Hearing Loss in Adults: Assessment and Management
National Institute for Health and Care Excellence. (2018).
London (United Kingdom): National Institute for Health and Care Excellence, (NICE Guideline NG98), 1-282.
This guideline from the UK's National Institute for Health Care Excellence (NICE) provides recommendations regarding the assessment and management of hearing loss in adults, 18 years and older. The target audience includes health care and social care professionals, commissioners of health and social care services, people with hearing loss, and the families and caregivers of adults with hearing loss.
National Guideline Centre (United Kingdom); National Institute for Health and Care Excellence (United Kingdom)
Counseling and educating an adult with hearing loss, and/or their family and caregivers, should include discussion about:
<ul>
<li>pure tone audiogram results;</li>
<li>causes of hearing loss;</li>
<li>possible impact of hearing loss (e.g., on communication, in noisy environments);</li>
<li>device management options (e.g., hearing aids, assistive listening devices) with potential benefits and limitations;</li>
<li>compensatory strategies (e.g., reducing background noise);</li>
<li>assistive listening device options (e.g., personal loops, TV amplifiers, smoke alarms) and coordinating support services (e.g., government programs, social services);</li>
<li>referral for implants (e.g., cochlear implantation, auditory brainstem implant), as indicated;</li>
<li>referral for appropriate medical and/or surgical treatment, as indicated;</li>
<li>a personalized plan of care that includes goals and preferences; and/or</li>
<li>external organizations or support groups for individuals with hearing loss.</li>
</ul>
Hearing aids should be offered to adults with hearing loss that affects their communication and listening abilities. Adults with bilateral hearing loss should be advised on
<ul>
<li>the benefits of wearing bilateral hearing aids (e.g., sound localization, sound quality); and</li>
<li>the appropriate hearing aid features to use in different environments (e.g., noise reduction settings).</li>
</ul>
Audiological assessment of adults with suspected hearing loss should include:
<ul>
<li>a case history of symptoms, comorbidities, cognition, physical mobility, hearing and communication needs across settings, and psychosocial difficulties;</li>
<li>an assessment of the individual's expectations, motivations, and activity restrictions;</li>
<li>otoscopy;</li>
<li>pure tone audiometry; and/or</li>
<li>tympanometry, as indicated.</li>
</ul>
Hearing aid counseling and education for adults with hearing loss should address:
<ul>
<li>any questions or concerns about their hearing or device;</li>
<li>hearing aid maintenance;</li>
<li>proper insertion and removal of hearing aid;</li>
<li>whether the device meets the individual's needs for comfort, sound quality, and volume;</li>
<li>how much the hearing aid is worn;</li>
<li>personalized goals of the individual;</li>
<li>resources available for communication, social care, or rehabilitation support services; and</li>
<li>any changes to the individual's plan of care.</li>
</ul>
Adults with hearing loss not explained by acute external or middle ear causes should be referred to an audiologist for evaluation when they present with any of the following symptoms:
<ul>
<li>unilateral or asymmetric hearing loss as a primary concern;</li>
<li>fluctuating hearing loss, not associated with an upper respiratory tract infection;</li>
<li>hyperacusis;</li>
<li>persistent tinnitus;</li>
<li>vertigo;</li>
<li>hearing loss not related to age;</li>
<li>diagnosed or suspected dementia or mild cognitive impairment; and/or</li>
<li>learning disabilities.</li>
</ul>
Adults with dementia, mild cognitive impairment, and/or learning disabilities should be referred to an audiologist for hearing assessment every two years if they have no prior diagnosis of hearing loss.
<p>Hearing aid follow-up for adults with hearing loss should be scheduled six to twelve weeks after hearing aid fitting. Adults with hearing aids should be scheduled for regular reassessment of their hearing levels and of their hearing aid.</p>
<p>Assistive listening devices and other communication strategies used by adults with hearing loss should regularly be reassessed at follow-up appointments.</p>
