Quality statement 2: Sudden onset of hearing loss

Quality statement

Adults with sudden onset of hearing loss in one or both ears that is not explained by external or middle ear causes are referred for immediate or urgent specialist medical care.

Rationale

Sudden onset of hearing loss in one or both ears that is not explained by external or middle ear causes is an emergency. This means that referral for immediate or urgent specialist medical care in appropriate healthcare services is needed. Sudden hearing loss (occurring over 3 days or less) that developed within the past 30 days needs immediate referral so that the person is seen by a specialist within 24 hours. Sudden hearing loss that developed more than 30 days ago needs urgent referral to ensure that the person is seen by a specialist within 2 weeks.

Sudden-onset sensorineural hearing loss needs immediate or urgent investigation for treatable causes such as autoimmune disease, chronic infection, rapidly expanding vestibular schwannoma or stroke. Idiopathic sudden sensorineural hearing loss is typically treated with oral steroids as soon as possible. Delayed management can lead to increased morbidity.

Quality measures

Structure

Evidence of referral pathways in place to ensure adults with sudden onset of hearing loss in one or both ears that is not explained by external or middle ear causes are seen immediately or urgently by an ear, nose and throat (ENT) service, an audiovestibular medicine service or an emergency department for specialist medical care.

Data source: Local data collection, for example, clinical protocols and documented, locally agreed pathways.

Process

a) Proportion of adults with hearing loss in one or both ears that has developed over 3 days or less within the past 30 days, who are referred for immediate (seen within 24 hours) specialist medical care in an ENT service or an emergency department.

Numerator – the number in the denominator who are referred for immediate (seen within 24 hours) specialist medical care in an ENT service or an emergency department.

Denominator – the number of adults with hearing loss in one or both ears that has developed over 3 days or less within the past 30 days.

Data source: Local data collection, for example, audit of electronic case records.

b) Proportion of adults with hearing loss in one or both ears that developed over 3 days or less more than 30 days ago who are referred for urgent (seen within 2 weeks) specialist medical care in an ENT or audiovestibular medicine service.

Numerator – the number in the denominator who are referred for urgent (seen within 2 weeks) specialist medical care in an ENT or audiovestibular medicine service.

Denominator – the number of adults with hearing loss in one or both ears that developed over 3 days or less more than 30 days ago.

Data source: Local data collection, for example, audit of electronic case records.

Outcome

Morbidity rates for adults who have sudden onset of hearing loss.

Data source: Local data collection, for example, audit of electronic case records.

What the quality statement means for different audiences

Service providers (such as primary, community and secondary care) ensure that locally agreed referral pathways are in place for adults with sudden onset of hearing loss in one or both ears to be referred for immediate or urgent specialist medical care at an appropriate healthcare service such as ENT, emergency department or audiovestibular medicine services. Service providers also ensure that healthcare practitioners have training and expertise to recognise symptoms and signs of sudden onset of hearing loss in adults.

Healthcare practitioners (such as GPs, audiologists and community care nurses) refer adults with sudden onset of hearing loss in one or both ears for specialist medical care at an appropriate healthcare service such as ENT, emergency department or audiovestibular medicine services. Practitioners have a checklist or table of symptoms and signs with the recommended action, referral pathway and timeframe.

Commissioners (clinical commissioning groups) ensure that services they commission have the expertise to refer adults with sudden onset of hearing loss in one or both ears for specialist medical care.

Adults with hearing loss that starts suddenly in one or both ears are referred to a specialist, unless the hearing loss can be explained by a condition such as swimmer's ear, which affects the outer ear, or a cold affecting the middle part of the ear. They are seen by the specialist within 24 hours if the hearing loss started within the past 30 days, or within 2 weeks if the hearing loss started more than 30 days ago.

Source guidance

Hearing loss in adults: assessment and management (2018) NICE guideline NG98, recommendation 1.1.2

Definitions of terms used in this quality statement

Sudden onset of hearing loss

Hearing loss that has developed over 3 days or less.

[NICE's guideline on hearing loss in adults, recommendation 1.1.2]

Referral for immediate or urgent specialist medical care

Adults with sudden onset of hearing loss are referred as follows:

  • If the hearing loss developed suddenly (over 3 days) within the past 30 days, refer immediately (to be seen within 24 hours) to an ENT service or an emergency department.

  • If the hearing loss developed suddenly more than 30 days ago, refer urgently (to be seen within 2 weeks) to an ENT or audiovestibular medicine service.

[NICE's guideline on hearing loss in adults, recommendation 1.1.2]

Equality and diversity considerations

Healthcare practitioners should adapt their communication style to the hearing needs of the person with sudden onset of hearing loss. This will help to ensure that the person understands the need for an urgent or immediate referral for specialist medical care and is able to make decisions about their own care.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible information standard.