Can I refer to an Ear, Nose, and Throat (ENT) specialist for a hearing test to diagnose hearing loss?

Referral to ENT and Hearing Testing for Decreased Hearing Loss

Yes, you should refer patients with suspected hearing loss to an ENT specialist for comprehensive evaluation including hearing tests. 1

Initial Assessment and Referral Process

• Pure tone audiometry (PTA) is the gold standard diagnostic test for suspected hearing loss and should be part of the initial evaluation 2
• Any patient concern about hearing loss should be taken seriously and requires objective hearing screening 1
• Patients with suspected hearing loss should undergo audiometric evaluation to distinguish types and severity of hearing loss 1
• Comprehensive diagnostic testing by an audiologist should include:
  • Pure tone thresholds measurement
  • Speech audiometry
  • Tympanometry
  • Acoustic reflex testing 1, 2

When to Refer to ENT

• Refer patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing 1
• Sudden sensorineural hearing loss (loss of 30 dB or more within 72 hours) requires prompt otolaryngology referral 3
• Patients with persistent hearing symptoms that don't resolve should be referred to an otolaryngologist 1
• Patients with sensorineural hearing loss should be referred to an audiologist for consideration of hearing aids 3

Components of Hearing Evaluation

• Audiometric testing should include:
  • Pure tone thresholds measured at 250-8000 Hz
  • Speech recognition threshold or speech detection thresholds
  • Word recognition scores measured in percentage of correct answers 2
• Tympanometry to assess middle ear function 2
• Otoacoustic emission (OAE) measures to determine cochlear function 2

Special Considerations

• Due to critical workforce shortages in the US, 56.6% of counties don't have access to audiologists, with lower-income and older adults disproportionately affected 1
• Older adults may have difficulty completing audiometric testing if cognitive dysfunction is present 1
• Standard diagnostic test-retest variability in adults typically fluctuates by ±5 dB across frequencies 1
• Hearing loss is underrecognized, and hearing aids and other hearing enhancement technologies are underused despite affecting more than 30 million U.S. adults 3

Classification of Hearing Loss

• Hearing loss is categorized as:
  • Conductive (problem with sound transmission through outer/middle ear)
  • Sensorineural (problem with inner ear or nerve)
  • Mixed (combination of both) 3
• Age-related sensorineural hearing loss (presbycusis) is the most common type in adults 3
• Hearing levels are measured in decibel hearing levels (dB HL):
  • Normal speech: 0-20 dB
  • Soft speech: 21-40 dB
  • Moderate loss: 41-55 dB
  • Moderately-severe loss: 56-70 dB
  • Severe or profound loss: 71 dB or higher 1

Common Pitfalls to Avoid

• Don't rely on tuning fork tests alone for clinical screening as they lack sufficient accuracy 2
• Don't order routine laboratory tests for patients with sudden hearing loss unless specific risk factors are present 2
• Avoid using only pneumatic otoscopy and tympanometry for assessment as neither of these methods directly assess hearing 1
• Don't delay referral for sudden sensorineural hearing loss as this requires prompt evaluation and treatment 3

Follow-up Recommendations

• For patients with persistent symptoms, re-examination at 3-6 month intervals is recommended until the condition resolves or additional intervention is needed 2
• Patients with hearing aids should have regular follow-up visits with an audiologist 1
• Patients with hearing loss should be monitored for potential complications of hearing rehabilitation, such as otitis externa and cerumen impactions 1