A new way of managing ear symptoms: community audiology-led clinic supported by digital otology

In the past, all patients experiencing hearing problems would visit their GP.

Because ear wax makes it hard to see into the ear and GPs have limited tools, they often need to trial different medications to resolve the problem. When a patient's condition does not change or improve, GPs refer patients to secondary care.

There are many different pathways and not enough information to know which is the right one. As a result, patients can be referred down multiple pathways.

Situation

Community audiology clinics mean patients can self-refer to see an audiologist using an email.

Audiologists can remove ear wax to get a clearer picture of the patient's problem. Where necessary, they can take images to send to secondary care to support diagnosis and help decide whether further interventions are needed.

Resources for binocular ear examinations are often very limited in primary care. Therefore, accurate diagnosis for ear conditions is challenging.

Tools and time are needed to accurately diagnose hearing issues.

Aspiration

Within primary care it’s difficult to accurately diagnose a patient's needs and refer them onto the right pathway. The team wanted to redesign outpatient care and introduce a more efficient way to triage patients.

This would result in:

• a world-class modern service
• better use of clinical time and physical space
• better use of patients’ time
• patients and the system saving money
• improved clinical outcomes
• reduced CO2 emissions

Solution and impact

The remote digital otology service shortens treatment pathways by helping ear, nose and throat (ENT) surgeons assess patients’ hearing and ear problems in the community.

The TympaHealth device is a portable, all-in-one hearing assessment tool. It has:

• video otoscopes to record high-definition digital footage of patients’ ear drums
• microsuction wax removal
• a hearing screener

Clinicians can also upload images and videos of patients to share with audiology and ENT specialists for advice and guidance.

The TympaHealth system helps deliver ear and hearing health directly into the community. This increases accessibility for patients and reduces the outpatient waiting list burden which has grown substantially due to the COVID-19 pandemic.

The service is currently running 2 pilots using technology from TympaHealth.

Pilot 1 involved adult patients under 70 years old with hearing loss or tinnitus.

Patients were seen by University College London Hospitals NHS Foundation Trust (UCLH) audiologists in Boots stores using the Tympa device and audiometry tests.

58 patients attended Boots Hearing Care. Of these, 75.8% had their pathway shortened by one hospital visit. 65.6% of these patients avoided any hospital attendance. 98% of patients were satisfied with the pathway and would recommend the service to another patient.

Pilot 2 saw the UCLH community audiology clinic supported by digital otology. It was available to self-referral patients and advertised through primary care networks.

Patients booked a 45 minute appointment and admin staff used a screening questionnaire to identify suitable candidates.

Audiologists used a standardised history template to capture patient history which included dementia screening for over 60s.

Videos and images were captured for all patients and microsuction was performed by an audiologist with the Tympa device where needed.

Cases that needed otology review were flagged by the system. They were then submitted to an otology specialist for remote review.

Functionality

The app:

• records still and video magnified images of a patient’s ear
• records patient history
• transfers information onto a platform

Capabilities

• Image history is instantly uploaded to a computer connected to the internet.
• The device can also record some outcome measures.

Scope

Audiologists or trained healthcare professionals like healthcare assistants or pharmacists can use the system in a community setting.

Key learning points

• Faster appointments and ENT or otology advice given only when required. This resulted in more patients dealt within a consultant clinic session.
• A higher proportion of patients were discharged without needing to attend the hospital.
• A higher proportion of patients were managed with audiological intervention without needing an ENT face-to-face appointment.
• Used in the community setting, a higher proportion of patients had scans arranged before a hospital face-to-face appointment.
• The patient pathway is streamlined with fewer appointments overall.
• This has improved antimicrobial stewardship in the community for ear health.
• Learn by doing and understanding how the pathway can fit patient needs.

The next step is to evaluate the service. If successful, the team will roll out the service across the North London area.

Key figures

• The service has won a prize from ENT UK best young consultant project 2020-2021.
• The service has won Royal Society of Medicine Mr N Shah ENT Innovation Award 2020.
• Tympa Product has won multiple global awards at the UX Design Awards, iF Design Awards and Good Design Awards.

Key contact

Joseph Manjaly, ENT Consultant, UCLH

joseph.manjaly@nhs.net

Krishan Ramdoo, CEO and Founder, TympaHealth Technologies

krishan@tympahealth.com