Our known condition in a world of unknowns

This is a little something I wrote for work to help with my thinking, however they haven’t asked me post this and reflects only my personal views. It’s on the topic of how Audiologists treat OME with special considerations concerning the COVID19 pandemic.

Otitis Media with Effusion (OME) is a known disease in ENT and Audiology. It is known in its incidence; being a medical condition suffered by most humans. Eight in ten will have had it by age 5 [1]. It is known in its symptomatology; being the most common cause of transient childhood hearing loss. Clinicians know how to diagnose OME, and they know how to treat it – albeit the treatment is flavoured by structural, financial, practical, and habitual variations across the globe. Every hearing professional within the United Kingdom knows that treatment for OME needs to be considered three months following its detection [2] or risk the child’s normal speech and language development. They know about critical periods in a child’s auditory development [3] which is why haste is needed once the balance between the risk of waiting or acting has shifted. Clinicians know about the yearly cycles in an OME pathway; they feel the pressures when waves of winter referrals hit, equally as much as they feel individual responsibility to each patient they treat.

Clinicians will not presume to be lectured on what they know and how to go about their clinic, however, quite rudely, this global epidemic does not seem to care. 2020 has been a year of unprecedented disruption to everyday life, including the provision of routine hearing health pathways which were tried and tested and did not need change. With ever-increasing certainty, we are coming to terms with the protracted nature of this situation we find ourselves in. The government expects restrictions could be enforced around the UK until as far away as March 2021 [4]. With such a realisation comes a second; that our pathways may need added flexibility and practicality. The same systems which we ourselves have shaped and built were done so in times when clinicians quarantining was not a variable. “Hot” and “cold” hospitals did not exist, and routine surgeries were… routine. Clinicians need not despair reading this, because they are skilled and fluid enough to innovate through these times. However, as clinicians adapt, flexibility could be an influencer of the degree of success in these times.

A system you may be already familiar with can help alleviate some of the concerns discussed. The Ponto System is a practical tool to consider or reconsider for your clinical repository in these times: it is a solution which can be deployed immediately in an environment where appointments need to be reduced. There is no harm caused if follow-up is missed or if the degree of conductive loss caused by OME fluctuates. This is because bone anchored devices are fitted to cochlear thresholds, so fluctuations in the middle ear do not affect the BAHS prescription, nor does the BAHS device ever over or under amplify, once fitted. Bone Anchored Hearing Systems devices are proven to provide better speech recognition scores than hearing aids for conductive losses with an air-bone gap of 30 dB HL or greater [5]. The BAHS device can be attached to a headband called a softband and placed over the mastoid bone. Fitting is quick and easy, and if the child is uncooperative on the day, existing BC levels from the audiogram can be used to fit the device without it being worn. Lastly, because the device is fitted on a softband the ears are clear, removing the need for earmolds or any distracting sensation in the ear canal.

This is not “just an advert”. It is a call to re-evaluate your practice in these current times. BAHS devices provide access to a high-quality sound whilst adhering to Oticon’s principles of BrainHearing™ and offering excellent connectivity and apps for their users. While they have always been part of the treatment options for chronic OME, the practicality of a Bone Anchored Hearing System is all the more appreciated in times like these.

Oticon Medical on Twitter: "New Ponto Softband for one or two processors -  fits snugly to the size of the head of your child https://t.co/kHkVHyAalV…  https://t.co/mxen4KF4yh"

[1] NICE, “What is the prevalence of otitis media with effusion (OME)?,” National Institute for Health Care Excellence, 2016. [Online]. Available: https://cks.nice.org.uk/topics/otitis-media-with-effusion/background-information/prevalence/. [Accessed: 20-Oct-2020].

[2] NICE, “Otitis media with effusion in under 12s: surgery,” National Institute for Health Care Excellence, 2008. [Online]. Available: https://www.nice.org.uk/guidance/cg60/chapter/1-Guidance. [Accessed: 20-Oct-2020].

[3] A. Kral, “Auditory critical periods: A review from system’s perspective,” Neuroscience, vol. 247, pp. 117–133, 2013.

[4]  UK Government, “Section 80,” Coronavirus Act 2020, 2020. [Online]. Available: https://www.legislation.gov.uk/ukpga/2020/7/section/80/enacted?view=plain. [Accessed: 22-Oct-2020].

[5] M. de Wolf, H. Sander, C. Cremers, and A. Snik, “Better performance with bone-anchored hearing aid than acoustic devices in patients with severe air-bone gap,” Laryngoscope2, vol. 121, no. 3, pp. 613–616, 2011.

Credits: Thanks to Barinder Samra for helping inspire the essay and information about Ponto System.
Thanks to Mark Daft for proof-reading.

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