Referral Pathways

Regional variations exist, please check local services.

Adult Rehabilitation (Audiology)

Referring patients as a direct referral for routine hearing difficulties:
  • Some audiology services are now taking direct referrals from age 16, but most take referrals from age 18 onwards or from age 50 onwards. Please check with local services for age criteria.
  • A hearing assessment is undertaken and further management in the form of hearing aid provision or assistive listening devices
  • Patients are followed-up and are routinely reassessed at the discretion of the local audiology service. Please refer to sections 1.5, 1.6, 1.7 in the NICE guidance NG98 for further details on assessment and management undertaken in audiology services.
  • If an exclusion criterion is met during the patient’s assessment in audiology they will be referred onwards to the local Ear, Nose, Throat (ENT) Department, audiovestibular medicine (AVM) service, or GP for further investigation and management.
  • The British Academy of Audiology has produced this 'Guidance for Primary Care: Direct Referral of Adults with Hearing Difficulty to Audiology Services' (PDF), which contains further details and explanation of the exclusion criteria.


  • If patient meets any of the exclusion criteria outlined in the guidance, please refer onwards to the local ENT department, AVM, or specialist audiology practitioner depending on local services/protocols.
  • Refer to AVM for complex hearing and/or balance disorders (i.e. central pathologies).
  • Refer to ENT for conditions that may require surgical management (i.e. otosclerosis, otitis media with effusion, cholesteatoma etc

Audiology Led Clinics (ALC)

  • Please check your local area if this service exists.
  • It is a direct access clinic for adults aged 18 to 75 with non-complex: tinnitus and/or hearing loss or balance problems (peripheral, inner ear disorders i.e. BPPV, vestibular neuritis etc.) Patients are seen by audiologists with an extended scope of practice and expertise beyond routine hearing assessments.

Hearing Therapy/Clinical Psychology

  • For patients who have had all necessary medical investigations completed by ENT/AVM, GP or audiologists
  • Refer complex patients for counselling, habilitation and further management of tinnitus, hyperacusis, auditory processing disorder management, and mindfulness

Auditory Implant Services

  • Please refer adults with severe to profound deafness for a cochlear implant assessment if they do not receive adequate benefit from acoustic hearing aids
  • Please refer to NICE guidance for further details and criteria

Sensory Services

  • Sensory services is under adult social services and is for those who are visually impaired, deaf or hard of hearing, or dual sensory impairments. The team provides specialist equipment to aid mobility, communication and daily living in response to assessed needs, for example, vibrating alarms, flashing smoke alarms, telecoil systems and others
  • Please check with your local council.