Adult Audiology

How long does it take?

Depending on your referral, your appointment will last around an hour

What happens?

You will be seen by an audiologist, who is trained in the assessment of hearing, and rehabilitation using hearing aids. Sometimes the audiologist will be working with an associate audiologist.

The audiologist will ask you questions about your hearing such as when you have difficulties hearing, and for how long you have had problems. They will also ask some questions about the health of your ears, such as if you have had infections or perforations, as well as about your general health. They will look into your ears using a special torch (an otoscope) to make sure they are healthy. The hearing test involves wearing headphones and listening to different sounds. Each time you hear a sound, you will be asked to press a button. These sounds will vary in loudness. The audiologist will find out which sounds you are able to hear, separately for each ear. After the test, the audiologist will explain the results.

This will show if you have a hearing loss, and if so, which pitches of hearing are affected and to what degree. If you have a hearing loss, it is very likely that you would benefit from hearing aids. If hearing aids are recommended and you would like to try them, a cast of your ears will be taken so individual ear inserts (earmoulds) can be made. An appointment will be arranged for you to come back for the hearing aid fitting.

Fitting Appointments

A fitting appointment will be arranged if you have agreed to have NHS hearing aid/s. We understand that having hearing aid fitted for the first time is a big step.

The Audiologist will carefully programme your NHS hearing aid/s in accordance to your prescription. This means that we verify your hearing aids and make sure that you receive the appropriate amount of amplification for your hearing loss. We advise that you ensure that your ears are clear of wax prior to your fitting appointment to allow for an optimal fitting.  

Once we have programmed your hearing aids to your prescription we will confirm that the hearing aids sound and feel comfortable and we will discuss with you what to expect from your new listening situations.

We will go through how to use your hearing aids. This may include:

• How to change hearing aid batteries
• How to use the controls on the hearing aids
• How to insert the hearing aids into your ears
• How to connect your hearing aids to other devices

In this appointment you will have the opportunity to ask any questions about your hearing loss and new hearing aids.

Once you have been fitted with hearing aid/s you will be on an open appointment and will be able to contact us with any queries or concerns.

Review Appointments

Once you have been fitted with hearing aids you will have an open appointment with Audiology. Please contact if you would like further support.

This may include:

• You need to have your hearing aid tubing changed
• You have lost your hearing aid/s
• Your hearing aid is not working
• Your hearing aid doesn’t sound right
• Your hearing aid is not comfortable in your ear
• You need advice on how to connect your hearing aid to your devices
• You would like to purchase custom fitted swim plugs

A repair is a 15 minute appointment with an audiologist. You can choose to have your repair at The Ropewalk House or at one of the local health centres. Please contact the Audiology department for a repair appointment. We will try our best to appropriately manage your needs in the repair appointment or triage you into the most appropriate clinic.

If you feel that there has been a change to your hearing and it has been 3+ years since your last hearing test then you may request for a reassessment. Please ensure that your ears are clear prior to booking in for a hearing test. If your hearing test was less than 3 years ago we will triage you into the right appointment.

There may be instances where you may have multiple queries/concerns. If this the case then you may be booked into a follow up appointment which will allow the audiologist more time to manage your situation.

BCHI programme

Bone conduction hearing instruments can offer an alternative hearing solution for service users who have limited success with conventional hearing aids. By utilising the body’s natural ability to transmit sound via bone conduction we can directly stimulate the inner ear, by-passing the outer and middle ear. This method of management can benefit adults and children with:

• Congenital abnormalities of the outer and/or middle ear (e.g. atresia, microtia)
• Permanent conductive or mixed hearing loss (unilateral or bilateral)
• Single sided deafness

Our experienced team of specialist audiologists are able to assess, counsel and manage patients through the BCHI process. Surgical provision of BCHI is a joint service between Audiology and Otology (ENT) however we are also able to provide long-term non-surgical options for those service users who opt for this.

At Nottingham we are able to offer both Bone Anchored Hearing Aid (BAHA) and Osia systems

Tinnitus Clinic

Tinnitus is the sensation of hearing a sound when there is no external source for that sound. It is very common, affecting about 1 in 7 people in the UK.

The ears convert sound energy into nerve signals in the inner ear and send the information to our brains, but this is only part of the story. We don’t hear with our ears, but instead with our brains. The ears are there to tell the brain what sounds are out there. Every sound that reaches out ears will be intercepted by the brain. Some sounds are ignored completely, since there are no important at the time, whereas other will be “heard.”

The tinnitus clinic in Nottingham was established over 25 years ago. Our dedicated tinnitus team use up-to-date research to provide management for people with tinnitus. This includes information counselling to explain the mechanisms of hearing and to demystify tinnitus, sound enrichment techniques and equipment and further advice such and breathing and relaxation techniques.

