Page 9 - Primary Care Audiology

Ear and hearing care

Developments in antibiotics, the operating microscope and
anaesthetics fundamentally changed ENT services in the 1950s,
making catastrophic diseases of the ear, such as serious infection,
very rare. Immunisation programmes and improved public and
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population health have also helped reduce cases of measles, mumps
and rubella, protecting against preventable hearing loss in childhood. 17
As a result, the ear and hearing problems people are most likely to seek
help for in the UK are age-related hearing loss, earwax and tinnitus. 18
Most of these presentations are not acute and need the support of
audiology professionals in the community rather than doctors in
hospitals. Despite this, the NHS still operates a medical model of ear
and hearing care, often requiring people to see their GP and an ENT
doctor when the most appropriate care for most adults could be
provided by a primary care audiologist close to home.
The medicalised model of care is essentially a legacy issue without
an evidence base, as those with the ability to pay have always been
able to access safe and effective primary care audiology.

This historical and structural anomaly exacerbates inequalities between
people with different sensory needs, for example, between people
with ear and eye problems. In the UK, the risk of a person in the
general population having a sight-threatening eye disease is greater
than having a disease that risks permanent hearing loss. To meet this
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demand, the NHS has normalised seeing an optometrist for most care,
sending only those who require a medical opinion (<5%) for a hospital
appointment. This means most eye health needs are met very quickly,
delivered closer to home and cost less than hospital-based services.
In contrast, patients with ear and hearing issues are often required to
see GPs before accessing NHS care and then wait again to be referred
to a hospital-based service. This is not only wasteful of NHS resources
and an unnecessary barrier to care but also unsustainable, given the
current pressures on GP and hospital capacity.

Primary care audiology – accessible ear and hearing care for all 9