What are the recommended initial assessments for an adult presenting with hearing loss in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Initial assessments for an adult presenting with hearing loss in primary care include:

  • Excluding impacted earwax and acute infections such as otitis externa, then arranging an audiological assessment (for more information, see recommendation 1. 5. 1) .
  • Performing otoscopy to examine the outer ear and tympanic membrane .
  • Conducting pure tone audiometry to assess hearing thresholds and differentiate conductive from sensorineural hearing loss .
  • Performing tympanometry if indicated, to evaluate middle ear function .
  • Assessing relevant symptoms, comorbidities, cognitive ability, physical mobility, and dexterity, as part of a full history .
  • Gathering information about the person's hearing and communication needs at home, work, or social situations, and any psychosocial difficulties .

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