Hearing Loss in Adults

🔍 When to Suspect

Perceived reduction in hearing ability, which can be gradual or sudden, affecting one or both ears, with or without tinnitus or vertigo

From the full topic in The Ocean Library: Hearing Loss in Adults

🧭 When to suspect

Hearing loss is one of the commonest reasons adults consult in primary care, yet it is easy to under-recognise. It usually develops gradually, is often dismissed as ageing, and may present indirectly – social withdrawal, difficulty on the telephone, or a partner complaining the television is too loud. Suspect it whenever a patient or relative reports reduced hearing, struggling to follow conversation in background noise, or associated tinnitus (ringing or buzzing in the ears) or vertigo (a spinning sensation).

The first task is to localise the problem. Conductive loss arises in the outer or middle ear, where sound cannot reach a healthy cochlea, and is often reversible. Sensorineural hearing loss (SNHL) arises in the cochlea or auditory nerve and is usually permanent. The two are separated at the bedside with otoscopy and tuning-fork tests, and confirmed by audiology.

Conductive (outer / middle ear)	Sensorineural (cochlea / nerve)
• Impacted earwax (cerumen) – the commonest reversible cause • Otitis externa; acute otitis media • Otitis media with effusion (OME, "glue ear") • Tympanic membrane perforation • Otosclerosis (often younger adults; worse in pregnancy) • Cholesteatoma; foreign body	• Presbycusis (age-related) – the commonest cause overall • Noise-induced hearing loss • Idiopathic sudden SNHL (an emergency – see Red Flags) • Ménière's disease • Ototoxic drugs (e.g. gentamicin, cisplatin, loop diuretics) • Vestibular schwannoma; viral or meningitic infection

Risk factors for SNHL include age over 65, male sex, cumulative noise exposure (occupational or recreational), previous ear disease, and microvascular risk – diabetes, hypertension and smoking. A family history of early hearing loss (for example otosclerosis) is also relevant.

Source: NICE NG98

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