Hearing loss adults - first presentation

Hearing loss is a common condition, affecting about 945 000 people in Scotland. This is set to increase over the next 20 years to one in five people.

Hearing problems usually deteriorate as people get older and are most common in people over 65. Hearing loss affects approximately 80% of people over 85.

There is also a large group of people (15%) with dual sensory (vision and hearing) loss. This group of people is also set to increase.

Hearing difficulties can happen at any age and have a number of different causes. People are often put off getting help for hearing loss. Yet it can have a major impact on their quality of life, causing them to lose confidence and feel isolated from family and friends. It can also lead to depression and anxiety.

Referral criteria to Audiology and ENT

Patient assessment of adults with hearing problems and/or tinnitus

Refer to Audiology:

Refer to ENT:

Hearing Aid referral information

  • Experiencing symmetrical, non-fluctuating hearing loss of gradual onset
  • For re-assessment of hearing aid
  • Patient known to service

Adults with suspected or diagnosed dementia, mild cognitive impairment or a learning disability

  • Consider referring adults with diagnosed or suspected dementia or mild cognitive impairment to an audiology service for a hearing assessment because hearing loss may be a comorbid condition.
  • Consider referring people with a diagnosed learning disability to an audiology service for a hearing assessment when they transfer from child to adult services, then every 2 years.
Specific referral criteria:
  • Patient must be over 18 years
  • Ears MUST be wax free
  • NORMAL appearance of canals and tympanic membranes
  • Any pre-existing ear condition should already have been investigated by ENT

Persistent otalgia affecting either ear with continuous episode of pain for 7 days or more within previous 90 days.

Vertigo within last 90 days.

Hearing loss with a conductive element.

Unilateral or asymmetrical hearing loss.

Sudden hearing loss (24 hours) or rapid (up to 90 days) onset or recent (within 1 year) worsening of an existing hearing loss.

Unilateral, pulsatile or distressing tinnitus (within last 90 days).

Any other unusual presenting feature.

Management - audiology department

Although the following will be performed by the Audiology department where referrers are able to perform any aspects, this is appropriate, and the information should be forwarded to the audiology department with the referral.


  • A full history
  • Hearing Aid Benefit Profile
  • Otoscopy
  • Full diagnostic pure tone audiometry including air conduction and bone conduction with masking
  • Tympanometry if indicated
  • Counselling on hearing loss and hearing aid types
  • Referral to ENT for medical or surgical treatments, if these might be suitable.

Hearing aids

Offer 2 hearing aids to adults whose hearing loss affects their ability to communicate and hear.
When discussing hearing aids with adults for the first time, encourage acceptance and use.


When prescribing and fitting hearing aids, explain the features on the hearing aid that can help the person to hear in background noise, such as directional microphone and noise reduction settings.
Give adults with hearing aids information about getting used to hearing aids, cleaning and caring for their hearing aids, and troubleshooting.

Assistive listening devices

Give adults with hearing loss information about assistive listening devices such as personal loops, personal communicators, TV amplifiers, telephone devices, smoke alarms, doorbell sensors, and technologies such as streamers and apps. Include where to obtain these locally.

Audiology screening questionnaire

The following audiology screening questionnaire can be used with the patient by a GP or similar referrer. (NHS Highland intranet access required). 

Yes (2)
Sometimes (1)
No (0)

1. Do you feel that difficulties with your hearing limit or hamper your personal or social life?

2. Does a hearing problem make you feel embarrassed when meeting new people?

3. Does a hearing problem cause you to feel frustrated when talking to family or friends?

4. Do you have difficulty hearing when someone talks in a whisper?

5. Does a hearing problem cause you difficulty when visiting friends or relatives?

6. Does a hearing problem cause you difficulty when listening to the TV or radio?


  • 0 – 2: No problem.
  • 3 – 6: Possible mild/moderate loss. Consider referral to Audiology via local pathway.
  • 7 - 12: Possible significant loss. Refer to Audiology via local pathway.

Printable questionnaire

Hearing aid referral information

The following checklist information is a requirement when referring a patient for an audiological assessment and fitting of hearing aid, if appropriate:

I can confirm that this patient is:

  • over the age of 55
  • has no significant past history of ear disease
  • has no associated ear symptoms (mild, intermittent tinnitus or balance disturbance are acceptable)
  • has essentially normal ear drums with minimal canal wax
  • has no significant past history of industrial or service exposure
  • if considered for hearing aid, would be willing and likely to wear it

I agree that should the audiological assessment produce any unexpected or unusual findings, then the patient may be referred to an ENT specialist or appropriate measures taken.

Contact details

An Adult pre-pathway screening hearing test is also available at the following 3rd sector and Social Work services. Please contact these centres directly if patient just needs advice and signposting.

Hearing and Sight Care
Telford Street, Wick KW1 5EQ
Fax/Tel: 01955 606170
email: hsc@sensorycentre.org.uk

Lochaber area
Caol Shopping Centre, Caol, Fort William, PH33, 7DR
Tel: 01397 704889 
email: manager@lochabersensorycare.org.uk

Inverness/Dingwall Area
Deaf Services and Hearing Support Team
4 Fodderty Way, Dingwall IV15 9XB
Tel: 01349 868700

Further information for patients

NHS Highland audiology department webpages: http://www.nhshighland.scot.nhs.uk/Services/Pages/AudiologyDepartment.aspx

 Accessible information about having a hearing test and the audiology department can be accessed here.

Fact sheets are available from Action on Hearing loss:

Information about hearing loss onNHS Choices

Advice and support can be found from:

Last reviewed: 20/09/2023

Next review date: 30/09/2026

Author(s): Audiology Review Team.

Version: 1

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Head of Audiology.

Document Id: TAM171