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Audiologist and ENT Referral Guide

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What is an audiologist?

An audiologist is a hearing health-care expert who helps prevent, diagnose, and manage hearing and balance disorders for people of all ages. An audiologist holds either a master’s (MS) or a doctoral level degree in audiology (AuD/PhD/ScD), completes a fellowship or externship year, and is licensed to practice state by state. An audiologist helps patients understand what part of their hearing system may be causing a breakdown, conducts a functional communication assessment to identify a patient’s hearing needs, and helps guide patients through the process of selecting the most appropriate level and type of hearing technology to address their hearing needs. It is recommended anyone with concern about their hearing get evaluated by a licensed audiologist as the first step, even if they intend to purchase an OTC hearing aid.

Refer a patient to an audiologist when the patient reports  

  • being younger than 18 years of age (OTC hearing aids are intended for patients 18+ only);
  • asymmetrical hearing;
  • a sudden onset of hearing loss in one or both ears (see ENT referral below);
  • ringing, roaring, or beeping in one or both ears (tinnitus);
  • a history of exposure to ototoxic medications;
  • a history of chemotherapy and/or radiation to the head and neck region (hearing loss related to chemotherapy often occurs closer to treatment, whereas hearing loss related to radiation can have a delayed onset); and/or
  • experiencing greater than a perceived mild to moderate hearing loss.

For quick reference, see the table below. An OTC hearing aid is not intended for hearing loss greater than moderate in degree (designated by red font below).*

Category

Quiet Environments

Noisy Environments

NORMAL HEARING

I have good to excellent hearing.

I have good hearing; I rarely have difficulty following/participating in a conversation.

MILD HEARING LOSS

I do not have problems hearing what people say.

I may have difficulty following/participating in a conversation.

MODERATE HEARING LOSS

I have difficulty hearing a normal voice.

I have difficulty hearing and participating in a conversation.

MODERATELY SEVERE HEARING LOSS

I can hear speech if it is loud speech.

I have great difficulty hearing and participating in a conversation.

SEVERE HEARING LOSS

I can hear loud speech if it is directly in my ear.

I have very great difficulty hearing and participating in a conversation.

PROFOUND HEARING LOSS

I have great difficulty hearing.

I cannot hear any speech.

COMPLETE OR TOTAL HEARING LOSS

I cannot hear any speech or loud sound.

I cannot hear any speech or sound.

Refer to Ear, Nose, and Throat (ENT) physician when the patient reports experiencing

  • a sudden onset of hearing loss or fluctuating hearing loss in one or both ears (seek help as soon as possible; treatment for sudden sensorineural hearing loss is most effective within 48 hours of the onset of symptoms);
  • a pulsing tinnitus;
  • active fluid from one or both ears within the past 90 days;
  • pain or discomfort in one or both ears;
  • a feeling that one or both ears are clogged;
  • visible congenital or traumatic deformity of the ear or surgically altered ears; and/or
  • dizziness.

*Source: Global Burden of Disease Expert Group on Hearing Loss [Stevens et al., 2013 https://doi.org/10.1093/eurpub/ckr176], adapted from Olusanya, David & Hoffman, 2019. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796665/] This is an adaptation of an original work Hearing loss grades and the International classification of functioning, disability and health. Geneva: World Health Organization (WHO); 2019. License: CC BY-NC-SA 3.0 IGO. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition.

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