The National Center for Evidence-Based Practice
in Communication Disorders
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Summary of Clinical Practice Guideline

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)

Royal College of Speech and Language Therapists Clinical Guidelines: 5.7 Deafness/Hearing Loss
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.

AGREE Rating: Highly Recommended

Description:
This evidence-based guideline provides recommendations for the assessment and management of communication impairments caused by deafness or hearing loss in children and adults. This guideline is intended for speech-language pathologists. Each recommendation is graded:

  • A - requires at least one randomized controlled trial,

  • B - requires at least one well-conducted clinical study, or

  • C - requires evidence from expert committee reports.

Recommendations:

Adult Hearing Loss

  • Screening/Assessment

    • Assessment

      • Case History

        • In addition to gathering information about medical history, the clinician should consider collecting the following case history information (Grade C):

          • Age at diagnosis, type, nature, and etiology of hearing loss

          • Age at intervention

          • Audiological test results

          • Type of amplification, age at fitting, and consistency of use (if applicable)

          • Recommended hearing aid settings and use of environmental devices (if applicable)

          • First language, including sign language

          • Preferred language, including sign language, manually coded English, cued speech, gesture, and speech

          • Level of speech reading competency

          • Other audiological/vestibular symptoms (e.g., tinnitus, balance impairment)

          • Need for interpreter

          • Links to Deaf community.

  • Treatment

    • Hearing Aids

      • Validation

        • Sound Field Testing

          • “The individual’s ability to use their aided hearing for auditory perception should be assessed in order to ascertain their ability to detect, discriminate and identify both environmental and linguistic sounds

          • Post-lingually deafened adults and some, but not all, school-aged deaf children may require assessment with closed-set speech perception materials” (Grade C, p.56).

        • Self-Report Questionnaires

          • “The individual’s ability to use their aided hearing for functional listening in everyday home, school or work environments should be assessed” (Grade C, p. 54).

    • Aural Rehabilitation

      • Clinicians should collaborate with others to adapt the physical, social, sensory, and linguistic environment to enhance language and communication accessibility (Grade C).

      • “Direct and/or indirect approaches might be undertaken to facilitate the individual’s development of:

        • Non-verbal communication

        • Conversational and discourse skill

        • The social rules of communication

        • Strategies used to compensate for linguistic or communicative difficulties” (Grade C, p. 58).
Permanent Childhood Hearing Loss
  • Assessment/Diagnosis/Screening

    • Audiologic Assessment

      • General Findings

        • In addition to the typical case-history questions, additional information should be collected on:

          • Etiology of the hearing loss

          • Age at diagnosis and type of hearing loss

          • Audiological test results

          • Age at amplification or intervention

          • Preferred methods of communication

          • Amplification settings

          • Languages and modalities used across settings (Grade C Recommendation).

    • Communication Assessment

      • General Findings

        • In addition to the typical case-history questions, additional information should be collected on:

          • Etiology of the hearing loss

          • Age at diagnosis and type of hearing loss

          • Audiological test results

          • Age at amplification or intervention

          • Preferred methods of communication

          • Amplification settings

          • Languages and modalities used across settings (Grade C Recommendation).

        • An assessment should include the child’s ability to use their amplification for functional listening in everyday situations. It should also include the child’s use of multi-modal communication (e.g., gesture, sign). Assessment of sign language competence will require collaboration with fluent sign users. The speech-language pathologist will need to consider the unique needs of children with hearing loss from multi-lingual backgrounds (Grade C Recommendation).

        • When appropriate the assessment should include an evaluation of:

          • Preverbal communication skills including symbolic play, eye contact, turn-taking and independence in spontaneous interaction and communicative contexts (Grade B Recommendation). 

          • Social and interaction skills including gesture use and understanding, facial expressions, social communication skills, and discourse skills (Grade C Recommendation).

          • Understanding and use of language in all relevant modalities. This should include an analysis of use and understanding of semantics and grammar (Grade C Recommendation).

          • Aided and unaided auditory skills (Grade C Recommendation).

          • Speech production and intelligibility (Grade C Recommendation).

          • Vocal characteristics including prosody, pitch, resonance, and range (Grade C Recommendation).

  • Treatment

    • Communication

      • At the beginning of each session, the speech-language pathologist (SLP) should visually inspect the amplification equipment (e.g., hearing aids, cochlear implant) and “check the quality of the signal of hearing aids using stetaclips” (p. 54). As appropriate, the SLP should consult with other relevant professionals (e.g., teacher of the deaf, educational audiologist) (Grade C Recommendation).

      • When appropriate to the child, management of hearing loss in children should include:

        • Intervention to develop early communication skills (e.g., eye contact, initiation, turn-taking) (Grade C Recommendation).

