What are the recommended initial assessments for a patient presenting with hearing loss in primary care?

For an adult patient presenting with hearing loss in primary care, the recommended initial assessments involve several key steps:

• Exclude impacted earwax and acute infections, such as otitis externa ¹.
• If earwax is contributing to the hearing loss or other symptoms, or needs to be removed to examine the ear, offer to remove the earwax in primary care or community ear care services ¹. Manual syringing is not recommended for earwax removal ¹. Methods like electronic irrigation, microsuction, or manual removal can be considered by practitioners with appropriate training and equipment ¹. If ear irrigation is unsuccessful after a second attempt, the patient should be referred to a specialist ear care service or an ear, nose and throat (ENT) service for earwax removal ¹.
• After excluding impacted wax and acute infections, arrange an audiological assessment ¹.
• Refer for additional diagnostic assessment if needed, based on specific symptoms or signs ¹. This includes:
  • Immediate referral (to be seen within 24 hours) to an ENT service or emergency department for sudden onset hearing loss (developed over 3 days or less) within the past 30 days ¹.
  • Urgent referral (to be seen within 2 weeks) to an ENT or audiovestibular medicine service for sudden onset hearing loss (developed over 3 days or less) more than 30 days ago, or for rapidly worsening hearing loss (over 4 to 90 days) ¹.
  • Immediate referral (to be seen within 24 hours) for acquired unilateral hearing loss with altered sensation or facial droop on the same side ¹.
  • Immediate referral (to be seen within 24 hours) for immunocompromised adults with otalgia and otorrhoea that has not responded to treatment within 72 hours ¹.
  • Consider referral to an ENT service if, after initial treatment of earwax or acute infection, the patient has specific issues such as partial or complete obstruction of the external auditory canal, pain lasting 1 week or more not responding to treatment, persistent discharge, abnormal appearance of the outer ear or eardrum, or a middle ear effusion persisting after an acute upper respiratory tract infection ¹.
  • Consider referral to an audiology service for adults with diagnosed or suspected dementia or mild cognitive impairment, or for those with a diagnosed learning disability ¹.