AUDIOLOGY PRIMARY CARE INFORMATION
Please follow the British Academy of Audiology (BAA) Guidelines for
Referral to Audiology of Adults with Hearing Difficulty
Direct Referral Checklist (2009) History
Persistent pain affecting either ear (defined as earache lasting
Yes / No
more than 7 days in the past 90 days before appointment)
History of discharge other than wax from either ear within the last
Yes / No
90 days
Sudden loss or sudden deterioration of hearing (sudden=within 1
Yes / No
week, in which case send to A&E or Urgent Care ENT clinic)
Rapid loss or rapid deterioration of hearing (rapid=90 days or less)
Yes / No
Fluctuating hearing loss, other than associated with colds
Yes / No
Unilateral or asymmetrical, or pulsatile or distressing tinnitus lasting
Yes / No
more than 5 minutes at a time
Troublesome, tinnitus which may lead to sleep disturbance or be
Yes / No
associated with symptoms of anxiety or depression
Abnormal auditory perceptions (dysacuses)
Yes / No
Vertigo including dizziness, swaying or floating sensations
Yes / No
Normal peripheral hearing but with abnormal difficulty hearing in
Yes / No
noisy backgrounds; possibly having problems with sound
localization, or difficulty following complex auditory directions.
Ear examination
Complete or partial obstruction of the external auditory canal
Yes / No
preventing proper examination of the eardrum and/or proper
taking of an aural impression.
Abnormal appearance of the outer ear and/or the eardrum (e.g., Yes / No
inflammation of the external auditory canal, perforated eardrum;
active discharge).
Audiometry
Conductive hearing loss, defined as 25 dB or greater air-bone gap Yes / No
present at two or more of the following frequencies: 500, 1000,
2000 or 4000 Hz.
Unilateral or asymmetrical sensorineural hearing loss, defined as a
Yes / No
difference between the left and right bone conduction thresholds
of 20 dB or greater at two or more of the following frequencies:
500, 1000, 2000 or 4000 Hz.
Evidence of deterioration of hearing by comparison with an
Yes / No
audiogram taken in the last 24 months, defined as a deterioration
of 15 dB or more in air conduction threshold readings at two or
more of the following frequencies: 500, 1000, 2000 or 4000 Hz.
Other
Any other unusual presenting features at the discretion of the
Yes / No
audiologist.
… please give details
* If any of the answers above is yes, please seek a medical opinion as the
patient is unsuitable for direct referral to Audiology clinic
Validated Questionnaire
This questionnaire can be used to help primary care professionals decide whether a
new patient has a hearing loss that would benefit from hearing aid(s) and whether the
loss affects both ears.
1) Do you have any difficulty with your
hearing?
2) Do you find it very difficult to follow a
conversation if there is background noise
such as TV, radio, telephone
conversations, and children playing?
Yes / No
Yes / No
3) How well do you hear in a quiet room if
someone is talking to you from your right
side?
No difficulty
Slight difficulty
Moderate difficulty
Cannot manage at all
4) How well do you hear in a quiet room if
someone is talking to you from your left
side?
No difficulty
Slight difficulty
Moderate difficulty
Cannot manage at all
If a patient responds yes to 1) and 2) and the response to both 3) and 4) is at least
slight then hearing aids would provide benefit and would be more likely to be used.
Referral Management
The following table can be used to decide about the most appropriate referral for the
patient.
Aged 50+
Communication Problems
Refer for assessment with Audiology Clinic
Other symptoms reported
and/or under 50 years of
age
Refer to ENT consultant
Sudden hearing loss
Urgent referral to ENT consultant
Mild symptoms of
symmetrical Tinnitus
Refer for assessment with Audiology Clinic
Unwillingness to have a
hearing aid or only mild
problems
Watchful waiting, with counselling and
information provided by primary care
staff/GP