10-Minute Consultation

Hearing loss in adults

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2496 (Published 25 April 2013)
Cite this as: BMJ 2013;346:f2496

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  1. Rachel Edmiston, specialty core trainee year 1, ENT 1,
  2. Caroline Mitchell, general practitioner2
  1. 1ENT Department, Tameside General Hospital, Ashton-under-Lyne, OL6 9RW, UK
  2. 2Institute of General Practice and Primary Care, University of Sheffield, Community Sciences Centre, Northern General Hospital, Sheffield S5 7AU, UK
  1. Correspondence to: R Edmiston rachel.edmiston{at}nhs.net
  • Accepted 25 January 2013

A 60 year old former steelworker mentions to his general practitioner that his family is complaining that the television is too loud.

What you should cover

Hearing difficulties

  • Onset of symptoms: acute, chronic, fluctuating, or recurrent?

  • Unilateral v bilateral?

  • What impact is there on day to day communication (for example, hearing in groups or one to one)?

Associated ear, nose, and throat (ENT) symptoms

  • Vertigo: described as a sensation of dizziness likened to “room spin” associated with or without nausea

  • Otorrhoea: is it purulent or clear?

  • Tinnitus

  • Otalgia: otitis media or externa (is there any associated itching or discharge?)

  • Head and neck: localised pain, swelling, lump

  • Nasal obstruction

  • Epistaxis

Risk factors for otological disease

  • Infection (adult or childhood), trauma, or previous surgery

  • History of exposure to noise (including occupational)

  • Use of ototoxic drugs: permanent damage from aminoglycosides (such as gentamicin) or chemotherapy drugs (particularly platinum based treatments such as cisplatin); reversible damage from salicylates (most common in older people); quinine toxicity; and very high dose loop diuretics.

  • Medical history: diabetes (doubles the risk of hearing loss); vasculitis; autoimmune inner ear disease; stroke (can lead to central loss of hearing).

  • Family history: common for otosclerosis, owing to autosomal dominant inheritance.

Red flags

  • Be aware of the red flag symptoms and signs (box 1)

Box 1 Red flags

Sudden onset or rapidly progressive hearing loss
  • A rapid onset (over a 72 hour period) of a sensation of hearing impairment in …

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