Hearing aid
18. Mrs O complains the Service did not action her request for a skeleton mould for her left hearing aid. She says she requested this in October 2022. She says her left hearing aid would fall out and was eventually lost. Mrs O says she was without any left hearing aid until May 2023.
19. The Service explained Mrs O still had her left hearing aid on 13 December 2022. It did not say when Mrs O first reported it as lost or when it was replaced.
20. NICE guidance on hearing loss says:
‘Statement 5: Adults presenting with hearing loss affecting their ability to communicate and hear are offered hearing aids.’
21. The guidance does not say what should happen when someone requests a specific mould like skeleton moulds. The guidance says a patient should be offered a hearing aid. In line with guidance, we can see Mrs O was offered hearing aids. The guidance does not say what timeframe these should be provided.
22. The NHS website says:
‘Batteries, repairs and replacements: Your local hearing aid service can also replace hearing aids that have been lost or damaged, although there may be a charge for this.’
23. Our adviser explains there is no recognised guidance for the timing of replacing lost hearing aids. The records show the Service did a mould for a left hearing aid on the same date it found out Mrs O had lost her left hearing aid. This is in keeping with recommended practice.
24. Mrs O could not remember exactly when she requested a skeleton hearing aid. She says it was ongoing from October 2022.
25. We do not dispute Mrs O’s version of events. The first record where it is noted that she requested skeleton hearing aids is on 13 December 2022. The first record of the hearing aid being lost is on 14 March 2023. After Mrs O’s hearing aid was recorded as lost the Service provided a replacement on 19 April. Mrs O’s skeleton moulds were provided on 5 May.
26. We know this was a frustrating time for Mrs O because she felt she did not have the right hearing aids. Our adviser has confirmed there is no guidance for how quickly replacement hearing aids should be provided. In line with NICE guidance the Service offered Mrs O hearing aids and it replaced the lost hearing aid in five weeks. It provided Mrs O’s new mould within five months. We do not think it did anything wrong.
Ear infection
27. Mrs O complains that on 15 March 2023 her right eardrum was damaged during a suction procedure to remove earwax.
28. The Service said the consultant noted her eardrums looked normal after the procedure. It said during an appointment on 21 March both her eardrums were reported to be intact. It explained a pressure suggested there may be fluid behind her eardrum. It decided it was unlikely it had damaged Mrs O’s eardrum.
29. The ENT report on 15 March has no information about Mrs O’s right ear drum. The report says wax was removed from the left ear. It explains one of the notes refers to the right ear but after the procedure, both ears had normal eardrums.
30. NICE guidance on earwax management says:
‘How should earwax be removed?
Microsuction (using a vacuum to suck the wax out under a microscope) or another method of earwax removal (such as manual removal using a probe) may also be considered if the expertise is available and there are no contraindications to the methods.
What are the risks and possible complications of earwax removal procedures?
Possible complications of earwax removal include: • otitis externa (outer ear infection) • perforation of the tympanic membrane (eardrum)’.
31. In line with this guidance the Service used an appropriate method for removing the earwax. The guidance notes a possible risk is perforation. Our adviser agrees the guidance states the risks of this procedure include outer ear infection and perforation of the eardrum.
32. We have looked at if there is evidence of damage to Mrs O’s eardrum.
33. On 21 March Mrs O went to hospital and the audiologist recorded Mrs O’s pain and discomfort. They explained Mrs O’s ear canal volume was normal in both ears which suggests there was no perforation. The record notes her eardrums were intact.
34. On 31 March Mrs O was seen by an out of hours GP. They noted that on examination of her right ear the eardrum was party visible, there was slight swelling and the ear looked wet but with no discharge. No perforation noted.
35. We asked our adviser if a perforated eardrum would have been visible in the two appointments after the procedure on 15 March. Our adviser says it would have been visible and any damage caused would have resulted in abnormal tympanometry. Tympanometry refers to a test that helps in the evaluation of the proper functioning of the middle ear. Both records on 21 March and 31 March indicate Mrs O’s eardrums were intact.
36. We know Mrs O was upset as she felt her right eardrum had been damaged on 15 March. We understand this has caused frustration because her hearing had been affected. In line with guidance the procedure was appropriate. An accepted risk of the procedure is perforation of an eardrum. But, we have not seen evidence that Mrs O’s eardrum was perforated or damaged. As records from the next two appointments do not note any issues that suggest perforation or damage, we think it is unlikely that harm was done on the 15 March appointment.
Appointments
37. Mrs O complains the Service failed to give her an appointment after the 15 March procedure until 27 April 2023.
38. The Service said it got her GP’s referral on 4 April. It explained it was not marked as urgent and was not added to its system until 19 April. Mrs O had an audiology appointment on 19 April where she was then given an appointment for an ENT consultation on 27 April. It apologised for not being able to bring her appointment forward.
39. On 21 March there is no record of Mrs O requesting an ENT appointment with the Service.
40. On 30 March Mrs O called her GP practice’s out of hours number. She was given an appointment on 31 March. Her appointment record on 31 March confirms a referral to ENT was needed. The referral is not noted in the records as urgent.
41. None of the NICE guidance gives specific timeframes for appointments after a microsuction procedure. Our adviser explains the Service is not an urgent treatment provider. Mrs O correctly went to her GP who referred her as it should.
42. The Service noted this referral on 4 April 2023.
43. On 6 April Mrs O emailed the Service saying she had received a notification to say her referral for an appointment was being reviewed. She asked to have her appointment as soon as possible.
44. On 14 April Mrs O emailed the Service and asked for a reply to her email dated 6 April. On 19 April Mrs O attended an audiology appointment. The audiologist noted they had booked Mrs O in for an ENT appointment. On 24 April the Service replied to Mrs O. It explained the audiology team had booked her in for an appointment with an ENT doctor on 27 April.
45. We asked our adviser if the Service acted correctly and they confirmed the referral was not marked as urgent so the appointment was provided appropriately.
46. We are sorry to hear Mrs O felt she was not given an appointment soon enough. We realise this would have caused her stress. The records show the first request for an appointment was sent on 31 March and received on 4 April. An appointment was provided within four weeks. As the referral was not marked as urgent we do not think the Service did anything wrong when providing this appointment.