When should I consider referring a patient with otosclerosis to an ENT specialist for further evaluation or surgical intervention?

Consider referring a patient with otosclerosis to an ENT specialist for further evaluation or surgical intervention if they have conductive hearing loss that is not explained by external or middle ear causes and is impacting their quality of life or daily functioning.

Referral is appropriate when hearing loss is unilateral or asymmetric, progressive, or associated with symptoms such as tinnitus or vertigo that are persistent or causing distress.

Specifically, after excluding other causes such as impacted earwax or acute infections, patients with otosclerosis who have significant hearing impairment that may benefit from surgical intervention (e.g., stapedectomy) should be referred to ENT for diagnostic assessment and consideration of surgery.

Additionally, if hearing aids are insufficient or not tolerated, referral for surgical evaluation is indicated.

Routine referral to ENT or audiovestibular medicine is recommended for adults with hearing loss not explained by external or middle ear causes, especially if the hearing loss is gradual, unilateral or asymmetric, fluctuating, or associated with other otologic symptoms.

Early referral ensures timely assessment, audiological evaluation, and discussion of management options including surgery.

This approach aligns with NICE guidance on hearing loss assessment and management in adults.