Audiology Hearing Aid Dept (NMGH)

Paediatric Service Information

The Children’s Hearing Service (or Paediatric Audiology) is available for babies, children, and young people in North Manchester where there is a concern about their hearing or a known hearing problem. It offers a comprehensive and specialist clinical service to diagnose and help babies, children, and young people with hearing loss. The Paediatric Audiology Service follows national guidelines and recognised best practice whilst also meeting the individual needs of children and their families. We involve parents in the decision making for their child and in the development and improvement of our services.

 

A hearing problem is not always obvious, particularly in young children.  There are different degrees and types of hearing impairment.  Although a child may respond to some sounds around the home, they may not be able to hear all the sounds that they should be hearing.

• A child may not respond to some sounds around the house e.g. a key turning in a lock, creaking floors, or a door opening.
• A child may have difficulty hearing you when you are out of sight.
• A child may not respond to quiet sounds but respond to loud sounds.
• A child may have more difficulty hearing in noisy places.
• A child’s behaviour may alter, becoming more disruptive or naughty.

The level at which a child can hear plays a key role in their development and their ability to develop good speech and language skills.

All babies born in England are offered a Hearing Screen via the newborn hearing screening programme (NHSP) shortly after birth. A clear response on the hearing screen means that there is unlikely to be a hearing loss that will significantly affect the development of speech and language.  This hearing screening test will allow those babies who do have a hearing loss to be identified early. Early identification is known to be important for the development of the child. It also means that support and information can be provided to parents at an early stage.

When children are 4-5 years old, they are offered a hearing screening test in school. This is completed by a specially trained school screener. Any children who do not pass the screen are offered an assessment in Audiology for a full hearing test. This ensures hearing problems are picked up early and treated.

Who is the service for?

The Children’s Hearing Service is a service for babies, children, and young people who:

• need a hearing test because of concerns about their hearing or development.
• have a known hearing loss and need help and support.

What services are provided?

Services offered include:

• Specialist hearing assessment from newborn babies to adolescents
• Fitting of hearing aids
• Evaluation of progress with hearing aids
• Referral for cochlear implantation assessment and other specialist hearing aids as appropriate
• Specialist assessment and rehabilitation for children with a range of conditions, including learning disabilities and/or Autism.
• Paediatric to Adult Transition Service
• ENT diagnostic Support

Our aim:

• To provide you with an excellent service to meet your individual needs.
• To give you individual attention
• To offer you access to any service within the department.
• To offer you a suitable appointment date
• To make every effort to see you for an appointment on time.
• To be available to you should you or your child need advice or reassurance.
• To provide support when you are coming to terms with a hearing loss.
• To offer you help if a hearing loss causes problems when yours or your child’s lifestyle changes.
• To ensure you and your child feel confident and happy using a hearing aid.

Additional Support:

• Verbal and BSL Interpreters are available.
• Easy read information available prior to or following appointments.

We are also actively involved in the Children’s Hearing Services Working Group (CHSWG) for Manchester that works to promote the development of all services to support children and their families.

 

CHSWG Leaflet:

https://search3.openobjects.com/mediamanager/rochdale/fsd/files/20191004_hi_chswg_information_leaflet.pdf

 

What to Expect:

Newborn Hearing Screening:

All babies in the Manchester area are offered a hearing screen when they are born. Babies who do not get a clear response during this screen are seen by our service to find out more about their hearing. We can test for all types of hearing problems in babies using tests such as auditory brainstem response testing, otoacoustic emissions and tympanometry.

Auditory brainstem response testing and otoacoustic emissions testing require your child to be asleep as the response to be detected is small and can be hidden if there is a lot of movement.

If a baby gets a clear response on the hearing screen it means they are unlikely to have hearing loss. However, a small number of children can develop or acquire a hearing loss later in childhood, so if you or anyone else is concerned about their hearing, it is important to get it checked.

Useful Link:

Video Link: https://youtu.be/Ruz0e6xg10w

More information regarding this can be found on  Newborn hearing screening – NHS (www.nhs.uk)

Paediatric Hearing Assessment Clinics:

There are several reasons why a child may have been asked to attend for a hearing test:

• They did not have clear responses in both the right and left ears on the hearing screen.
• There is concern about their hearing.
• There is concern about their speech and language or general development.
• Your child needs another hearing test following their hearing screen at birth.
• Your child may have had many ear infections or colds.
• There may be a family history of hearing problems.
• Your child may have had an illness that can cause hearing problems.

