What are the key considerations for managing age-related hearing loss in adults within a primary care setting?

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

Key considerations for managing age-related hearing loss in adults within primary care include:

  • Initial assessment: Exclude reversible causes such as impacted earwax and acute ear infections (e.g., otitis externa or otitis media) before further management ,.
  • Earwax removal: Offer earwax removal if it contributes to hearing loss or obstructs examination, using safe methods like microsuction or electronic irrigation by trained practitioners; avoid manual syringing .
  • Medication review: Discontinue or avoid unnecessary ototoxic medications where possible, considering that ototoxicity is usually reversible except for some agents .
  • Referral for audiological assessment: Arrange routine audiology referral if hearing loss persists after excluding treatable causes, or if the patient is at risk (e.g., dementia, learning disability) ,.
  • Specialist referral: Refer to ENT or specialist audiology if there are red flags such as unilateral/asymmetric hearing loss, persistent ear pain, discharge, abnormal ear appearance, or sudden/rapid hearing loss ,.
  • Patient-centered discussion: Discuss audiogram results, communication impact, management options including hearing aids, assistive devices, and implantable devices, and agree a personalized care plan .
  • Hearing aids and assistive devices: Offer hearing aids to adults with hearing loss affecting communication, preferably bilateral aids if both ears are affected, and provide education on use and maintenance ,.
  • Support and information: Provide information about hearing loss causes, communication strategies, and signpost to support organizations such as RNID and Hearing Link .
  • Consider cognitive comorbidities: Recognize that hearing loss can contribute to social isolation and may be misinterpreted as cognitive decline; consider regular audiology assessments in people with dementia or mild cognitive impairment .

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