What are the current treatment guidelines for managing hearing loss?

Current Guidelines for Managing Hearing Loss

The latest guidelines for hearing loss recommend a systematic approach including screening, diagnosis, and intervention with appropriately fit amplification as the cornerstone of treatment for age-related hearing loss, and specific protocols for sudden hearing loss. 1

Screening and Diagnosis

• Adults aged 50 years and older should be screened for hearing loss using validated screening tools 1
• When screening suggests hearing loss:
  • Physical examination of the ear should be performed to identify correctable causes 1
  • Audiogram should be obtained to determine type and degree of hearing loss 1
  • Sociodemographic factors and patient preferences should be identified as they influence access to hearing healthcare 1

Evaluation of Specific Types of Hearing Loss

Sudden Sensorineural Hearing Loss (SSNHL)

• Requires prompt evaluation and treatment within 14 days of symptom onset 1
• MRI of brain and internal auditory canals recommended for unilateral ANSD to evaluate for cochlear nerve deficiency and retrocochlear pathology 2
• Patients with asymmetric hearing loss, conductive/mixed hearing loss, or poor word recognition should be evaluated by a specialist 1

Treatment Recommendations

Age-Related Hearing Loss

1. Amplification is strongly recommended as first-line treatment 1

   • Clinicians should offer or refer patients for appropriately fit hearing aids 1
   • Hearing aids improve hearing-specific health-related quality of life, general health-related quality of life, and listening ability in adults with mild to moderate hearing loss 3

2. Communication strategies and assistive listening devices

   • All patients with hearing loss should receive counseling on communication strategies and assistive listening technologies 1
   • Options include:
     • Hearing assistive technologies (headphones with microphones)
     • Infrared and frequency modulated (FM) systems
     • Auditory, visual, and tactile alerting systems 1

3. Cochlear implant evaluation

   • Patients with appropriately fit amplification who have persistent hearing difficulty with poor speech understanding should be referred for cochlear implant evaluation 1
   • Cochlear implantation is beneficial for patients with unrecovered severe to profound SSNHL, especially those with tinnitus 1

Unilateral Hearing Loss

• Contralateral routing of signal (CROS) hearing aids recommended for unilateral hearing loss with normal hearing in the contralateral ear 2
• Options for single-sided deafness include:
  • Osseointegrated bone conductive devices
  • Deep intracanal devices
  • Bilateral contralateral routing of signals hearing aids 1

Sudden Sensorineural Hearing Loss

• Systemic corticosteroids should be initiated within 14 days of symptom onset 2
• Intratympanic corticosteroid injections can be considered if no response to oral treatment or contraindications to systemic therapy 2
• Hyperbaric oxygen therapy can be considered within 3 months of diagnosis 2

Follow-up and Monitoring

• Assess if communication goals have been met and if there has been improvement in hearing-related quality of life at subsequent healthcare encounters or within 1 year 1
• Hearing should be reassessed at least every 3 years in patients with known hearing loss 1
• Regular audiometric assessment is recommended, with follow-up within 6 months of diagnosis 2

Patient Education and Support

• Educate patients and family/care partners about the impact of hearing loss on communication, safety, function, cognition, and quality of life 1
• Address psychological aspects of hearing loss, including anxiety, depression, and social isolation 2
• Consumer-based organizations like the Hearing Loss Association of America (HLAA) can provide valuable support and information 1

Common Pitfalls to Avoid

• Underestimating the functional impact of unilateral hearing loss, which can significantly affect sound localization and hearing in noisy environments 2
• Delaying treatment for sudden hearing loss, which should be treated as a medical emergency requiring prompt intervention 1
• Overlooking the psychological impact of hearing loss, which can cause significant burden 2
• Failing to consider cochlear implantation for patients with persistent hearing difficulty despite appropriate hearing aid use 1
• Not addressing sociodemographic factors that may influence access to and utilization of hearing healthcare 1

By following these guidelines, clinicians can provide comprehensive care for patients with hearing loss, improving their quality of life and reducing the negative consequences of hearing impairment.