We compared the mean ages of those who had a clear TEOAE response in both ears with those who had no clear response. A <emph>t</emph> test revealed no significant difference in mean ages in relation to hearing screen results (<emph>p</emph> = .28). This indicates that age did not affect hearing ability for this group.</p> <p>2 TableA comparison of the mean ages of participants according to their hearing screen results</p> <p> <ephtml> <table><thead valign="top"><tr><th align="left" /><th align="left">Clear response</th><th align="left">No clear response</th></tr></thead><tbody><tr><td align="left">N</td><td align="left">32</td><td align="left">25</td></tr><tr><td align="left">Mean age (years)</td><td align="left">26.2</td><td align="left">31.0</td></tr><tr><td align="left">Standard deviation (years)</td><td align="left">14.7</td><td align="left">12.9</td></tr></tbody></table> </ephtml> </p> <hd id="AN0155361180-11">Referral to Audiology</hd> <p>Of the 25 people with suspected hearing loss (who did not pass the TEOAE assessment), we found that three were already under the care of local audiology services. Their data were excluded from the study from this point onwards. Therefore, 22 individuals required a referral to Audiology to confirm their hearing thresholds and receive management of their hearing loss where indicated. Figure 2 summarises the outcomes for these people.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/F04/01mar22/bld12377-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bld12377-fig-0002.jpg" title="2 A flowchart highlighting the outcomes for those who required referral to Audiology" /> </p> <p></p> <p>Despite summary letters and requests for onward referral being sent to GPs, and the Health Promotion Team facilitating contact, referrals were not made for 9/22 individuals (41%). For those who were referred, the mean time period between the pop‐up clinic and the scheduled audiology appointment was 5 months (range 2–12 months). The Audiology department are required to offer diagnostic appointments to individuals within 6 weeks of receipt of referral; therefore, it is unlikely that delays in the referral process were caused by waiting times within Audiology.</p> <p>Of the 13 individuals who were referred, 11 attended the audiology appointment. Each person was able to comply with diagnostic hearing assessment, which determined their hearing status fully. Hearing loss was confirmed for 10/11. This suggests the diagnostic hearing test agreed with the TEOAE screen result in 91% of participants.</p> <p>The audiology assessments also revealed that a referral to the Ear, Nose and Throat Department was required to investigate additional red flag symptoms (such as asymmetric hearing thresholds, potentially caused by an acoustic neuroma), for five of the 10 people.</p> <p>Of the 10 people with confirmed hearing loss, seven were likely to benefit from being fitted with hearing aids, but only two agreed to a trial of hearing aids. Both are now successful hearing aid users, and they (or their caregivers) have reported an improvement in their responsiveness to sound and communication abilities at follow‐up appointments.</p> <hd id="AN0155361180-13">Comparing outcomes with annual health checks</hd> <p>For the 10 people with confirmed hearing loss via audiology assessment, a review of their primary care records was completed to determine whether they had received an annual health check within the last year and if they had, whether hearing concerns had been identified as a result. Nine people had received an annual health check and of those:</p> <p></p> <ulist> <item> No hearing concerns documented = 7.</item> <p></p> <item> Hearing concerns documented but no referral made to Audiology = 2.</item> <p></p> <item> Hearing concerns documented and referral made to Audiology = 0.</item> </ulist> <p>Therefore, without the hearing screening performed as a result of this study, none of the individuals who were subsequently diagnosed with hearing loss would have had this hearing loss detected as a result of their most recent annual health check.</p> <p>As the TEOAE assessment appeared to be an accurate indicator of hearing loss in this study, the most recent annual health check records were also reviewed for the other 11 people with suspected but unconfirmed hearing loss (where a referral was requested but not made (<emph>n</emph> = 9) and a referral was made but the audiology appointment not attended (<emph>n</emph> = 2)).</p> <p>Including these 11 and recalculating the totals presented above, the most recent annual health check results for those who "failed" the TEOAE hearing screen and were not already known to Audiology (<emph>n</emph> = 22) were as follows:</p> <p></p> <ulist> <item> No annual health check completed within the last year = 4.