How to manage chronic hearing loss?

Management of Chronic Hearing Loss

For patients with chronic hearing loss, a comprehensive audiologic evaluation is essential, followed by appropriate interventions including hearing aids or assistive listening devices to improve quality of life and reduce associated morbidity.

Initial Assessment

• Distinguish between sensorineural hearing loss (SNHL) and conductive hearing loss (CHL) through history, physical examination, and tuning fork tests (Weber and Rinne) 1
• Perform comprehensive audiologic evaluation to accurately determine the type, degree, and pattern of hearing loss 1, 2
• Assess for symptoms that may be attributable to hearing loss, including balance problems, poor school performance (in children), behavioral problems, ear discomfort, or reduced quality of life 1
• Evaluate for associated conditions such as tinnitus, which may require additional management strategies 3

Management Based on Type and Severity of Hearing Loss

For Conductive Hearing Loss (CHL)

• Address underlying causes such as cerumen impaction, middle ear effusion, or chronic otitis media 1, 4
• Consider tympanostomy tube placement for chronic otitis media with effusion, especially in children with documented hearing difficulties 1
• Monitor patients with chronic otitis media for potential development of sensorineural component of hearing loss 4

For Sensorineural Hearing Loss (SNHL)

• Mild hearing loss (21-39 dB): Implement strategies to optimize listening environment and consider amplification 1
• Moderate to severe hearing loss: Recommend appropriate hearing amplification devices 1
• For sudden SNHL that has become chronic: Complete follow-up audiometric evaluation within 6 months to assess outcomes and determine rehabilitation needs 1

Amplification and Assistive Technologies

• Hearing aids should be recommended for patients with chronic hearing loss that affects communication and quality of life 1
• For unilateral hearing loss, consider specialized options:
  • CROS (contralateral routing of signal) hearing aids 1
  • BICROS for those with preexisting hearing loss in the better ear 1
  • Osseointegrated bone conductive devices for single-sided deafness 1
• Hearing-assistive technologies (HAT) can provide additional support in specific listening environments 1
• Over-the-counter hearing aids may be appropriate for mild to moderate hearing loss 2

Follow-up and Monitoring

• Perform periodic audiometric evaluations to monitor stability of hearing loss 1
• For adults and children over 5 years, annual evaluation of hearing and amplification/assistive devices is recommended 1
• More frequent monitoring may be warranted for individuals with fluctuating hearing loss 1

Special Considerations

For Children

• Implement strategies to optimize the listening-learning environment:
  • Position speaker within 3 feet of the child 1
  • Reduce background noise 1
  • Use visual cues and clear speech 1
  • Consider classroom accommodations such as preferential seating 1
• Screen for speech and language delays that may be associated with hearing loss 1
• Consider tympanostomy tubes for children with bilateral OME and documented hearing difficulties 1

For Adults with Persistent Hearing Loss

• Address psychosocial impacts of hearing loss through counseling and support 1
• Consider cognitive impacts, as hearing loss is increasingly recognized as a potentially modifiable risk factor for dementia 5
• Implement communication strategies to improve patient-provider interactions 5

Common Pitfalls and Caveats

• Relying solely on patient self-report of hearing improvement is inadequate; objective audiometric testing is essential 1
• Untreated hearing loss can lead to social isolation, depression, and cognitive decline 2, 5
• Pharmacotherapy has limited evidence for chronic hearing loss; avoid recommending supplements like Ginkgo biloba, melatonin, or zinc 3, 6
• Medicare Parts A and B typically do not cover hearing aids, which may create financial barriers to treatment 2
• For patients with tinnitus associated with hearing loss, sound therapy and Cognitive Behavioral Therapy have the strongest evidence for improving quality of life 3