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 loss, 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 loss, that occurred more than 30 days ago
• Rapidly progressive unexplained hearing loss (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 deafness without adequate benefit 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

References

Original Guidelines