</item> <p></p> <item> Primary care records out of area = 1.</item> <p></p> <item> No hearing concerns documented = 14.</item> <p></p> <item> Hearing concerns documented but no referral made to Audiology = 3.</item> <p></p> <item> Hearing concerns documented and referral made to Audiology = 0.</item> </ulist> <p>This suggests that if some of the 11 people who did not reach the audiology assessment do have a hearing loss (as their TEOAE results suggest), this will not be detected by the annual health check in its current format.</p> <hd id="AN0155361180-14">DISCUSSION</hd> <p></p> <hd id="AN0155361180-15">The feasibility of hearing screening in community locations</hd> <p>This study has demonstrated that objective hearing screening is possible, outside of the traditional hospital environment. Every individual who volunteered to take part completed the screen as fully as their ear health permitted, suggesting that hearing screening can be accepted by this population. A previous qualitative study (Giles et al., 2019) identified the importance of preparation and briefing in advance of screening, as a mechanism to assist with acceptance and engagement. We used briefing sessions prior to each pop‐up clinic to provide an opportunity for explanation and discussion. This may have influenced the willingness of our volunteers to participate and their ability to undergo the screening process without the need for adjustments or modifications. It is unclear how volunteer compliance would have been affected (if at all), by removing this preliminary element from the study timeline.</p> <p>Of the 57 people who reached Step 3 of the screen (the TEOAE assessment), 44% did not have a recordable clear response in both ears. If we assume this equates to a definite hearing loss, the prevalence of hearing loss in this study group correlates closely with the 40% figure cited in the literature (Emerson et al., 2012). Though the screen is not a diagnostic tool itself, we found agreement between the TEOAE outcome and the diagnostic assessment in Audiology in 10/11 cases. Although our sample is small, similar findings were also reported by Hild et al. (2008), from a sample of 552 people with learning disabilities.</p> <p>Our study population was relatively young (with a mean age of 28 years), and a comparison between the mean ages of those who "passed" the TEOAE assessment and those who "failed" revealed no significant difference. This reinforces other evidence in the literature suggesting earlier age of onset for hearing loss in people with learning disabilities (Bent et al., 2015). It is therefore important that detection of hearing loss is timely, and appropriate management is offered.</p> <p>Bent et al. (2019) suggest that 30% of those with learning disabilities have excessive or impacted earwax, compared to 2% of the general population. Twenty‐three percent of our participants had excessive wax preventing hearing screening (as there were no wax removal facilities at the pop‐up clinics). These volunteers were unable to progress beyond the first step of the screen, highlighting the effect of wax both on screening success (see also Bent et al., 2015), and on the strength of our study findings due to restricted numbers. For the individual, impacted, untreated ear wax can lead to hearing loss, ear infections and may also mask detection of more serious ear disease. It is of concern that so many individuals with learning disabilities are living with such significant earwax, when a visual inspection of the ear canals should be performed on at least an annual basis in primary care, during a health check.</p> <hd id="AN0155361180-16">Examining the annual health check</hd> <p>The second aim of this study was to examine the annual health check for hearing in its current format, by comparing the results obtained from the objective hearing screen to the individual's most recent annual health check. This has not been done in the literature to date. Seventeen of the 22 people who required referral to Audiology had had an annual health check within the previous year, and 82% (14/17) had been described as having satisfactory hearing. Hearing concerns were identified for the other 18% (3/17), though these were not acted upon (i.e. resulted in no referral).</p> <p>It could be argued that the most recent annual health check result cannot be disproven for several of the individuals with suspected hearing loss, as they did not reach the diagnostic audiology appointment, and therefore, their hearing status has not been conclusively determined. However, similar annual health check findings exist for those individuals who did have hearing loss confirmed via assessment in audiology. 