Quality statement 3: Rapid worsening of hearing loss

Quality statement

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

Rationale

Hearing loss that has worsened over a period of 4 to 90 days in one or both ears and is not explained by external or middle ear causes needs urgent medical care. An urgent referral to appropriate healthcare services is needed to ensure that the person is seen by a specialist within 2 weeks.

Rapidly deteriorating hearing needs urgent investigation for treatable causes such as autoimmune disease, chronic infection, vestibular schwannoma or intracranial tumours. Delayed management can lead to increased morbidity.

Quality measures

Structure

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

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

Process

Proportion of adults with hearing loss in one or both ears that has worsened over a period of 4 to 90 days 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 has worsened over a period of 4 to 90 days.

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

Outcome

Morbidity rates for adults who have rapid worsening 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 rapid worsening of hearing loss in one or both ears to be referred for urgent specialist medical care at an appropriate healthcare service such as an ENT or audiovestibular medicine service. Service providers also ensure that healthcare practitioners have training and expertise to recognise symptoms and signs of rapid worsening of hearing loss in adults.

Healthcare practitioners (such as GPs, audiologists and community care nurses) refer adults with rapid worsening of hearing loss in one or both ears for specialist medical care at an appropriate healthcare service such as an ENT or audiovestibular medicine service. 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 rapid worsening of hearing loss in one or both ears for specialist medical care.

Adults with hearing loss that gets worse rapidly in one or both ears are referred to be seen by a specialist within 2 weeks,unless the hearing loss can be explained by a condition like swimmer's ear that affects the outer ear, or a cold affecting the middle part of the ear.

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

Rapid worsening of hearing loss

Hearing loss that occurs over a period of 4 to 90 days.

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

Referral for urgent specialist medical care

Adults with rapid worsening of hearing loss (over 4 to 90 days) should be referred 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 rapid worsening 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.