What is the recommended treatment plan for a 76-year-old patient with significant hearing impairment, as indicated by a pure-tone average (PTA) of 64 dB in the left ear and 73 dB in the right ear, and hearing test results showing impaired hearing at various frequencies?

Treatment Plan for Severe Bilateral Hearing Loss in a 76-Year-Old

This patient requires bilateral hearing aids as the primary treatment, given the severe bilateral sensorineural hearing loss with PTA of 64 dB (left) and 73 dB (right), both falling in the moderately severe to severe range where hearing aids provide significant functional benefit. 1, 2

Severity Classification and Functional Impact

• The left ear PTA of 64 dB represents moderately severe hearing loss (56-70 dB HL range), while the right ear PTA of 73 dB represents severe hearing loss (71-90 dB HL range) 2
• Both ears demonstrate hearing loss across all tested frequencies (500-8000 Hz), with particularly poor thresholds at high frequencies (8000 Hz: 75 dB left, 90 dB right), consistent with age-related presbycusis 3, 2
• This degree of hearing loss significantly impairs speech understanding in the critical 500-4000 Hz range, where most conversational speech occurs 2
• According to the AAO-HNS functional classification, this patient has Class C serviceable hearing (PTA >50 dB), which is considered usable hearing appropriate for amplification 2

Primary Treatment: Bilateral Hearing Aids

Hearing aids are the definitive treatment for this patient and can improve self-reported hearing, communication, and social functioning in adults with age-related hearing loss. 3, 1

Referral and Fitting Process

• Refer immediately to an audiologist for comprehensive hearing aid evaluation and fitting 4, 5
• The patient requires bilateral amplification given significant impairment in both ears 1
• Consider over-the-counter hearing aids as a potentially more affordable option for this degree of hearing loss, though custom-fitted devices may provide superior outcomes 5

Expected Benefits Beyond Hearing

• Improved communication with family, friends, and healthcare providers 1
• Enhanced safety and daily functioning 1
• Potential reduction in cognitive decline risk 1
• Decreased social isolation and improved mental health outcomes 1

Addressing Barriers to Treatment Success

Patient adherence to hearing aids may be compromised if the patient doesn't perceive hearing loss or if initial results are disappointing, so proactive counseling is essential. 3, 1

Common Obstacles

• Social stigma associated with hearing aid use 1
• Fear of losing independence 1
• Financial barriers, particularly since Medicare Parts A and B do not cover hearing aids (though some Medicare Advantage plans may) 5
• Unrealistic expectations about hearing aid performance 3

Strategies to Improve Adherence

• Assess the patient's self-perceived hearing loss, as those who acknowledge hearing difficulty are more likely to use hearing aids successfully 3
• Provide realistic expectations about the adjustment period and limitations of amplification 1
• Counsel about audiologic rehabilitation and supportive measures 1
• Connect patient with support groups such as the Hearing Loss Association of America 1

Adjunctive Treatment Options

Assistive Listening Technologies

• Hearing assistive technology (HAT) systems can supplement hearing aids in specific listening environments (restaurants, theaters, meetings) 1
• These devices use headphones and handheld/lapel-worn microphones to transmit sound directly to the listener 1

Communication Strategies for Family and Caregivers

• Face the patient at the same level in good lighting 1
• Speak clearly and naturally without shouting 1
• Minimize background noise during conversations 1
• Provide important information in writing 1

When to Consider Alternative Interventions

• If hearing aids provide insufficient benefit after appropriate trial and adjustment, refer to otolaryngology for evaluation of bone conduction devices or cochlear implant candidacy 4
• Cochlear implants can be helpful for severe hearing loss refractory to hearing aids 4
• Osseointegrated bone conductive devices are typically reserved for conductive hearing loss or single-sided deafness, not bilateral sensorineural loss 1

Critical Next Steps Before Treatment

• Confirm the diagnosis is sensorineural (not conductive or mixed) through otoscopic examination to rule out cerumen impaction or middle ear pathology 3, 4
• Evaluate for asymmetry: the 9 dB difference between ears (64 vs 73 dB PTA) is modest, but the right ear shows markedly worse thresholds at 1000 Hz (90 dB) and 4000 Hz (85 dB) compared to left 6, 5
• Consider otolaryngology referral if asymmetry is confirmed on repeat testing, as unilateral or asymmetrical sensorineural hearing loss can indicate retrocochlear pathology requiring imaging 6, 5
• Assess for ototoxic medication use and eliminate or reduce when possible 4

Monitoring and Follow-Up

• Schedule audiologic follow-up at 1-3 months after hearing aid fitting to assess benefit and adjust devices 1
• Reassess hearing annually or sooner if the patient reports worsening 2
• Standard test-retest variability is ±5 dB, so changes <10 dB may not represent true threshold shifts 2