78% (7/9) of these individuals were described as having satisfactory hearing at their most recent annual health check, whilst 22% (2/9) had hearing concerns documented, but no action taken. Although it is a positive finding that some hearing concerns have been identified, without onward referral the annual health check is reduced to a "box ticking exercise" (McShea, 2015a).</p> <p>The primary function of the TEOAE assessment used in this study is to detect sensorineural hearing loss. While it is possible that hearing could have deteriorated markedly in the time between an individual's last annual health check and our screening, we believe that this is unlikely (sudden sensorineural hearing loss affects up to 0.02% of the population each year; Stachler et al., 2012). We therefore believe the limitations of a subjective assessment of hearing during an annual health check (as is currently recommended), to be a much more plausible explanation of our findings.</p> <p>This study has shown that there was undetected hearing loss in this community despite annual health checking, that was identifiable by objective hearing screening. Whilst no health check may be expected to capture every case, it is striking to note that the annual health checking that had been performed resulted in no conclusive diagnoses of hearing loss or referrals to Audiology whatsoever. With the aims of annual health checking being early identification of undetected health conditions and timely diagnosis and treatment (RCGP, n.d.), this study provides evidence that the aims of the annual health check are unmet in this population and therefore the value in its current form must be questioned for hearing loss detection.</p> <hd id="AN0155361180-17">Issues around referral to audiology</hd> <p>If hearing concerns have been documented in primary care records for some, why have onward referrals not been made to audiology for confirmation? This contradicts the assertion on the RCGP website that "<emph>GPs and practice nurses have the much needed generalist skills to help people with LD get timely access to increasingly complex health systems</emph>" (RCGP, n.d.). It appears these generalist skills are not assisting access to audiology services in this population. This echoes the findings of Felce et al. (2008) that even when annual health checking is performed, it does not lead to increased contact with specialists.</p> <p>The reasons for this are likely to be multifactorial. Hearing loss is often overlooked or perceived as less important than other health needs (Newsam et al., 2010). Other work investigating hearing loss detection in primary care identified a high threshold for referral for people with learning disabilities, where GPs required reports of hearing concerns from caregivers, and the ability to complete a thorough history and an examination of ears before they would consider referral to Audiology (McShea, 2015a).</p> <p>We hoped that providing GPs with a summary of the purpose of the pop‐up clinic, and the objective screening results, would be sufficient to give confidence in making a referral. However, Figure 2 highlighted that a referral was not made in 41% of cases where one had been requested. It is concerning that this reluctance to refer has been seen previously (e.g. McShea, 2015b) and is still present. Those who were referred waited an average of 5 months between pop‐up clinic and audiology appointment. In some cases, individuals waited a year. This suggests possible inertia in primary care and a lack of urgency for hearing assessment. Further work is needed to explore the reasons for this in more detail. McShea (2015a) uncovered similar attitudes from GPs relating to cost effectiveness of referrals, the perceived success of hearing assessment and benefit of a hearing aid trial. Evidence of hearing aid benefit for people with learning disabilities exists in the literature (e.g. Coppens‐Hofman et al., 2013; McShea et al., 2014). McClimens et al. (2015) therefore rightly highlight a potential human rights angle, by not facilitating referral for assessment and thus depriving an individual of the known benefit of hearing aids.</p> <p>Another important outcome from this study is that every individual referred to audiology was able to participate in a full diagnostic hearing assessment. It is important that findings like these are shared to help dispel the persisting myth that people with learning disabilities cannot have their hearing tested (Bent et al., 2015). Not only was it possible to determine hearing status, but to identify the need for onward referral for serious medical conditions associated with hearing loss. This level of detail would be unlikely to be achieved via questioning caregivers in an annual health check or simply performing a visual inspection of the ears as it current practice.