Children of any age are seen for hearing assessment using a wide variety of techniques including otoacoustic emission testing, visual reinforcement audiometry, play audiometry, tympanometry, and speech testing.

How can I get an appointment?

If your baby has been referred from the newborn hearing screen, you will automatically receive an appointment.

If you have concerns about your child’s hearing you can go to your family doctor or health visitor and ask them to refer your child for a hearing test. The service receives referrals from any professionals in contact with children and young people where there are concerns about the hearing.

Referrals can be made via the ‘Children and Young Peoples Services referral form’ available in all North Manchester GP and Community centres.

Click here to download the referral form.

If you are new to the area and your child has a known hearing loss and wears hearing aids, you should ask for your family doctor to refer to us so that we can continue to monitor your child’s hearing and progress with hearing aids.

We are also happy to see children at the request of parents if your child has previously been seen in the department and discharged but you have concerns.

Useful link – Preparing your child for their hearing test: Going to the hearing clinic | Documents and resources (ndcs.org.uk)

How long will I have to wait for an appointment?

You will be offered an appointment for your child within six weeks of us receiving the referral.  We aim to find out what your child can hear as quickly as possible. Often, we can do this in just one appointment but sometimes it takes several appointments before we can get all the information we need.

What will happen when I have my appointment?

At the first appointment we will test your child’s hearing. We will explain the results with you and talk about what they mean for your child and their development.

If your child has a hearing loss, we will talk about the options that are available and how they can help. We will then agree the next step with you and set a care plan. This will include your child’s specific needs and what we have agreed to do to address them. Sometimes we can decide to monitor your child’s hearing and progress. Sometimes we need to do something to help your child hear better and this can include having a small operation (grommets) or wearing a hearing aid. We may also talk about using sign language to help your child communicate. The options available will depend on your child and the cause of the hearing loss.

You will always receive a letter after your appointment with us. This summarises what you told us at the appointment, the test results and what they mean and the plan that we agreed for you and your child. We copy this letter to your family doctor, your health visitor or your child’s school nurse and to any other people your child sees.

We offer appointments at North Manchester General Hospital and Newton Heath Health Centre. If you receive an appointment from us, it is important to check the appointment letter for details of where the appointment is.

Complex Paediatric service:

For children who need a more flexible approach to their appointments, we have a special complex paediatric clinic. There are a wider range of tests available and specially trained staff who can adapt the hearing assessment and rehab to suit each child. Children in this clinic are monitored routinely and see the same member of staff at each visit.

 

Useful links:  https://www.sense.org.uk

 

Can I bring my child’s siblings to the appointment?

It is always best to try and make alternative arrangements for your child’s siblings.  To test the hearing, we need the test room to be very quiet and to have as few distractions as possible.  If you cannot arrange for anyone to look after your other children, we will try our best to ensure everything runs smoothly.

What do I do if my child is ill on the day of the appointment?

If you child is unwell, please phone the department and let us know as early as possible.  We can then change the date of the appointment for you.

What if my child has a hearing loss?

If your child has a hearing loss, we will discuss the best ways to help your child with their hearing.  We will also carry out further testing as needed to get as much information as possible about your child’s hearing.

 

Types of hearing loss in Children:

Permanent hearing loss Hearing aids can be required from birth if a child is born with a permanent hearing loss, or they can acquire a permeant hearing loss after birth due to several reasons.  We may offer further tests to see if we can find a cause for your child’s hearing loss.

Even a mild hearing loss can have an impact on a child’s speech, language and overall development.  Establishing good hearing aid use as soon as possible from identification of a permanent hearing loss can significantly improve the outcomes for the child, including speech, language and overall development.  The New born hearing aid screening program means we can identify a hearing loss within days of birth, so hearing aids can be fitted from as early as 4 weeks old.

https://www.ndcs.org.uk/information-and-support/first-diagnosis/

Hearing loss associated with middle ear fluid ( middle ear effusion) Some children get temporary middle ear fluid that if causing significant problems with their hearing can impact on their speech, language and overall development. These children benefit from wearing hearing aids on a temporary basis to help overcome the hearing loss caused by the fluid.  The hearing of the child is monitored, and the aids can be adjusted to account for any fluctuations in hearing.  When the hearing improves the hearing aids can be removed.

