Next Steps for Moderate to Mild Hearing Loss
Obtain comprehensive audiologic evaluation immediately to confirm the type and degree of hearing loss, then refer to audiology for hearing aid fitting, as hearing aids provide large beneficial effects on hearing-specific quality of life and listening ability in adults with mild to moderate hearing loss. 1, 2
Immediate Diagnostic Priorities
Confirm Type of Hearing Loss
- Perform otoscopic examination to rule out conductive causes including cerumen impaction, middle ear effusion, tympanic membrane perforation, or other external/middle ear pathology that could be contributing to or causing the hearing loss 1, 3
- Remove any obstructive cerumen completely, as impaction is more common in older adults and can worsen overall hearing severity 1
- Obtain formal comprehensive audiologic evaluation (if not already completed beyond screening) including pure tone thresholds, speech audiometry (word recognition scores), tympanometry, and acoustic reflex testing 1, 4
Assess for Asymmetry and Red Flags
- Check for asymmetric hearing loss: differences in pure tone average between ears >15 dB or word recognition scores >15% warrant MRI evaluation to rule out retrocochlear pathology such as vestibular schwannoma 1, 4
- Evaluate for any focal neurologic findings, bilateral sudden onset, or recurrent episodes that would suggest alternative diagnoses requiring different management 1
Primary Management Pathway
Hearing Aid Fitting (First-Line Treatment)
- Refer to audiologist for hearing aid evaluation and fitting as soon as hearing loss is confirmed, as this is the primary clinical intervention for mild to moderate hearing loss 1, 2, 5
- Hearing aids provide:
- Do not delay amplification waiting for "spontaneous improvement" as untreated hearing loss leads to cognitive decline, social isolation, depression, and increased fall risk 5, 6
Alternative Amplification Options
- For patients who cannot afford hearing aids, discuss assistive listening technology and remote microphone technology 4, 5
- Consider cochlear implant evaluation only if hearing aids fail to provide adequate benefit or for severe/profound loss 3
Ongoing Monitoring and Support
Follow-Up Schedule
- Obtain repeat audiometry within 6 months after initial hearing aid fitting, then at least annually thereafter to monitor for progression 1, 4
- Assess quality of life before and after hearing aid fitting to evaluate treatment effectiveness 4
Address Comorbidities
- Screen for common comorbidities that frequently co-exist with hearing loss: visual impairment, mobility restrictions, cognitive impairment, depression, diabetes, and cardiovascular disease 6
- These conditions have higher prevalence in people with hearing loss and may require coordinated management 6
Critical Pitfalls to Avoid
- Never assume hearing loss is "just normal aging" that doesn't require treatment—ARHL significantly impacts emotional, physical, and social aspects of daily life and requires active management 5
- Do not rely on patient self-report alone to characterize hearing loss severity or type; objective audiometric testing is essential 7, 4
- Avoid prolonged observation without intervention for bilateral hearing loss, as the evidence supports early amplification rather than watchful waiting in adults 2
- Do not use ototoxic ear drops until tympanic membrane integrity is confirmed intact 7