The future of audiology – hall of mirrors, hearing loss and donkeys

There’s good news if you have long ears, a braying call and a taste for carrots: the Donkey Sanctuary is ranked 52 in terms of charitable donations and secured £34 million in 2017-18. Our own highest ranking charity, the National Deaf Children’s Society, only secured a ranking of 74 with donations of £23 million. Surprisingly, at least to me, Action on Hearing Loss doesn’t make the top 100. I wonder if both a new name (for what it’s worth, my vote is for Action on Hearing) and an emphasis on the benefits of hearing health, not the consequences of hearing loss, might be worth considering? Sadly, the relatively low charitable donations for hearing loss is matched by less than 1% of UK health research funding being directed at hearing loss.

How can resources be so low when the study of global burden of disease reported by Vos et al (2012) places hearing loss higher than many high profile chronic conditions including diabetes and dementia? Hearing loss hampers communication and affects health and wellbeing. In our recent national study (Armitage et al, under review), public awareness of hearing loss was low. Low public awareness and low financial support (possibly not unconnected) are bad for the health of the nation and must be addressed.

Raising awareness

It’s relatively rare for the media to take an interest in hearing loss. A recent exception is the media’s obsession with the relationship between hearing loss and brain ageing/dementia.  I’d like to remind the evangelists who proclaim hearing loss causes dementia, that causality has yet to be established (watch out for a future blog by Jenna Littlejohn).  A letter focused on hearing health for all, penned by yours truly, appeared in The Times in July (found at this link, but you’ll need to scroll through if you want to avoid the Brexit letters). It was a pleasant surprise that the letter caused journalists to ‘prick up their ears’ and request interviews.

The evening before an article on our hearing research was due to appear in a national newspaper, I picked up a novel by Sara Collins. On the first page I read the following: “For newspapers are like a mirror I saw once in a fair that stretched my reflection like a rack, and gave me two heads so I almost didn’t know myself. If you’ve ever had the misfortune to be written about, you know what I mean. “Was this a sign of things to come? The next morning I was pleased to see the article was published, but embarrassed by the misleading headline: “Deafness on verge of being cured by hearing loss hero.” However, despite my embarrassment it’s good news to have hearing loss on the nation’s radar. It was Oscar Wilde who said, “There is one thing in the world worse than being talked about, and that is not being talked about.”

Understandably the article provoked numerous emails from patients, hoping for a cure for their hearing loss. I found myself responding along the following lines: “Apologies, the article headline is misleading and there are no cures, but we will redouble our research efforts.” This reply was my attempt to balance reality with an olive branch of hope. There are few heroes (most of us will achieve, at best, a passing footnote in the annals of audiology history) and no quick fixes, although, to be fair, there is considerable interest in inner ear therapies that may, one day, prevent or cure hearing loss.

Where do we go from here?

We’ve come a long way since the Manchester Centre for Audiology and Deafness was formed 100 years ago. However, hearing health professionals are faced with an uncomfortable truth. There is a shortage of high quality research evidence on which to underpin much of our clinical practice. Consider the National Institute for Health and Care Excellence (NICE) national guideline (NG98) on the assessment and management of hearing loss in adults. The guideline is structured around key areas of interest where there is variation, and uncertainty, in current practice. For 50% of the research questions posed in the hearing loss guideline there is no evidence, and the quality of evidence for the remaining questions was frequently rated as low or very low. As a professor of audiology, and a member of the NICE guideline committee, this was an uncomfortable outcome for me. A review of over 100 guidelines published on the NICE website confirms we are not alone in lacking a strong evidence base for clinical practice. On the one hand, this is a comfort: on the other hand, it’s unsettling. Can so much clinical practice be based on opinions and consensus?

The blogs in this series have highlighted some of our recent research developments and demonstrate that we have cause for optimism. Our research programmes build on new discoveries in prevention of hearing loss, diagnosis and intervention. Our work is driving improvements in hearing health and lasting change for all, through (we hope) life-changing research that bridges the gap between new discoveries and individualised care.

I am delighted that on 9th October we will be sharing our latest work at our Hearing Health theme showcase in Manchester.

Providing an evidence base on which to base clinical practice is a good starting point. Timely implementation is another. In the (adapted) words from the lyrics of ‘Ripple’ by the Grateful Dead, “There is a road, but no simple highway, between the research lab and the reality of clinical practice.”