Your child may also be offered investigations into the cause of the hearing loss Deafness causes before birth | Deafness in childhood (ndcs.org.uk)

Understanding your child’s hearing tests

Paediatric Hearing Aids:

 

All NHS hearing aids are available free of charge.  All the hearing aids we fit in the Audiology department are digital and come in a range of colours. This means they can be programmed by a computer and adjusted to suit your child’s individual hearing needs. The hearing aid(s) will be set to adjust automatically to suit the listening environment.

 

For children who require hearing aids we provide a family friendly auditory rehabilitation service. A range of digital hearing aids are available dependant on the severity of the child’s hearing loss. If a child is unable to wear conventional digital hearing aids and may benefit from an implantable hearing aid, the paediatric Audiology team can arrange for the child to be assessed.

We have close links with education, and children are supported throughout nurseries and school by teachers of the hearing impaired.

There is support for the families of deaf children through the NDCS family officer whose key role is to provide information and advice regarding education, benefits, communication, and technology.

Useful Link:

More information can be found on https://www.ndcs.org.uk/documents-and-resources/hearing-aids-information-for-families/

Technology and hearing aids

Children can benefit from radio aids, especially in the school environment.  They transmit the teachers voice directly to the hearing aid, this helps overcome background noise and poor classroom acoustics.  They can also be useful in other situations such out-of-school activities.  It can also be connected to other devices such as a smartphone or tablet. If suitable the radio aid will be provided by the teachers of the deaf.

Other devices can also be purchased such as streaming devices that link the hearing aids to smartphones, tablets etc.  Loud or vibrating alarm clocks can help promote an older child’s independence.

Further information on all aspects of childhood deafness, hearing aids and technology can be found at The National Deaf Children’s Society (NDCS) website: https://www.ndcs.org.uk/

https://www.ndcs.org.uk/information-and-support/first-diagnosis/people-you-may-meet/education-services/

As children move from the paediatric service to the adult service a phased ‘transition’ service is offered. This allows young adults to meet the Audiologists in the adult team and become familiar with Adult Audiology services, while still being supported by the Paediatric team. It helps young adults, and their families know what to expect when they move into adult services. It helps the adult service understand the young person’s needs and previous experiences within Audiology

Useful link:

https://www.ndcs.org.uk/media/4481/qs_transition_from_paediatric_to_adult_audiology_2011.pdf

Meet the Paediatric Team

Service lead

Maxine Holden (MSc, BSA, AHCS)

Clinical & Operational Head of Service – Adult and Paediatrics

Clinical Team:

Julie Bradley                     Clinical Lead – Paediatric Service

Jill Hughes                        Specialist Paediatric Audiologist

Nazma Begum                  Specialist Paediatric Audiologist

Dunia Al Noufal Bourini  Specialist Paediatric Audiologist (Acting)

 Administrative

Michelle Langford       Systems and Admin Manager

Joanne Hawe             Admin Assistant

Janice Scott                 Admin Assistant

Colina Blell                   Admin Assistant

Natalie Davies             Admin Assistant

Cassidy Aspinall         Receptionist

Newborn hearing screening – NHS (www.nhs.uk)

National Deaf Children’s Society | Supporting deaf children (ndcs.org.uk)

home (manchesterdeafcentre.com)

www.hearing.screening.nhs.uk

The Sensory Team at Manchester City Council | Help & Support Manchester

How to use Oticon ON app | Bluetooth® hearing aids | Oticon

How to pair your hearing aid with a mobile phone (oticon.co.uk)

How to use an FM system in a classroom (oticon.co.uk)

How to use computer and tablet with your hearing aids (oticon.co.uk)

Watch TV (oticon.co.uk)

How to listen to music and audio with your hearing aids (oticon.co.uk)

Adults Service Information:

The Adult Hearing Service is available for adults in and around North Manchester who are concerned about their hearing or who have a known hearing problem. It offers a comprehensive and specialist clinical service to diagnose adults with hearing loss and to provide support and options to help improve hearing. The Adult Hearing Service follows national guidelines and recognised best practice while also meeting the individual needs of adults and their families.

We involve adults in the decisions around the management of their hearing loss and in the development and improvement of our services.

A hearing problem is not always obvious, as many hearing losses come on gradually over an extended period. There are different degrees and types of hearing impairment. A hearing loss may not be obvious in all situations, but it can limit a person’s social and work activities and can place a strain upon relationships.

Many adults with a hearing loss may first notice that they struggle to hear:

• In environments where there is lots of background noise
• On the phone
• If someone calls them from another room
• Listening to TV (needing to turn it up)

Who is the service for?