</p> <p>Of additional concern is that only 29% of people who were offered hearing aids accepted them. There is more work to be done regarding awareness raising of potential hearing aid benefit. It is also important to note that the value of audiology extends beyond provision of hearing aids. Even for those who decline hearing aid fitting, there is value in an awareness of hearing loss and inclusion of communication tactics in individuals' support plans, as a mechanism to enhance communication and quality of life (McShea et al., 2014).</p> <hd id="AN0155361180-18">Limitations</hd> <p>Despite an initial sample size of 75, losses at various stages meant that the screen outcome could only be compared to the diagnostic audiology assessment for 11 people, with only 2 individuals fitted with hearing aids from a potential initial group of 22.</p> <p>As the focus of this study was on the individuals who reached Step 3 of the screen and did not have a clear TEOAE response in both ears, the hearing status of the 17 individuals with wax occlusion at the time of screening is not presented here. Contact was made with their GPs, and a rescreen was offered subject to satisfactory wax removal; however, the results of these offers are unknown. It is accepted that including the data from this group, though logistically challenging, could have mitigated against some of the losses described in the previous point.</p> <p>Although the gender of volunteers was recorded, no other information (such as ethnicity) was noted. Inclusion of such data could have enriched the study findings.</p> <p>The audiologist completing the diagnostic assessment of hearing in Audiology was not blinded to the result of the initial hearing screen. However, this was unlikely to have influenced the result of the assessment as standard audiometric test procedures were followed.</p> <p>Our volunteers may not have been representative of the learning disability population as a whole, as all participants had capacity to consent to their involvement. We did not screen any individuals with profound or multiple learning disabilities. However, because of this, the level of hearing loss detected in this group is likely to be an underestimate of the wider population, as previous work (Bent et al., 2015) suggests that as the level of learning disability increases, so too does the prevalence and severity of hearing loss.</p> <p>Although we found that every individual who attended the diagnostic appointment in Audiology was able to complete a full hearing assessment, not all of the individuals that we had asked to be referred, actually were. Further work (e.g. interviewing the GPs involved) would be needed to fully understand why 9/22 individuals were not referred. It may be that the GPs in question restricted onward referral to those individuals they thought able to comply, and that if all had been referred without any gatekeeping, it may not have been possible to successfully assess every person in Audiology. Previous evidence from the literature (e.g. Bent et al., 2015; McClimens et al., 2015 and McShea, 2015a) would suggest that this is unlikely to be the case; however, an updated view on GPs perspective would have enhanced this study further.</p> <hd id="AN0155361180-19">Suggested changes to practice</hd> <p>The findings of this study echo those elsewhere (e.g. McClimens et al., 2015; McShea, 2015a) by suggesting that in its current format, the annual health check is not fit for purpose as a mechanism to detect unidentified hearing loss. However, we agree with others (such as Heyman et al., 2004) who feel that primary care should play a vital role. We believe the annual health check is an important opportunity to encounter with people with learning disabilities. However, the current guidance should be refined, to include evidence‐based practice (such as an objective assessment for hearing), and advocate collaboration with specialist audiology services.</p> <p>We have received funding to continue the pop‐up clinics on a wider scale. The next stage involves examining the feasibility of nonaudiologists (such as support workers) being trained to complete hearing screens. Though the screen was successful, we have identified issues regarding its worth and impact if the referral recommendations are not followed. By embedding the screening technology within the annual health check itself, and allowing primary care practitioners to complete the hearing screen themselves, practitioners would be empowered to make informed decisions regarding onward referral.