Refer adults with sudden-onset (developing within 72 hours) unilateral or bilateral hearing loss that has occurred within the past 30 days immediately (to be seen within 24 hours) to an ear, nose, and throat (ENT) service or emergency department NICE CKS.
Refer adults with sudden-onset (developing within 72 hours) unilateral or bilateral hearing loss that developed more than 30 days ago, or with rapidly progressive hearing loss over 4–90 days, urgently (to be seen within 2 weeks) NICE CKS.
Refer adults with hearing loss that is not explained by external or middle ear causes, especially if it is unilateral, asymmetric, fluctuating, associated with hyperacusis, persistent tinnitus, or vertigo, for diagnostic assessment in specialist audiology or ENT services NICE CKS,NICE NG98.
Refer adults with hearing loss that does not improve with hearing aids or assistive listening devices, or if they have specific symptoms such as unilateral or asymmetric loss, fluctuating loss, or associated distress, for specialist evaluation NICE CKS,NICE NG98.
Refer adults with suspected or diagnosed dementia, mild cognitive impairment, or a learning disability for audiology assessment, especially if they have not previously been diagnosed with hearing loss, or every 2 years if already diagnosed NICE CKS,NICE NG98.
Refer adults with suspected or confirmed middle ear pathology, such as earwax impaction, discharge, or abnormal appearance of the ear or eardrum, to ENT services after initial treatment or assessment NICE CKS,NICE NG98.