Guidelines
Referral Criteria
Immediate Referral
Refer within 24 hours to ENT or to emergency department if any of the following:
- Sudden onset (<72 hours) unexplained hearing lossCannot be explained by external or middle ear causes Such as impacted wax, otitis externa, tympanic membrane perforation, otitis media, that occurred within the past 30 days
- Unilateral hearing loss + focal neurological deficits
- Hearing loss associated with head / neck injury
- Hearing loss + serious infective cause (e.g. necrotising otitis externa)
Urgent Referral
Refer to ENT within 2 weeks if any of the following:
- Sudden onset (<72 hours) unexplained hearing lossCannot be explained by external or middle ear causes Such as impacted wax, otitis externa, tympanic membrane perforation, otitis media, that occurred more than 30 days ago
- Rapidly progressive unexplained hearing lossCannot be explained by external or middle ear causes Such as impacted wax, otitis externa, tympanic membrane perforation, otitis media (over 4-90 days)
Suspected Cancer Pathway Referral
- Person of Chinese or Southeast Asian family, with
- Hearing loss and a middle ear effusion,
- That is not associated with URTI
Idiopathic Sudden Sensorineural Hearing Loss (SSNHL)
1st line: consider steroids (oral steroids and/or intratympanic steroid injections)
- Rationale: steroids may reduce inflammation and oedema in the cochlea, which are thought to contribute to the pathogenesis of SSNHL
Hearing Loss Without Reversible Causes (Adults)
Interventions should be offered if hearing loss affects the patient's ability to:
- Communicate
- Hear
- Awareness of warning sounds and environment
- Appreciation of music
Choice of interventions:
- 1st line: hearing aids
- 2nd line: cochlear implants
- Recommended if there is severe to profound deafnessDefined as hearing only sounds that are louder than 80 dB HL (pure-tone audiometric threshold equal to or greater than 80 dB HL) at 2 or more frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz and 4,000 Hz) bilaterally without acoustic hearing aids without adequate benefitDefined for this guidance as a phoneme score of 50% or greater on the Arthur Boothroyd word test presented at 70 dBA (in adults) from acoustic hearing aids
- Although not stated by NICE, some major contraindications to cochlear implantation are
- Absence / damage to cochlear nerve
- Congenital malformations of the inner ear
- Chronic active middle ear infection / cholesteatoma
- If deafness caused by damage to vestibulocochlear nerve (due to surgery / tumour) → auditory brain stem implants are an option