Hearing loss is a prevalent condition affecting over 30 million adults in the United States, frequently underdiagnosed and undertreated with hearing aids and assistive technologies. Understanding the differential diagnosis of hearing loss is crucial in primary care settings to ensure appropriate management and referral. Hearing loss is broadly classified into conductive, sensorineural, or mixed types. Age-related sensorineural hearing loss, known as presbycusis, is the most common form in adults. While various screening methods for hearing loss exist, their widespread benefits remain under investigation.
Patients may recognize hearing loss themselves, or family members might notice indicators such as difficulty following conversations or increasing the volume of the television. When hearing loss is suspected, primary care physicians should perform initial in-office hearing evaluations like the whispered voice test or basic audiometry. A physical examination should follow, checking for cerumen impaction, exostoses, and other abnormalities in the external auditory canal and tympanic membrane. A neurological examination is also recommended as part of a comprehensive assessment.
Sudden sensorineural hearing loss, defined as a loss of 30 dB or more within a 72-hour period, necessitates urgent referral to otolaryngology. Routine laboratory testing is not typically indicated unless an underlying systemic illness is suspected. Computed tomography (CT) or magnetic resonance imaging (MRI) should be considered in cases of asymmetrical hearing loss, sudden sensorineural hearing loss, or when ossicular chain damage is suspected.
Initial treatment in primary care often focuses on addressing reversible causes. Cerumen impaction can be effectively treated with irrigation or curettage, potentially resolving conductive hearing loss. Further management strategies include auditory rehabilitation, patient education on hearing conservation, and minimizing or discontinuing ototoxic medications when possible. Patients diagnosed with sensorineural hearing loss should be referred to an audiologist for consideration of hearing aids. For conductive hearing loss or sensorineural hearing loss that does not improve sufficiently with hearing aids, referral to an otolaryngologist is recommended for further evaluation and management, including possible surgical interventions or consideration for cochlear implants in cases of severe or refractory hearing loss. Effective primary care management of hearing loss necessitates a strong understanding of differential diagnosis and treatment pathways, aligning with principles outlined in resources like “Differential Diagnosis And Treatment In Primary Care 6th Edition” for comprehensive patient care.