Vestibular (balance) Assessment

The initial appointment is usually up to two hours, your audiologist will take a full clinical history, discussing your symptoms, general health and medical history. 

It is beneficial to have a timeline of your symptoms so the audiologist can have a full picture of what your experiencing, and this can aid your testing and management.

The audiologist will then conduct a series of tests, assessing your balance system by recording your eye movements. The balance system is made up of the balance organs in each of your ears (vestibular information), your eyes (visual information); and the sensors in your joints and muscles (proprioceptive information). Your brain also has to combine all of this information so that it can work out where your head and body are in relation to your environment. As audiologists, we are most interested in the function of your vestibular organs. They are the balance organs, located inside your ears.

It is advisable to avoid wearing eye make up as this interferes with the eye recordings.

Please do not consume any alcohol, recreational drugs, or balance medication 48 hours prior to your appointment. These too interfere with test results and can delay diagnosis and management.

Vestibular Rehabilitation

Some patients require a vestibular rehabilitation programme. This is a programme of tailored exercises aimed at reducing your dizzy symptoms and speeding up your recovery. 

When there is a disruption to the balance organs, it can take time for your brain to adapt to the change in information from them. Vestibular rehabilitation aims to assist the brain in re-learn how to use this information. It is important that you remain as active as possible.

The audiologist will assess your symptoms, discuss balance mechanisms, and develop a tailored exercise plan with you. This requires you to complete exercises on a daily basis, in a safe and controlled manner.

These appointments are up to 45 minutes in duration.

Audiology Dementia Service

Dementia and a hearing impairment appear to have the same characteristics, often they develop slowly and it is not always obvious in the early stages. At present a hearing assessment is not included on the dementia screen.

Listening, understanding and communication require cognition, attention and memory as well as hearing.  The similarities between hearing impairment and dementia may appear in the form of loss of speech perception or comprehension, people may become more isolated, psychological symptoms may change they may become more frustrated, anxious, or depressed, are these changes due to poor hearing or early indicators of dementia?

We recommend that anyone who has newly been diagnosed with any sort of dementia or Alzheimer’s to get their hearing tested. We are able to provide specific clinics tailored for people with dementia, we can provide customised rehabilitation programmes to increase communication skills, perhaps involving family and carers.  Regular hearing assessments on our dedicated clinic, and open access for any future appointments.

Hearing aids if recommended have the potential to slow down cognitive decline in dementia patients, and have the potential to improve people’s way of life and living.

We offer a young person’s clinic and a young person advisory clinic aimed at hearing aid users between the ages of 16 and 25. Our primary aim is to offer support and guidance to our patients who are in the process of transferring from our paediatric to adult services at an important stage of their life.

As well as offering reassurance along their journey we give advice on higher education, help in the work place, assistive listening devices, funding. We also look into ways technology can further enhance their lifestyle and help ensure they are able to continue being a part of their social group, so they can enjoy similar opportunities to that of their peers. The service provides information to the young person, partners, families, and friends. Our goal is to empower the young person to become more independent and take control of their own health and decision making.

The service provided is run by a team of specialist audiologists with extensive experience of working with hearing aids and modern hearing aid technology. We have a multidisciplinary team with strong links with adult services and ENT where we modernise our service regularly to help meet patient’s individual’s needs

Adult Learning Disability Service

Within the Adult Learning Disability Service, we have a dedicated team who specialise in the hearing care of adults with any form of learning difficulty. The aim of the service is to support people with learning disabilities in getting the most from their hearing, whether this is by the use of hearing aids, ongoing support and advice on communication tactics or even general advice on ear care.

We are able to visit people at their home, at day centres or support groups, or wherever they feel most comfortable so as to minimise anxiety and encourage co-operation. We offer adapted hearing assessments and regular hearing aid checks.

Anyone can refer to the service. Please contact us if you would like to make an appointment.

In addition to Ropewalk House, we offer Hearing aid repair clinics at the following locations:

• Carlton Health Centre – Monday mornings
• Keyworth Health Centre (repairs and triage) - Monday Afternoons
• Bulwell Health Centre (repairs and triage) – Tuesday Mornings
• Clifton Health Centre – Tuesday Mornings
• Lark Hill Retirement Village – Tuesday afternoon (once a month)
• Hucknall Health Centre and Arnold Health Centre – Wednesday Mornings
• Arnold Health Centre – Wednesday Afternoons
• West Bridgford Health Centre – Thursday morning 2^nd & 4^th Thursdays of the month
• Bingham Health Centre -Thursday Afternoon 2^nd & 4^th Thursdays of the month
• Bulwell Health Centre (triage only)  – Thursday Afternoons 
• Beeston Health Centre – Friday mornings
• Eastwood Health Centre - Friday mornings
• Stapleford Health Centre (repairs and triage) – Friday mornings

All clinics listed above offer repairs unless otherwise stated. 