The Adult Hearing Service is a service for adults who:

• Need a hearing test because they, or their family, have concerns about their hearing
• Have a known hearing loss and need further help and support

What services are provided?

• Adult diagnostic hearing assessment including direct access MRI scanning.
• Adult rehabilitation using high specification NHS hearing aid amplification.
• Specialist assessment and rehabilitation for adults with a range of conditions, including learning disabilities, autism, and dementia.
• Hearing aid maintenance, review, and reassessment
• Tinnitus assessment and management
• Vestibular (balance) diagnostic assessment and Vestibular (balance) rehabilitation
• Bone Anchored Hearing Aid (Baha) reassessment and rehabilitation.
• Ear Care (wax removal) for NHS hearing aid wearers
• Adult ENT diagnostic support
• Signposting into other services: Social Services sensory team, Falls Service, Smoking cessation, ENT.

We provide appointments at:

• North Manchester General Hospital
• Newton Heath Health Centre
• Harpurhey Health Centre
• Clayton Health Centre (Hearing aid Service and Repair Clinics only)
• Home visit service for the housebound (this must be requested by the referrer at initial referral stage).

Our aim

• To provide you with an excellent service to meet your individual needs
• To give you individual attention
• To offer you access to any service within the department
• To offer you a suitable appointment date
• To make every effort to see you for an appointment on time
• To be available to you should you need advice or re-assurance
• To provide support when you are coming to terms with a hearing loss
• To offer you help if a hearing loss causes problems or lifestyle changes
• To ensure you feel confident and happy using a hearing aid

Additional Support:

• Verbal and BSL Interpreters are available.
• Easy read information available prior to or following appointments.

 

How can I get a hearing assessment?

If you would like a hearing assessment and you do not currently use a hearing aid issued by North Manchester General Hospital, visit your General Practitioner (GP) who can refer you to the Audiology department via one of two routes:

• Direct referral to Audiology: your GP can decide to refer you directly to an Audiologist who will ask detailed information about your hearing problems, test your hearing, and will suggest the best treatment for you which may include one or two hearing aids.

 

• Referral to Audiology via the Ear, Nose and Throat (ENT) Department: Your GP may decide to refer you to an ENT doctor for a medical opinion before you are seen by an Audiologist. The ENT doctor will then refer you to an Audiologist if appropriate.

How do I get an appointment if I am an existing patient?

You can call us for an appointment on 0161 720 2678 or email Audiology.north@mft.nhs.uk

 

What to expect from an initial hearing assessment

First Appointment

Your first appointment can last up to an hour and will include the following:

• History
• Otoscopy (where we look in your ears)
• Hearing Test
• Tympanometry – Where we test how well your ear drums are moving
• Develop an individual communication plan – The Audiologist will explain the test results and options available to you. You and the Audiologist will decide on a care plan individually designed for you. This might include different hearing aid options dependant on your loss of hearing, assistive listening devices, lip-reading, hearing therapy, or communication tactics.

We are a dementia friendly service – our staff have received expert training to provide the best care for people with dementia.

Further management

There are several different options available, but the most common option is hearing aid(s).

If you have decided on a different communication option, the Audiologist will refer you to another specialist in the department or to another professional to provide this.

Useful Links

Information and support on living with a hearing loss can be found here: Resources to help you manage your hearing loss (idainstitute.com)

Easy Read information on Hearing: Sight and Hearing Loss – Easy Health

Preparing for your hearing test (easy read and in a range of languages): Information leaflets – RNID

Information on Hearing, Communication and Dementia: https://youtu.be/Qaf9jco4V70

Hearing loss and dementia: how are they linked? – RNID

Hearing Aids:

All NHS hearing aids are behind the ear and available free of charge. All of the hearing aids we fit in the Audiology department are digital and come in a range of colours. This means they can be programmed by a computer and adjusted to suit your individual hearing needs. You may choose to have a volume control or different programs available which can help you to hear in different listening environments. Alternatively, you can have the hearing aid set to adjust itself automatically to suit the listening environment.

The size of a hearing aid depends on the degree of your hearing loss. The Audiologist will select the hearing aid most suitable for your hearing. The more powerful hearing aids are larger in size.

We are often asked why NHS departments do not currently offer In-the-ear (ITE) hearing aids. These hearing aids are expensive to manufacture compared to hearing aids which sit behind-the-ear (BTE), because they must be individually made for each person’s ear. They also break down more frequently, as they are more easily blocked up by wax. For these reasons, the NHS does not offer ITEs unless there are exceptional medical circumstances. However, the technology for both ITE and BTE hearing aids are the same so they will both be just as beneficial to your hearing.

