Deafness and hearing loss toolkit
Guidance for GPs on the care of patients dealing with deafness and hearing loss.
Common Red Flags and Referral Guidelines Timeline
NICE guidelines: Hearing Loss in Adults was updated in September 2019. The recommendations on the timeliness of referrals for patients with a hearing loss to Ear Nose Throat (ENT) specialist, emergency department or audiovestibular medicine service are based on the guidance from the British Academy of Audiology and expert opinion in review articles.
Red Flags
- Asymmetrical or Unilateral Hearing Loss - Age related hearing loss should be symmetrical. If an individual is reporting hearing loss that is greater in one ear than the other, then further investigation is required.
- Sudden hearing loss (over >72 hours or less) within the past 30 days is considered a medical emergency. Individuals should be seen within 24 hours by an ear, nose and throat service or an emergency department.
- If the hearing loss worsened rapidly (over a period of four to 90 days), refer urgently (to be seen within two weeks) to an ear, nose and throat or audiovestibular medicine service.
- For otalgia (earache) with otorrhoea (discharge from the ear) that has not responded to treatment within 72 hours and the individual is immunocompromised, refer to an ear, nose and throat service to be seen immediately within 24 hours.
- Persisting middle ear effusion in patients of Chinese or Southeast Asian origin.
- Fluctuating hearing loss.
- Hyperacusis (intolerance to everyday sounds that causes significant distress and affects a person’s day-to-day activities).
- Persistent tinnitus that is unilateral, pulsatile, has significantly changes in nature or is causing distress.
The guideline covers timelines of when to:
- Sudden onset (over three days or less) unilateral or bilateral hearing loss which has occurred within the past 30 days and cannot be explained by external or middle ear causes
- Unilateral hearing loss associated with focal neurology
- Hearing loss associated with head or neck injury
- Hearing loss associated with severe infection, for example, necrotising otitis externa
- Sudden onset (over three days or less) unilateral or bilateral hearing loss which developed more than 30 days ago and cannot be explained by external or middle ear causes
- Rapidly progressive hearing loss (over a period of four to 90 days) which cannot be explained by external or middle ear causes.
- Suspected head and neck malignancy — refer using a two-week cancer pathway
- Unilateral or asymmetric gradual onset hearing loss as their main symptom
- Fluctuating hearing loss that is not associated with an upper respiratory tract infection
- Hearing loss associated with hyperacusis
- Hearing loss associated with persistent tinnitus which is unilateral, pulsatile, significantly changed or causing distress
- Hearing loss associated with persistent or recurrent vertigo
- Hearing loss that is not age related
- Diagnosed dementia or mild cognitive impairment
- Suspected dementia
- Diagnosed learning disability
If unsure if to refer to ENT or AVM or Audiologists, please refer to the referral pathways section of the toolkit.
Additional information and further reading:
- NICE guidelines - Hearing loss in adults: assessment and management - Assessment and referral
- NICE guidelines- Hearing loss in adults: assessment and amangement - When should I refer a person with hearing loss to secondary care?
- NICE guidelines NG98 Full document - Hearing loss in adults: assessment and management - Immediate, urgent, and routine referral - see page 55