Direct access hearing aid provision guidelines for GPs

Please read the following guidelines before deciding whether to refer to audiology for an assessment possibly leading on to a hearing aid or if an ENT opinion is needed first. If a patient is referred to us and then we need to refer on to ENT or back to yourselves if wax is present, this will prolong the patient journey.

Both ears are completely free of wax

Both tympanic membranes must be clearly visible to ensure that there are no abnormalities/middle ear problems.

Wax may result in inaccurate test results.

Wax will prevent the taking of the impression of the ear for the hearing aid, as this may push the wax deeper in the ear, causing discomfort and possible damage.

Any wax may lead to an inaccurate impression, and lead to a poor fitting ear mould, causing acoustical feedback.

No infection / perforation / significant otalgia

ENT advice is required prior to fitting a hearing aid to patients who have perforations or infections or significant otalgia. ENT can provide treatment and advice to these patients.

Wearing a hearing aid when a middle ear problem is present may make the condition worse.

No significant vertigo

Patients with true vertigo - a spinning sensation, not related to general unsteadiness due to their age, may require an ENT opinion to exclude any sinister pathology, e.g. a retro cochlea lesion or to provide treatment.

Gradual hearing loss V Sudden loss

Presbyacusis is a gradual hearing loss. A sudden loss will always need an ENT opinion to exclude any sinister pathology or to provide treatment. A visit to A and E may also be advisable.

Hearing loss similar in both ears V asymmetry

Presbyacusis will lead to both ears having similar hearing loss.

Significant asymmetry between the ears (15 dB or more) could be due a retro cochlea lesion.

No significant fluctuation in hearing

Fluctuation in hearing, other than that associated with colds, may be due to a middle ear problems or conditions such as Menieres. ENT advice /treatment is needed.

No unilateral or disturbing tinnitus

Where tinnitus is the main complaint, or it is in one ear only, then ENT opinion/treatment is needed.

The patient would consider a hearing aid as an option

The patient should be aware that a hearing aid/s might be offered following the assessment.