There is a charge of £80 (per aid) if you lose your hearing aid or damage it due to neglect.

We appreciate that when you are fitted with hearing aids for the first time there is a lot of information to take in all at once

Useful links:

The Nottingham Hearing Biomedical Research Unit has produced a series of informative videos, available on YouTube, specifically designed for new hearing aid users. available by clicking here

We can recommend these videos to help you understand how to use your hearing aids and what to expect: C2 hear online

Easy Read information on Hearing Aids: Information leaflets – RNID

What can I do if my hearing aids break?

If your hearing aids have been issued by us, you can contact us to arrange a repair appointment. We offer timed appointments every weekday for hearing aid repair. These appointments must be booked in advance: for hearing aids and bone conduction hearing aids: Telephone 0161 720 2678 or email: Audiology.north@mft.nhs.uk

How often do I need my hearing aid checked?

You need have the tubing changed on your hearing aid every 6-8 months. If you need help with this, you can book a service appointment. We offer timed appointments every weekday for hearing aid services. These appointments must be booked in advance: constact the dedicated service telephone line on: – 0161 625 8080 or email: Audiology.north@mft.nhs.uk

We also can offer a postal service for hearing aid tubing and batteries therefore please contact us via the same methods to request this.

Where can I collect batteries?

Batteries are free of charge, and you can collect batteries from the Audiology reception desk in outpatients B at:

• North Manchester General Hospital – Audiology Reception (Outpatients B)
• Newton Heath Health Centre
• Harpurhey Health Centre

If you find it difficult to attend the department, you can send someone else to collect batteries on your behalf or we can arrange postal on request.

Please bring your yellow battery card that was issued at fitting stage to collect your batteries.

Assistive Listening Devices (ALDs):

These devices help to make noises around the home louder and clearer e.g. the doorbell or TV. They can work with hearing aids or separately. They can be provided for free by Salford Council or bought privately.

Useful Links:

Information on Salford Sensory Service:  The Sensory Team at Manchester City Council | Help & Support Manchester

A website to get advice and purchase ALDs: https://www.connevans.co.uk/

Cochlear Implants:

For people with severe and profound deafness, hearing aids may not give much benefit and it may be difficult to hear people talking, especially if lip reading is not possible. A Cochlear Implant bypasses the damaged inner ear and sends clearer sounds to your brain. This means speech is easier to hear and you may rely less on lip reading e.g. you may be able to have a conversation on the phone. A Cochlear Implant requires an ear operation with an over-night stay in hospital. We can discuss your suitability for a Cochlear Implant, provide information on Cochlear Implants, and offer you a referral to our local implant team.

Useful Links:

Information on the Manchester Cochlear Implant team can be found here: The Manchester Adult Cochlear Implant Programme – Manchester Royal Infirmary (mft.nhs.uk)

Information on how a Cochlear implant works and why they may be better than hearing aids, can be found here: https://youtu.be/kcwatbIWpkY

Tinnitus and Hyperacusis Service

The Tinnitus Service at the North Manchester General Hospital and provides assessment, information, counselling and advice about tinnitus and the strategies available that can be used to manage tinnitus to make it less intrusive.

What is tinnitus?

Tinnitus is often known as ‘ringing in the ears’, but it can take the form of many different sounds. It can be defined as a perception of sound when there is no external sound source.

Tinnitus is more common than you might think, about 10% of adults in the UK experience tinnitus. Many people with tinnitus are not affected by it, but for others it can have a profound effect.

What is causing my tinnitus?

There are many different causes of tinnitus. It can be linked to exposure to loud noise, hearing loss, injuries to the ear or head, some diseases of the ear, some illnesses or emotional stress. However, many people may experience tinnitus without ever having experienced any of these provoking factors and may not have a hearing loss.

What do tinnitus appointments typically involve?

Your first tinnitus appointment will often involve a member of the Audiology tinnitus team finding out more about the nature of your tinnitus and explore the feelings and difficulties it may be causing. Once the Audiologist knows more about your tinnitus, they will go on to discuss the results of your hearing test and the mechanism of hearing and an explanation of the model of tinnitus. The Audiologist will also provide information and advice about the different strategies available to help manage it.

If you have tinnitus in only one ear this will need to be investigated further via scan which we can arrange. In most cases just because you have tinnitus in one ear does not mean you will also eventually get it in the other ear.

What help is available for tinnitus?

