RAG rating
n/a
Document type
Clinical pathways
Place
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Pathway
Adult Hearing Loss/Deafness Pathway

Hearing Loss/Deafness | Adult

Pathway Publish Date: March 2024
Pathway Next Review Date: March 2026
 
 
 
 Hearing loss is common, can occur at any age, and can be temporary or permanent, of sudden onset (developing within 72 hours), or slowly progressive, and can be classified as:
    • Conductive — hearing loss occurs due to abnormalities of the outer or middle ear, which impair conduction of sound waves to the cochlea, and/or
    • Sensorineural— hearing loss occurs due to abnormalities in the cochlea, auditory nerve, or other structures in the neural pathway leading from the inner ear to the auditory cortex.
  • It can be categorised as mild, moderate, severe, or profound, based on the quietest sound that can be heard measured in decibels on pure tone audiometry.
  • The most common causes of hearing loss are ageing and exposure to excessive noise.
  • Complications include reduced quality of life, social withdrawal, reduced educational and occupational opportunities, anxiety and depression, and increased risk of dementia and falls.
  • Assessment of a person presenting with hearing loss includes:
    • Asking about who has noticed symptoms; its onset, characteristics and duration; whether unilateral or bilateral; associated symptoms; the impact on daily functioning, cognition, and emotional wellbeing; any underlying causes and comorbidities; family history; current or past ototoxic medications.
    • Examination including assessment of hearing; the pinna, ear canal and tympanic membrane (using otoscopy) for signs of an underlying cause; cranial nerves and cerebellar signs; head and neck for masses.
    • Possible tuning fork tests to assess for symmetrical hearing loss and distinguish between conductive and sensorineural hearing loss.

  • Immediate referral to ENT or an emergency department should be arranged if a person has hearing loss, which is:
    • Sudden-onset occurring in the past 30 days and not explained by external or middle ear causes.
    • Unilateral associated with focal neurology.
    • Associated with a head or neck injury.
    • Due to a potentially serious infective cause.

  • Urgent ENT referral should be arranged if a person has hearing loss which is:
    • Sudden-onset developing more than 30 days ago, or rapidly progressive, which is not explained by external or middle ear causes.
  • Urgent referral using a suspected cancer pathway should be arranged if a person has hearing loss and:
    • Suspected head or neck malignancy.

  • Routine ENT referral should be arranged if a person has hearing loss, which is:
    • Unilateral or asymmetric and gradual onset.
    • Fluctuating and not associated with an upper respiratory tract infection (URTI).
    • Associated with hyperacusis.
    • Associated with persistent, pulsatile, changing, or distressing tinnitus.
    • Associated with persistent or recurrent vertigo.
    • Not age-related.

  • Routine audiology referral for pure tone audiometry and consideration of hearing aids should be arranged if a person has suspected sensorineural hearing loss not needing specialist assessment.
  • Management of a person with hearing loss in primary care includes:
    • Excluding or managing any underlying cause(s) such as impacted earwax or acute infection.
    • Considering ENT referral if the tympanic membrane cannot be fully examined or if clinically indicated.
    • Advising on sources of information and support.
    • Signposting to other services.
    • Advising on auditory rehabilitation strategies.
 
Please see pathway attached.
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