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

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 ¹,².
• 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 ².
• Medication review: Discontinue or avoid unnecessary ototoxic medications where possible, considering that ototoxicity is usually reversible except for some agents ¹.
• 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) ¹,².
• 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 ¹,².
• Patient-centered discussion: Discuss audiogram results, communication impact, management options including hearing aids, assistive devices, and implantable devices, and agree a personalized care plan ².
• 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 ¹,².
• Support and information: Provide information about hearing loss causes, communication strategies, and signpost to support organizations such as RNID and Hearing Link ¹.
• 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 ¹.