</p> <hd id="AN0155361180-20">CONCLUSION</hd> <p>Objective hearing screening was possible in a range of community locations and was accepted by our volunteers with learning disabilities. This screening (in conjunction with referral to Audiology) appeared to be more successful at detecting previously undiagnosed hearing loss than the annual health checks that our volunteers had undergone previously, as per existing guidance for hearing assessment. Comprehensive, diagnostic hearing assessment in Audiology was possible for every individual who accessed it, further dispelling the myth that people with learning disabilities are unable to have their hearing tested. More education and awareness raising is required around the impact of undetected hearing loss in this population, the capabilities of Audiology and the benefits of hearing aids. Without this shift in mindset, the worth of any hearing screen will always be limited.</p> <hd id="AN0155361180-21">ACKNOWLEDGEMENTS</hd> <p>The authors would like to thank all of the people involved with the hearing screening events; the audiologists, the Health Promotion team, support workers, Interacoustics for technical support and, most importantly, the adults with learning disabilities who volunteered to take part.</p> <hd id="AN0155361180-22">DATA AVAILABILITY STATEMENT</hd> <p>The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.</p> <ref id="AN0155361180-23"> <title> REFERENCES </title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext> Bauer, A., Taggart, L., Rasmussen, J., Hatton, C., Owen, L., & Knapp, M. (2019). Access to health care for older people with intellectual disability: A modelling study to explore the cost‐effectiveness of health checks. BMC Public Health, 19, 706. https://doi.org/10.1186/s12889‐019‐6912‐0</bibtext> </blist> <blist> <bibl id="bib2" type="bt">2</bibl> <bibtext> Bent, S., Brennan, S., & McShea, L. (2019). Hearing impairment. In V. Prasher, & M. Janicki (Eds.), Physical health of adults with intellectual and developmental disabilities (pp. 169 – 185). Springer.</bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext> Bent, S., McShea, L., & Brennan, S. (2015). The importance of hearing: A review of the literature on hearing loss for older people with learning disabilities. British Journal of Learning Disabilities, 43, 277 – 284.</bibtext> </blist> <blist> <bibl id="bib4" type="bt">4</bibl> <bibtext> Byrne, J. H., Lennox, N. G., & Ware, R. S. (2016). Systematic review and meta‐analysis of primary healthcare interventions on health actions in people with intellectual disability. Journal of Intellectual and Developmental Disabilities, 41 (1), 66 – 74.</bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext> Carvill, S. (2001). Sensory impairments, intellectual disability and psychiatry. Journal of Intellectual Disability Research, 45 (6), 467 – 483. https://doi.org/10.1046/j.1365‐2788.2001.00366.x</bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext> Chauhan, U., Reeve, J., Kontopantelis, E., Hinder, S., Nelson, P., & Doran, T. (2012). Impact of the English Directly Enhanced Service (DES) for Learning Disability.. The University of Manchester. Retrieved from <ulink href="http://clok.uclan.ac.uk/17396/1/17396%5fchauhan.pdf">http://clok.uclan.ac.uk/17396/1/17396%5fchauhan.pdf</ulink></bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext> Coppens‐Hofman, M. C., Koch, H. H., Maassen, B. A. M., & Snik, A. F. M. (2013). Evaluating the subjective benefit of hearing rehabilitation in adults with intellectual disability. Hearing, Balance and Communication, 11, 24 – 29. https://doi.org/10.3109/21695717.2012.756625</bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext> Department of Health (2009). Valuing people now: A new three‐year strategy for learning disabilities. Department of Health.</bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext> Emerson, E., Baines, S., Allerton, L., & Welch, V. (2012). Health inequalities & people with learning disabilities in the UK: 2012. Improving health and lives: Learning disabilities. https://<ulink href="http://www.basw.co.uk/system/files/resources/basw%5f14846‐4%5f0.pdf">www.basw.co.uk/system/files/resources/basw%5f14846‐4%5f0.pdf</ulink></bibtext> </blist> <blist> <bibtext> Emerson, E., Felce, D., & Stancliffe, R. J. (2013). Issues concerning self‐report data and population‐based data sets involving people with intellectual disabilities. Intellectual and Developmental Disabilities, 51 (5), 333 – 348. https://doi.org/10.1352/1934‐9556‐51.5.333</bibtext> </blist> <blist> <bibtext> Felce, D., Baxter, H., Lowe, K., Dunstan, F., Houston, H., Jones, G., Grey, J., Felce, J., & Kerr, M. (2008). The impact of checking the health of adults with intellectual disabilities on primary care consultation rates, health promotion and contact with specialists. Journal of Applied Research in Intellectual Disabilities, 21, 597 – 602. https://doi.org/10.1111/j.1468‐3148.2008.00432.x</bibtext> </blist> <blist> <bibtext> Giles, K., Ling, J., & Gordon, I. (2019). Can point‐of‐care testing improve access to diagnostic screening and testing for people with learning disabilities? Exploring perspectives to improve access and equity? British Journal of Learning Disabilities, 48 (1), 28 – 36. https://doi.org/10.1111/bld.12302</bibtext> </blist> <blist> <bibtext> Heyman, B., Swain, J., & Gillman, M. (2004). Organisational simplification and secondary complexity in health services for adults with learning disabilities. Social Science & Medicine, 58, 357 – 367. https://doi.org/10.1016/S0277‐9536(03)00210‐7</bibtext> </blist> <blist> <bibtext> Hild, U., Hey, C., Baumann, U., Montgomery, J., Euler, H. A., & Neumann, K. (2008). High prevalence of hearing disorders at the Special Olympics indicate need to screen persons with intellectual disability. Journal of Intellectual Disability Research, 52 (6), 520 – 528. https://doi.org/10.1111/j.1365‐2788.2008.01059.x</bibtext> </blist> <blist> <bibtext> Janicki, M. P., & Dalton, A. J. (1998). Sensory impairments among older adults with intellectual disability. Journal of Intellectual and Developmental Disabilities, 23 (1), 3 – 11. https://doi.org/10.1080/13668259800033541</bibtext> </blist> <blist> <bibtext> Kerr, A. M., McCulloch, D., Oliver, K., McLean, B., Coleman, E., Law, T., Beaton, P., Wallace, S., Newell, E., Eccles, T., & Prescott, R. J. (2003). Medical needs of people with intellectual disability require regular reassessment, and the provision of client‐ and carer‐held reports. Journal of Intellectual Disability Research, 47, 134 – 145. https://doi.org/10.1046/j.1365‐2788.2003.00453.x</bibtext> </blist> <blist> <bibtext> Lennox, N., Ware, R., Bain, C., Gomez, M. T., & Cooper, S. A. (2011). Effects of health screening for adults with intellectual disability: A pooled analysis. British Journal of General Practice, 61 (584), 193 – 196. https://doi.org/10.3399/bjgp11X561186</bibtext> </blist> <blist> <bibtext> McClimens, A., Brennan, S., & Hargreaves, P. (2015). Hearing problems in the learning disability population: Is anybody listening? British Journal of Learning Disabilities, 43 (3), 153 – 160. https://doi.org/10.1111/bld.12090</bibtext> </blist> <blist> <bibtext> McShea, L. (2015a). Managing hearing loss in primary care. Learning Disability Practice, 18 (10), 18 – 23.</bibtext> </blist> <blist> <bibtext> McShea, L. (2015b). "I will make a difference" – Training caregivers to improve the hearing of adults with learning disabilities. British Journal of Healthcare Assistants, 9 (3), 124 – 127.</bibtext> </blist> <blist> <bibtext> McShea, L., Corkish, C., & McAnelly, S. (2014). Audiology services: Access, assessment and aftercare. Learning Disability Practice, 17 (2), 20 – 25. https://doi.org/10.7748/ldp2014.02.17.2.20.e1531</bibtext> </blist> <blist> <bibtext> Newsam, H., Walley, R. M., & McKie, K. (2010). Sensory impairment in adults with intellectual disabilities – An exploration of the awareness and practices of social care providers. Journal of Policy and Practice in Intellectual Disabilities, 7 (3), 211 – 220.</bibtext> </blist> <blist> <bibtext> NHS Health Research Authority (2017). Best Practice – Helping you make your research project the best it can be. NHS Health Research Authority. Retrieved from https://<ulink href="http://www.hra.nhs.uk/planning‐and‐improving‐research/best‐practice/">www.hra.nhs.uk/planning‐and‐improving‐research/best‐practice/</ulink></bibtext> </blist> <blist> <bibtext> Pryce, H., & Gooberman‐Hill, R. (2012). 'There's a Hell of a Noise': Living with a hearing loss in residential care. Age and Ageing, 41, 40 – 46.</bibtext> </blist> <blist> <bibtext> RCGP (n.d.) Health checks for people with learning disabilities toolkit. Royal College of General Practitioners. Retrieved from https://<ulink href="http://www.rcgp.org.uk/clinical‐and‐research/resources/toolkits/health‐check‐toolkit.aspx">www.rcgp.org.uk/clinical‐and‐research/resources/toolkits/health‐check‐toolkit.aspx</ulink></bibtext> </blist> <blist> <bibtext> Stachler, R. J., Chandrasekhar, S. S., Archer, S. M., Rosenfeld, R. M., Schwartz, S. R., Barrs, D. M., Brown, S. R., Fife, T. D., Ford, P., Ganiats, T. G., Hollingsworth, D. B., Lewandowski, C. A., Montano, J. J., Saunders, J. E., Tucci, D. L., Valente, M., Warren, B. E., Yaremchuk, K. L., Robertson, P. J. ; American Academy of Otolaryngology‐Head and Neck Surgery (2012). Clinical practice guideline: Sudden hearing loss. Otolaryngology Head and Neck Surgery, 146 (3), S1 – S35.