Intended for healthcare professionals

Practice Guidelines

Hearing loss in adults, assessment and management: summary of NICE guidance

BMJ 2018; 361 doi: (Published 22 June 2018) Cite this as: BMJ 2018;361:k2219
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Hearing loss: triaged referral

A summary of new NICE guidelines

  1. Saoussen Ftouh, senior research fellow1,
  2. Katherine Harrop-Griffiths, retired consultant in audiovestibular medicine (paediatric)2,
  3. Martin Harker, health economics lead1,
  4. Kevin J Munro, professor of audiology3,
  5. Ted Leverton, retired general practitioner, clinical advisor for RCGP4
  6. on behalf of the Guideline Committee
  1. 1National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Royal National Throat Nose and Ear Hospital, UCLH NHS Foundation Trust, London WC1X 8DA
  3. 3Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
  4. 4Bere Alston, Devon
  1. Correspondence to: S Ftouh saoussen.ftouh{at}

What you need to know

  • In those with sudden hearing loss, unilateral hearing loss with neurological signs, or otitis externa unresponsive to treatment in an immunocompromised patient offer immediate referral to ear, nose, and throat services (ENT) or accident and emergency department

  • Early audiological assessment for suspected hearing loss is recommended. Be proactive and offer an audiological assessment if you suspect hearing loss in patients seeing you for other reasons; they may be unaware of their hearing loss.

  • Early fitting of bilateral hearing aids is cost effective and is recommended.

  • People with dementia, mild cognitive impairment, or learning difficulties should have regular hearing assessments.

  • Earwax: offer ear drops followed by irrigation or, where available, microsuction, to remove earwax. Ear drops can be used 15-30 minutes before ear irrigation to avoid unnecessary delay

Hearing loss is common—Over 9 million people in England123 have hearing loss and this is increasing with the ageing population (fig 1).4 Hearing loss ranks third for disease burden in England (years lived with disability).5 The average GP sees at least four patients every day who have hearing loss sufficient to interfere with their ability to communicate with ease.

Fig 1

Estimated prevalence of people with hearing loss in the better hearing ear of ≥25 dB by age band in England4

Hearing loss is disabling—It affects communication at work and home, affecting educational attainment, employment opportunities, personal relationships, enjoyment of music, and social independence. It can lead to significant reduction in people’s quality of life and is associated with mental health problems including depression and dementia.

Hearing loss is expensive—The overall economic burden associated with hearing loss in adults in the UK is estimated to be more than £30bn per year.67

Hearing loss can be managed successfully—Early and effective intervention can minimise the …

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