EVIDENCE TO DECISION

Substantial net benefits of the recommended alternative

• Overall, the benefits thus outweigh the harms.

• Hearing loss can lead to social isolation, loneliness, frustration and a loss of independence and is strongly associated with decreased quality of life, cognitive decline, depression and dementia.

• The balance between benefits, harms and burdens is uncertain due to a lack of evidence identified. The potential harms include the misuse of resources or over-referral to hearing healthcare specialists. However, it is not anticipated that a referral for a full audiological assessment will cause any harm to the individual, compared to not being referred. The impacts of hearing loss and delayed intervention are far-reaching, including decreased functional ability and a loss of ability to communicate with others.

Rationale

• No studies were identified that met the inclusion criteria for research question three. This is an evidence gap for further research to be conducted.

• Following a review of existing guidelines and in consultation with the CI Task Force, a consensus-based recommendation was developed.

• The National Institute for Health and Care Excellence (NICE) Hearing loss in adults: assessment and management guidelines1 were used to develop an initial draft as it was considered the most comprehensive. However, it was considered appropriate that in all scenarios, if a person presents for the first time with any level of hearing loss or is experiencing hearing difficulties then a full audiological assessment should be conducted. Without a hearing test, it is unknown if the cause of hearing loss has been addressed. If the primary healthcare professional suspects the adult has sudden or rapid onset hearing loss, then referral to an emergency department or ENT specialist for additional diagnostic assessment is recommended.