There is no medication that can be taken to cure tinnitus, but there are several things that can be done to help to manage tinnitus:

 

• Information/counselling – Knowing more about tinnitus and how the brain responds to the sound is an important stage in learning to manage tinnitus. In many cases when a person first hears tinnitus it can be quite alarming because it is an unknown sound and is strange and different to what is perceived as normal. It is often very reassuring to speak to someone who knows and understands about tinnitus. This can often be the first step in managing tinnitus.

 

• Sound enrichment – There are many forms of sound enrichment that can be used to help with tinnitus. Initially people often start to use radios, stereos and TVs to introduce sound into the environment to drown out the tinnitus. This can be helpful to start off with, but the clinician will be able to provide information and advice about different sound enrichment devices that can be used. These devices introduce more passive background sound into the environment that can help the brain to learn to filter out the tinnitus.

 

• Relaxation – Relaxation is a key component as some people find that it lowers their perception of the tinnitus. In the modern world we often lead busy and stressful lives, and it can be difficult to prioritise relaxation. Even when we do relax the forms of relaxation, we choose often involve some active process that does not enable us to reduce our levels of anxiety or stress.Relaxation – Tinnitus UK

 

• Sleeping routine: Addressing sleep problems and adopting good night-time routine is key. Avoidance of caffiene and ensuring you go to bed when tired. Having soft sound in bedroom may help you sleep better. The type of sound is up to you – as long as its pleasant or neutral Tinnitus and sleep disturbance – Tinnitus UK

 

• Cognitive Behavioural Therapy (CBT) – this is one psychological approach that can be useful in managing tinnitus. The idea is that when you first became aware of your tinnitus, you responded negatively to it. For example, you may have been worried there was something seriously wrong with your hearing (a belief) and this led to you being anxious (an emotion) and then you tried to feel better, for example, by avoiding silence (a behaviour). Some beliefs and behaviours are helpful and some arent. CBT helps you recognise the unhelpful beliefs and behaviours and finds different ways of responding to the tinnitus Link: Online self-help CBT techniques – Every Mind Matters – NHS (www.nhs.uk)

 

• Mindfulness – This is a meditation technique frequently used for pain management and more recently for tinnitus and balance anxieties. The idea is that we tend to resist unpleasnet sensations (e.g. hearing tinnitus). If we stop resisiting and allow the unpleasent sensation, this alters our awareness to include more sensations. We start to notice that sensations become less dominant once our attntion moves away from them and focuses on a different part of the body. All of this can change in a momvemnt, simply by chaning our awareness. IF we use mindfullness effectively we can create some space from the tinnitus and in that space, decide how we are going to respond to it.

How and where to learn mindfulness – Mind

Tinnitus Meditation: Clearing Your Mind With Guided Meditation (mindworks.org)

With tinnitus it is important to learn how to control your responses to stress. A member of the Audiology tinnitus team will be able to provide guidance on more structured forms of relaxation that can be effective in reducing stress and tension, so that a person with tinnitus can set up their own regular relaxation routine.

If I have a hearing loss, will wearing hearing aids help my tinnitus?

If a person with tinnitus has a hearing loss then hearing aids can be helpful. Firstly hearing aids will make sounds, like speech, more audible and this will help to reduce the level of difficulty a hearing loss gives when listening to sounds around you. Hearing aids are also likely to reduce some of the anxiety or stress caused by tinnitus and hearing loss when it comes to communicating with other people.

Secondly, tinnitus is often more noticeable in quiet environments and, with a hearing loss, environments are likely to seem quieter as less sound is being heard. Hearing aids will help by allowing you to hear more environmental sounds, so that more information is available to the brain which makes it easier for the brain to ignore the tinnitus.

Hyperacusis

Hyperacusis is an increased sensitivity to sound, and it can be more common in people with tinnitus. People with hyperacusis can feel that sound in general or certain sounds are uncomfortably or painfully loud, even when they are not particularly intense and might not bother other people.

For people with hyperacusis the temptation can be to use ear plugs to block out these sounds, but this can make the situation worse. It is important for people with hyperacusis to be gradually de-sensitised to the sounds they find uncomfortable. An Audiologist can provide information and guidance on this process so that a person with hyperacusis can gradually be exposed to a variety of sounds.