        • Approaches to develop social and interaction skills (e.g., non-verbal communication, discourse skills, social communication skills, and compensatory strategies for communicative deficits) (Grade C Recommendation).

        • Direct or indirect strategies to facilitate the development of receptive and expressive language skills (Grade C Recommendation).

        • Environmental modifications to make language and communication more accessible (Grade C Recommendation).

        • Auditory training (Grade B Recommendation).

        • Direct treatment to improve the child’s speech or sign intelligibility (Grade B Recommendation).

        • Speech reading (Grade C Recommendation).


School-Age Hearing Loss

  • Screening/Assessment

    • Assessment

      • Audiologic

        • Case History

          • In addition to gathering information about medical history, the clinician should consider collecting the following case history information (Grade C):

            • Age at diagnosis, type, nature, and etiology of hearing loss

            • Age at intervention

            • Audiological test results

            • Type of amplification, age at fitting, and consistency of use (if applicable)

            • Recommended hearing aid settings and use of environmental devices (if applicable)

            • First language, including sign language

            • Preferred language, including sign language, manually coded English, cued speech, gesture, and speech

            • Level of speech reading competency

            • Other audiological/vestibular symptoms (e.g., tinnitus, balance impairment)

            • Need for interpreter

            • Links to Deaf community.

  • Treatment


    • Hearing Aids


      • Verification and Validation


        • “The individual’s ability to use their aided hearing for functional listening in everyday home, school or work environments should be assessed” (Grade C, p. 54).

        • “The individual’s ability to use their aided hearing for auditory perception should be assessed in order to ascertain their ability to detect, discriminate and identify both environmental and linguistic sounds" (Grade C, p. 56).

        • "Post-lingually deafened adults and some, but not all, school-aged deaf children may require assessment with closed-set speech perception materials” (Grade C, p.56). 

    • Aural Rehabilitation

      • Clinicians should collaborate with others to adapt the physical, social, sensory, and linguistic environment to enhance language and communication accessibility (Grade C).

      • “Direct and/or indirect approaches might be undertaken to facilitate the individual’s development of:

        • Non-verbal communication

        • Conversational and discourse skill

        • The social rules of communication

        • Strategies used to compensate for linguistic or communicative difficulties” (Grade C, p. 58).

    • Educational Considerations

      • Clinicians may provide advice on classroom management to facilitate access to the curriculum. This may involve:

      • Modification of methods of presentation of information

      • Development of a range of tools to aid organization

      • Different methods of delivery

      • Staff training
        (Grade B).

    • Communication

      • General Findings

        • “Direct and/or indirect approaches might be undertaken to facilitate the individual’s development of:

          • Non-verbal communication

          • Conversational and discourse skills

          • The social rules of communication

          • Strategies used to compensate for linguistic or communicative difficulties” (Grade C, p. 58). 

        • Direct or indirect interventions should be considered to improve receptive and expressive aspects of spoken, signed, or written language (as appropriate) including semantic, grammatical and phonological competencies (Grade C).

      • Communication Modalities

        • Auditory/Oral Approaches

          • Auditory training is an essential prerequisite to any speech production work for children for whom spoken language will be the primary mode of communication. Auditory training extends from closed-set activities to functional listening which may include auditory/speech-reading activities (Grade B).

          • Consider direct therapy to improve speech intelligibility at the phonological and/or phonetic level including both segmental and supra-segmental features.  Development of speech perception should precede intelligibility therapy (Grade B).

          • Speech-reading may be a prerequisite for auditory training and “may facilitate recognition of lip shapes, anticipation and use of context from very basic lip patterns to single words to running speech”

        • Signed Language

          • Consider direct therapy to improve sign intelligibility in conjunction with a competent sign language user (Grade B).

Social Communication Disorders
  • Treatment

    • Cognition/Language

      • General Findings & Hearing

        • “The [Speech & Language Therapist] SL&T will explain the relationship between hearing and communication, and will be available for discussion and support.  Intervention should seek to facilitate the development of early communication skills, particularly appropriate eye contact, initiation, communicative intent and turn-taking skills” (p. 58). 

        • “Direct and/or indirect approaches might be undertaken to facilitate the individual’s development of [knowledge and abilities such as the social rules of communication as well as conversational and discourse skills]” (p. 58). 

  • Service Delivery

    • Provider

      • “The [Speech & Language Therapist] SL&T will explain the relationship between hearing and communication, and will be available for discussion and support.  Intervention should seek to facilitate the development of early communication skills, particularly appropriate eye contact, initiation, communicative intent and turn-taking skills” (p. 58).

Keywords:
Deafness, Hearing Loss

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