When Should the Physician Refer a Patient With Hearing Loss to a Specialist?
Referral to an audiologist is usually necessary in the context of sudden hearing loss for at least 2 reasons. First, it is important to document the hearing loss, as some patients who complain of hearing loss may, in fact, not have measurable loss. Second, the severity of hearing loss may have prognostic value, as patients with worse hearing loss tend to recover less hearing. Primary care physicians may evaluate and treat many patients with hearing loss (eg, by removing cerumen, treating outer or middle ear infections, or discontinuing ototoxic medications), but other patients may benefit from referral to an audiologist or an otolaryngologist. In general, patients with unilateral or asymmetric hearing loss should receive further evaluation. The following patients should be immediately referred to an otolaryngologist: patients with hearing loss after trauma or with evidence of trauma on examination; patients with perforated tympanic membranes, evidence of severe infection, and persisten
