Hearing Loss in Adults

NICE guideline [NG98] Hearing loss in adults: assessment and management. Last updated: Oct 2023. NICE CKS Hearing loss in adults. Last revised: May 2024. NICE Technology appraisal guidance [TA566] Cochlear implants for children and adults with severe to profound deafness. Published: Mar 2019. NICE Interventional procedures guidance [IPG108] Auditory brain stem implants. Published: Jan 2005.

Guidelines

Refer within 24 hour to ENT or to emergency department if any of the following:
  • Sudden onset (<72 hours) unexplained hearing loss, that occured 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)

Refer to ENT within 2 weeks if any of the following:
  • Sudden onset (<72 hours) unexplained hearing loss, that occured more than 30 days ago
  • Rapidly progressive unexplained hearing loss (over 4-90 days)

  • Person of Chinese or Southeast Asian family, with
  • Hearing loss and a middle ear effusion,
  • That is not associated with URTI

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

Interventions should be offered if hearing loss affect the patient's ability to:
  • Communicate
  • Hear
  • Awareness of warning sound 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
Author: Adams Lau
Reviewer:
Last edited: 13/07/25