</bibtext> </blist> <blist> <bibtext> Van Schrojenstein Lantman‐de Valk, HMJ (2005). Health in people with intellectual disabilities: Current knowledge and gaps in knowledge. Journal of Applied Research in Intellectual Disabilities, 18, 325 – 333.</bibtext> </blist> </ref> <aug> <p>By Lynzee McShea; Karen Giles; Ashley Murphy and Jonathan Ling</p> <p>Reported by Author; Author; Author; Author</p> </aug>
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  Data: An Alternative Approach for Detecting Hearing Loss in Adults with Learning Disabilities
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  Data: <searchLink fieldCode="AR" term="%22McShea%2C+Lynzee%22">McShea, Lynzee</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9699-9140">0000-0002-9699-9140</externalLink>)<br /><searchLink fieldCode="AR" term="%22Giles%2C+Karen%22">Giles, Karen</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4225-6915">0000-0002-4225-6915</externalLink>)<br /><searchLink fieldCode="AR" term="%22Murphy%2C+Ashley%22">Murphy, Ashley</searchLink><br /><searchLink fieldCode="AR" term="%22Ling%2C+Jonathan%22">Ling, Jonathan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2932-4474">0000-0003-2932-4474</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22British+Journal+of+Learning+Disabilities%22"><i>British Journal of Learning Disabilities</i></searchLink>. Mar 2022 50(1):66-75.
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: 10
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Audiology%22">Audiology</searchLink><br /><searchLink fieldCode="DE" term="%22Auditory+Evaluation%22">Auditory Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Learning+Disabilities%22">Learning Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Screening+Tests%22">Screening Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Referral%22">Referral</searchLink>
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  Data: 10.1111/bld.12377
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  Data: 1354-4187
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  Data: Background: Annual health checks in primary care include hearing assessment, though current guidance recommends subjective assessment only. Previous studies suggest this is inadequate and recommend objective alternatives such as hearing screening. This study aimed to assess the feasibility of hearing screening and examine the last recorded annual health check outcome for hearing, for those diagnosed with hearing loss as a result of the screening process. Method: Hearing screening took place in four locations and 75 people with learning disabilities participated. Contact was made with each individual's GP to share results and to request onward referral where indicated. Findings: Wax occlusion prevented screening for 23%. Fifty-seven people completed the screen, and 25 had suspected hearing loss. Of these, 22 people required referral to Audiology to verify their hearing thresholds. Only 13 were actually referred, and 11 individuals underwent assessment in Audiology, resulting in 10 being diagnosed with hearing loss. The most recent annual health check outcomes for hearing were examined for those diagnosed with hearing loss. Of the records we accessed, hearing loss had not been identified or actioned in every case. Conclusions: Hearing screening is shown here to be a suitable method for detecting hearing loss. We recommend changing current annual health check practice to incorporate objective screening. Only 12% of those with suspected hearing loss were known to Audiology services, suggesting a substantial proportion of undetected hearing loss in the community. We found evidence of apparent reluctance around referral and hearing aid fitting and make suggestions for improvement.
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      – SubjectFull: Auditory Evaluation
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      – SubjectFull: Hearing Impairments
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      – SubjectFull: Adults
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      – SubjectFull: Learning Disabilities
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      – TitleFull: An Alternative Approach for Detecting Hearing Loss in Adults with Learning Disabilities
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