Bilateral hearing loss

Background: Otitis media with effusion is fluid medial to the tympanic membrane.  It is categorised by conductive hearing loss in the affected ear in the absence of pain or discharge.  The condition is far more common in children but can occur in adults.  It may occur after an URTI.  Rare causes of unilateral OME include CSF leak and tumour obstructing the Eustachian tube.

How to assess:

Examine the ear

Perform Freefield hearing test

Management:

If symptoms persist more than 3 weeks then patients should be referred to ENT on a routine basis

Background: Presbycusis is age related hearing loss.  It is one of the most common conditions affecting adults and increases in incidence and severity with age.  It is estimated that more than 1 in 3 of the age of 65 will have a significant hearing loss.  This incidence is likely an underestimation of the actual number of patients affected. 

It is established that hearing restoration in the elderly population can have a positive impact on signs and symptoms of dementia. 

Patients may be reluctant for hearing assessment and rehabilitation with hearing aid(s) for multiple reasons.  We would suggest promotion of hearing assessment in the over 65 age group and support with appropriate information.  Hearing loss - RNID

How to assess: We would recommend performing Freefield hearing test in primary care setting as a useful assessment of those who would get benefit from a hearing aid.

Referral guidance: Please refer patients to Audiology on a routine basis.

Background: For adult patients who develop bilateral profound hearing loss (loud voice at close range on freefield hearing test), hearing aids are the mainstay of management.

There are a small number of patients in whom the hearing loss progresses to the point where they no longer get benefit from their hearing aids.  In this group of patients, cochlear implantation may be of benefit. 

Referral guidance: Patients should referred to their local audiology centre first. Patients can be referred from ENT and Audiology GG&C to the Cochlear Implant Programme at Crosshouse Hospital where appropriate. 

Background: Hearing loss can occur at any age.

Common causes include:

• Wax impaction
• Acute otitis media
• Otitis media with effusion (glue ear)
• Chronic squamous otitis media (cholesteatoma)
• Chronic mucosal otitis media (tympanic membrane perforation)

Hearing loss can occur even in those with a normal tympanic membrane on otoscopy. For example, sensorineural hearing loss or conductive hearing loss due to otosclerosis

How to assess: There are a number of patients who perceive a bilateral hearing loss who have no abnormality on pure tone audiogram and/or speech audiogram and so would not be candidates for hearing aids.  We would suggest performing Freefield hearing test on patients to assess for hearing loss prior to referral.  If the patient can hear a whispered voice at arm’s length, they are unlikely to have a significant underlying hearing disorder.

Asymmetrical hearing loss indicates possible underlying disease that requires review. 

Referral guidance: Please ensure that the patient would be willing to undergo hearing rehabilitation with a hearing aid prior to referral. Refer to audiology on a routine basis.

Wax management in the absence of chronic ear disease is not managed by secondary care.

Link to NHS inform: Earwax build-up | NHS inform