Useful Tinnitus Links:

Action on Hearing Loss Tinnitus Helpline (Freephone)

Tel: 0808 808 6666
Text: 0808 808 0007
SMS: 0780 000 0360
Fax: 020 7296 8199
Email: tinnitushelpline@rnid.org.uk

British Tinnitus Association (BTA)

The BTA is a charity providing support and advice about tinnitus

BTA Tinnitus Helpline (Freephone)
Tel: 0800 018 0527
Website: British Tinnitus Association

Manchester Deaf Centre – Tinnitus Support Group

Tel: (0161) 273 3415
Email: info@manchesterdeafcentre.com
Website: Manchester Tinnitus Support Group – Tinnitus UK

Tinnitus – RNID

Hyperacusis | British Tinnitus Association

Easy Read information on Tinnitus: Easy Read information | British Tinnitus Association

Vestibular (Balance) Service:

The balance assessment and rehabilitation service at North Manchester General Hospital offers a full diagnostic and rehabilitation service for patients who have dizziness and balance problems.

What is a balance problem?

Many people experience balance problems or dizziness at some point in their lives. In fact, one study has shown that it is the second most common problem that people see their GP about. Many different medical conditions can cause dizziness and imbalance, and one of the most common is a problem with the inner ear.

If you are experiencing dizziness or balance problems, you may be referred by your doctor for a balance assessment appointment to investigate whether it is a problem with the balance organs in your inner ears which is causing your symptoms.

Balance Assessment:

At this appointment you will see an audiologist who is specifically trained in balance assessment.  There are lots of different pieces of information that your brain uses to maintain your balance and information from your inner ears is just one of them, meaning that it can often be difficult to find out exactly what is causing your symptoms. We may be able to give you a definite answer regarding your dizziness however we may need to refer to other professionals who can assess factors contributing to the dizziness. Balance assessment appointments usually last for between 60 and 90 minutes and will usually include the following:

History:

This will involve an in-depth discussion about your balance problems and concerns. We will also ask you about your general health, hearing, and other issues which may affect your balance.

Balance Testing

The tests carried out will be based upon the information you give us regarding your symptoms.  Some of the tests that we may do are explained below:

• Otoscopy – where we look in your ears. This is to check your ears are free of wax and are healthy.
• Tympanometry – Where we test how well your ear drums are moving.
• Hearing test
• Videonystagmography (VNG) – We place goggles over your eyes that have a camera within them and will ask you to follow a dot on the screen with your eyes. Although these tests seem a lot like eye tests, they allow us to assess your balance organs
• Positional Tests – We may ask you to move your head, neck, or body into a particular position, or stand still in the same position for 30 seconds. Here we are testing for specific types of common balance problem.  Positional testing, including the Dix Hallpike Manoeuvre when Benign Paroxysmal Positional Vertigo (BPPV) is suspected.
• Air Caloric Testing – This test allows us to compare how well the left and right balance organs are working on the day of your appointment. In this test, we warm up or cool down your ears one at a time by running some warm or cool air into the ear for about 60 seconds and we use the camera goggles to record your eye movements during the test and compare your eye movements for each ear. This tells us how well your balance organs are working on the day of the appointment. This test can elicit dizziness.
• Video head impulse test (vHIT) – This test is used to diagnose reduction in vestibular function in one ear compared to the other. For this test patients will wear a pair of tight fitting goggles, often as tight as a pair of swim goggles. During this test patients are asked to watch a target on the wall which is usually a sticker. While they are watching this target on the wall we move their head back and forth very rapidly in a horizontal and vertical direction.

Preparing for your balance tests: Tests For Diagnosing Vestibular Disorders – VeDA

Discussion of Results and Care Plan

We may be able to discuss the results with you on the day of your appointment or we may need to review the results and they will be explained to you when you return to see your doctor.We may talk to you about ways you can help with your balance and may discuss balance rehabilitation.  We will also be able to discuss any concerns you have regarding hearing or tinnitus and discuss management options with you. Depending on your needs we can refer you to other professionals or book further appointments with an Audiologist.

• It is advised that you do not drive after your appointment for an hour or so and that you may like to bring a friend or family member with you as some of the tests may make you feel unsteady for a little while.
• We ask that if you have been prescribed any medication for your balance/dizziness that you stop taking these 48 hours before your appointment as the medicine can affect our test results.
• We also ask that you do not drink any alcohol for 36 hours before your appointment as this can affect our test results

• We also ask that you do not wear any eye make-up to the appointment as this can affect the image recorded by the camera in the goggles.

 

Vestibular Rehabilitation:

When there is a disruption to the balance system, such as an inner ear infection, you can feel dizzy and sick.  It can take a while for your brain to get used to the change in information it receives from the balance organs.  Balance rehabilitation aims to shorten the time it takes for the brain to re-learn how to use information from the balance organs.

