NCHA Member update - 20 May 2020

1. New: Covid-19 otology guidance

ENT UK has today published A graduated return to the provision of elective ENT services during the Covid-19 pandemic.

Peter Rea, Jaydip Ray, Simon Lloyd and Shakeel Saeed wrote the guidance, which includes:

Outpatients care

• When remote care can be beneficial and when to exercise caution
• When to consider face-to-face appointments. For example, audiometry and examination of the ear
• How “it is reasonable to request an ear swab is obtained in the community and treated appropriately to reduce hospital attendance when there are high volumes of Covid-19 patients in the hospital and the community”
• General advice on PPE in an outpatient setting
• How some balance clinic appointments can be “successfully undertaken virtually”, “including Hallpike’s test”, but this should be done with caution until there is more evidence on the effectiveness
• Advice on the use of otoscopy and the use of tuning forks
• More detailed information on the use of microsuction, wax impaction, otitis externa, NOE, sudden sensorineural hearing loss, Meniere’s disease and other conditions.

Surgery

• Prioritisation of otological surgery, including when to consider cochlear implantation, additional detail on precautions, PPE and other considerations during the pandemic.

The guidance also covers training and research/audit.

During the pandemic, the guidance makes it clear that providers will have to organise clinics very differently. Social distancing and increased infection control procedures will have a direct impact on how many patients can be seen for face-to-face care. It also highlights the importance of allocating sufficient time to allow consultants to analyse case histories and proactively manage patients remotely.

The authors also recommend reading Audiology and otology guidance during Covid-19 (AIHHP, BAA, BSA and BSHAA) – watch a webinar on this guidance.

The authors acknowledge the support they received from the BAA, BSA, NCHA and other stakeholders.

The NCHA continues to support all sector partners throughout the pandemic, sharing monitoring, scenario analysis, and intelligence to ensure care can be delivered safely and effectively, and to meet patient needs. The NCHA is currently seeking the views of sector partners on producing a framework to support the community audiology response as the pandemic progresses.

2. Government Covid-19 guidance

UK governments continue to monitor infection rate (R) and other system impacts of Covid-19. Current plans are as follows:

• England/UK – Government’s Covid-19 recovery strategy –11 May
• Scotland – Covid-19 framework for decision making – last updated 5 May
• Wales – Leading Wales out of the coronavirus pandemic – 24 April, and Unlocking our society and economy: continuing the conversation – 15 May
• Northern Ireland – Coronavirus – Executive approach to decision-making – 12 May.

Members can contact us directly for additional support and guidance, as well as scenario planning wherever in the UK they might be based. Contact us in the usual way by emailing [email protected].

3. Coronavirus testing update

Everyone in the UK with coronavirus symptoms is now eligible to get a test – read the full story.

Learn more about how to ask for a test to check if you have coronavirus. If your patients do not have access to the internet and need a test, they can call 119 in England and Wales, or 0300 303 2713 in Scotland and Northern Ireland to book a test.

4. Anosmia and Covid-19

In a follow-up to our Monday update, informing members that the UK CMOs added anosmia to the symptoms for suspect Covid-19 cases, you can learn more about anosmia and Covid-19 by listening to Science Weekly. Professor Carl Philpott, professor of rhinology and olfactology at the University of East Anglia and an honorary consultant ENT surgeon and rhinologist, explains which countries have taken similar steps and why. Listen to this podcast to learn more.

5. Remote care

The BAA and Manchester University have issued guidance on remote working. With the BSHAA later issuing a statement on remote care on 15 May. It is not clear at this stage why different guidance is needed for remote care within the same sector and during the same pandemic, but as soon as we learn more, we will update members.

Meanwhile, telehealth is on the rise, reports the BIHIMA and the BSA is carrying out a short survey on telehealth and Covid-19. You can take part here.

6. WHO survey handbook

In non-Covid-19 related news, the NCHA, with other subject matter experts, supported a World Health Organization (WHO) project to improve our understanding of the prevalence of hearing loss. Better data is essential to raising awareness of hearing loss and ear disease among WHO member states.

The survey handbook is the result of an extensive review by the WHO team. It provides guidance for planning and implementing hearing loss surveys, including information on possible data collection tools. The survey handbook will help countries – particularly low and middle-income countries – to gather data by planning and implementing population-based epidemiological surveys.

Harjit Sandhu of the NCHA said: “We have always supported taking a needs-based approach to tackling hearing loss, and have developed tools to facilitate this in the UK, including our hearing map and co-producing the JSNA guide for England. We are pleased we were invited to collaborate in and support this significant WHO initiative. We will continue to support initiatives like this in any way we can; with better data, we really can raise the importance of hearing loss locally as well as globally.”

Read the WHO handbook.

7. Other news

A group of US lawmakers is urging the Senate to allow audiologists to better serve people with hearing loss during the pandemic. It calls for the US Covid-19 response to include “packages to enable vulnerable seniors to readily access critical hearing, balance healthcare services, and allow audiologists to be better deployed to serve them.” If the bill is approved, it will allow audiologists to provide Medicare directly. Read more.

Read the BSHAA’s Covid-19 survey results, including that 87% of respondents had furloughed staff and that 58% of patient contacts would require being closer than two metres.

Professor Kevin Munro discusses ‘Face mask misery: do face masks impair speech understanding?’ in this podcast.

Action on Hearing Loss has called for action to implement communication tips so that people with hearing loss and deafness do not suffer because of the use of face masks.

David Welbourn, BSHAA CEO, gives his personal views on the impacts of Covid-19 on UK audiology. You can read the article here.