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Hearing Problems in Adults Glos Care Pathway Overview

Please click the relevant flowchart box to be taken directly to textual information.


Red Flags
  • Sudden onset (within 1 week) sensorineural hearing loss.
    Refer to on-call ENT Senior House Officer the same day
If sudden onset sensorineural hearing loss is suspected, the on call ENT Senior House Officer  will arrange an urgent audiogram and ENT follow up. Sometimes high dose steroids are also advised in these cases.

Presentation may be with sudden or gradual, unilateral or bilateral hearing loss, depending on the aetiology.

Differential Diagnosis
Initial Primary Care Assessment

Basic assessment of hearing loss in primary care can help establish the correct referral pathway.

Advice on hearing tests including Rinne's and Webber's tests can be found in this hearing loss guide.

In acute hearing loss these tests can help distinguish between conductive hearing loss (which is less urgent) and sensorineural hearing loss (which indicates urgent referral - see Red Flags above).

Initial Primary Care Management

Removal of ear wax via aural irrigation unless contraindicated (see Ear Wax pathway).

When to Refer

Refer Red Flags immediately.


Refer to ENT for:

  • Under 50 years old
  • Persistent ear pain
  • Discharge other than wax
  • Marked or proven asymmetrical hearing loss
  • Troublesome or distressing or unilateral tinnitus


Refer to Audiology if criteria is met:

Direct Access Audiology Criteria

  • Patient is aged 50 or above
  • Patient has not had a previous hearing aid
  • Patient’s ears are clear of wax
  • Both ear drums are seen and healthy looking
  • Hearing loss is equal in both ears
  • No tinnitus or balance problems
  • No sudden deafness
  • No conductive element

Refer via 18 week pathway – using this referral form.

Key Point

Please note that the referral must state that ears have been checked and cleared for wax otherwise it may be returned.

If wax is obstructing the ear canal then please do not refer until it has been cleared.

Secondary Care Management - Audiology (GHNHSFT)

May include:

  • Balance testing
  • Hearing therapy
  • Hearing aids
  • Cochlear implants

Please follow the resource link below to the GHNHSFT website for further information.

Ongoing Primary Care Management

Where there is no known treatment to restore hearing, efforts should be concentrated on maximising what hearing there is left and limiting the psychosocial impact, through access to patient support groups. See the Patient Information leaflets section and Lifestyle and wellbeing page.

Hearing Aid Consumables

Patients requiring hearing aid batteries, flexi tubes, domes, filters, hooks or any other item they might need for their hearing aid can contact Hearing Services via:

Repaired hearing aids can be collected from 8.30am - 4.30pm at GRH and CGH only.

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