Repair or replacement of faulty hearing aids, which includes:

• servicing including routine replacement of filters and accessories
• impressions for replacement earmoulds
• modification of earmoulds for comfort and acoustic reasons
• minor adjustment to hearing aid settings.

Some of the clinics above (as indicated) offer triage, which includes:

• triage for reassessment of hearing aid needs
• hearing reassessment for people with obsolete hearing aids
• hearing reassessment for people whose hearing needs have changed
• minor adjustment to hearing aid settings
• signposting and referral for further management.

What is earwax?

Earwax is produced naturally in your ears, It helps to keep the ear clean and free from any germs of infection. Earwax will normally come out of your ears on its own, but sometimes if can build up and reduce your hearing. If this happens might be necessary to have it taken out by someone who is qualified to remove it.

When does it become a problem?

The signs of earwax build up can be as simple as the feeling that your ear is blocked and you cannot hear as well. Sometimes you may experience ear pain and itching, or you may start to notice tinnitus (noises in your ear). If you have a hearing aid, you may notice that you hearing aid starts to whistle, or that the mould or tubing is blocked by earwax. This can affect the level of sound that you hear.

• If you experience a sudden change in hearing that is not thought to be the result of earwax build up, it is important to contact your GP surgery.
• If you have significant ear pain and itching or notice discharge from your ears this could be signs of an ear infection so you will need to seek GP advice.

What can you do about earwax build up?

If you have NO recent ear infections (within the last 6 weeks), perforations (a hole in your eardrum), past ear surgery or cleft palate history you can use olive oil in your ears to help soften the earwax.  If you do have a history of frequent or recent ear infections, perforations, cleft palate or had ear surgery please contact your GP surgery for advice.

It is important that you DO NOT use cotton wool buds or any other device in your ear as there is a risk of damage or pushing the wax down further down, which then becomes more difficult to treat.

You will need to purchase olive oil (for your ears) from your local chemist. It is usually available as drops or a spray. The spray may be easier to use. Warming the olive oil is not advised and it should be used at room temperature.

How to use olive oil in your ears:

• The most effective way is for you to lie down on a bed or sofa, with the ear facing up towards the ceiling. This helps drops need to cover the skin lining, the ear canal and the eardrum. 
• Use a dropper to put two or three drops into the ear canal, and allow the drops to flow down the canal (or if you’re using a spray, spray two or three times).  Wait ten minutes in this position so the solution reaches the innermost part of your ear canal.
• If you need to treat both ears, turn over onto your other side and repeat the process.
• Wipe away any excess when you sit up.  DO NOT insert cotton wool or tissue paper into your ears as this can absorb the oil, leaving the wax dry and hard.

When to seek further advice

If you have been using olive oil as outlined above for 7 days and your symptoms have not improved you should contact your GP surgery for advice. 

Earwax & Audiology appointments

Each time you have an appointment in Audiology, it is important that your ears are clear of excessive wax.
Your Audiologist can then examine your ear properly and carry out any tests needed.
Please use ear drops before you attend your appointment, unless you have been advised not to.

How is earwax removed

There are three methods of earwax removal in cases where self-management has not been successful or was not advised in the first place due to other ear related problems.

Manual removal

This is using a small instrument to remove wax from the ear without the need for any other equipment. Ideal in cases where the wax is quite dry but not hard, and not too close to the ear drum.

Irrigation

This is where water is used to flush wax out of the ear canal. The equipment required to do this has been designed for this purpose.  In people where there is a history of ear infections, perforation (a hole in your eardrum), cleft palate or past ear surgery, irrigation is not advised. Irrigation to remove wax is the common method used by district nurses and some GP practice nurses.

Micro-suction 

This is where air is used to remove wax from the ear canal by suction  The equipment required to do this has been designed for this purpose. A plastic tip is inserted into the ear canal to protect it and a suction probe is used to remove the wax. This method is safe for patients who have had perforations and some ear surgery, or had recent infections. 

With all procedures the wax must be softened before it can be removed so regular use of olive oil beforehand is advised. 

Does wax removal hurt?

Providing the wax has been softened beforehand the procedure should be painless. If the wax is too hard you will be advised to carry on with olive oil drops. Most people are able to have the procedure performed without any problem at all, while some people have very sensitive ear canals. At any point if you experience discomfort and want to stop, you can notify the person performing the procedure.

What should I do after earwax removal?

If your hearing has improved then no further action is required and you can continue to use olive oil drops or spray at least once a month to help with future wax build up issues.
If your hearing has not improved you should contact your GP surgery for advice.