The brain is very good at re-training itself however it has to experience the problem in order to do this.  It is therefore important that you remain as active as possible, and balance rehabilitation will help to expose your brain to challenging information from your balance organs, allowing it to re-learn how to use this information.

The Balance Service offers customised balance rehabilitation programmes for patients who are suffering with dizziness and has established links with the Falls Service and the Physiotherapy Service.

We will discuss what movements or situations can make the dizziness worsen and will practice some simple exercises together. We will agree upon a few exercises for you to practice at home that will expose your brain to more challenging information from the balance organs and allow it to re-learn how to use this information as quickly as possible.  The aim of this is to help you cope better in day-to-day situations.

We will either arrange to telephone you to see how you are getting on or we will arrange a further appointment to discuss this.

Access to the North Manchester Audiology Balance Service:

We accept referrals via a referral from an ENT (Ear, nose and throat) doctor or a GP.

Service/ Department lead

Maxine Holden   (MSc, BSA, AHCS)

Clinical & Operational Head of Service – Adult and Paediatrics

Clinical Team:

Shona Lewis                 Clinical Lead – Tinnitus

Robert Ronson             Clinical Lead – Vestibular (Balance Service)

Robert (Mark) Barrett   Specialist Audiologist

Jemma Harrison           Specialist Audiologist

LouJane Eljabri            Audiologist

Nikhil Merchant            Audiologist

Hajjrah Riaz                  Audiologist

Shiguftha Kazmi           Audiologist

Summaya Javed           Audiologist

Camila Addul Rahim    Audiologist

Soma Mandal                Assistant Audiologist

 Administrative:

Michelle Langford       Systems and Admin Manager

Joanne Hawes             Admin Assistant

Janice Scott                 Admin Assistant

Colina Bell                   Admin Assistant

Natalie Davies             Admin Assistant

Cassidy Aspinall         Receptionist

Related Adult Links 

 Hearing Loss and Hearing Aid Links:

https://mft.nhs.uk/mri/services/cochlear-implants/

https://mft.nhs.uk/mri/services/cochlear-implants/audiology/adult-hearing-services/bone-conduction-hearing-devices-and-middle-ear-implants/

home (manchesterdeafcentre.com)

The Sensory Team at Manchester City Council | Help & Support Manchester

https://rnid.org.uk

Resources to help you manage your hearing loss (idainstitute.com)

Lipreading classes in and around Manchester – Manchester Deaf Studies

Together Dementia Support | Manchester Dementia Care Charity

Age UK Manchester

Balance Links:

Meniere’s Society: The national charity for people with dizziness… | Ménière’s Society (menieres.org.uk)

http://vestibular.org/

Mental Health Links:

Mental Health and Deafness | Greater Manchester Mental Health NHS FT (gmmh.nhs.uk)

https://www.selfhelpservices.org.uk

https://www.manchestermind.org

Digital Mental Health Solutions in the UK | SilverCloud® by Amwell® (silvercloudhealth.com)

Manchester Carer Groups | Greater Manchester Mental Health NHS FT (gmmh.nhs.uk)

Extra content

The department is dedicated to improving patient experience of these services through research and audit. We constantly assess and evaluate services to monitor the effectiveness of our management of hearing-impaired patients.

We continually look at the following areas:

• Monitoring patient’s progress with their hearing aids through questionnaires.
• How our appointments and services are provided to both adult and paediatric patients.
• Monitoring our hearing aids and how we fit them.
• Looking at patients journeys to Audiology after diseases or treatments that can affect their hearing.
• Access into Audiology services
• Equality and Diversity
• Patient satisfaction through Friends and Family Test Friends and Family Test – Manchester University NHS Foundation Trust (mft.nhs.uk)

 

In addition, teaching and training is provided for students at the University of Manchester studying Health Care Science.  It is possible there will be a student observing your appointment or conducting your appointment under direct supervision of a qualified Audiologist however, you will always be asked if you consent to a student present or conducting your appointment.

Find out more about Audiology courses at the University of Manchester.

Being part of Manchester Foundation Trust, the audiology department has excellent links with both Manchester Royal Infirmary, Trafford General, Withington and the Royal Manchester Children’s Hospital ensuring that all patients have access to specialist interventions wherever necessary.

Qualifications and awards

Manchester Foundation Trust Quality Assurance – Silver Award