Hearing Loss Management

Diagnostic Approach

The American Academy of Otolaryngology-Head and Neck Surgery recommends determining the type of hearing loss through otoscopic examination and pure tone audiometry with air and bone conduction thresholds 1
Conductive hearing loss is characterized by abnormalities on otoscopy, such as cerumen impaction, middle ear effusion, tympanic membrane perforation, or cholesteatoma 1
Sensorineural hearing loss typically has a normal otoscopy, with dysfunction involving the inner ear, cochlear nerve, or central auditory pathways 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends offering oral corticosteroids within 2 weeks of symptom onset for SSNHL 2, 3, 1
Intratympanic corticosteroids may be offered as salvage therapy for incomplete recovery after initial oral therapy or as primary treatment when oral steroids are contraindicated 2, 1
Hyperbaric oxygen may be offered within 2 weeks of diagnosis or up to 1 month in conjunction with steroids 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends hearing aids as first-line management for age-related hearing loss 4
Cochlear implantation may be considered for severe to profound bilateral hearing loss when hearing aids provide insufficient benefit 4
Untreated age-related hearing loss has clear links to cognitive decline, including memory loss and increased risk of dementia; properly fitted hearing aids may reduce cognitive decline and dementia risk 5

The American Academy of Otolaryngology-Head and Neck Surgery recommends a stepwise approach for Ménière's disease management, starting with dietary modifications, progressing to pharmacotherapy, and then invasive treatments only if necessary 6
Sodium restriction, limiting alcohol and caffeine, identifying and managing allergies, stress management, and keeping a symptom diary are recommended as first-line dietary and lifestyle modifications 6
Intratympanic steroids may be offered to patients with active disease not responsive to non-invasive treatment, with an 85-90% improvement in vertigo symptoms 6

The American Academy of Otolaryngology-Head and Neck Surgery recommends addressing audiologic rehabilitation as soon as hearing loss is identified, as delay leads to auditory deprivation and poorer outcomes 2, 3, 4
Counseling on amplification options, addressing psychological impact, and involving family members in education and consultation are essential components of audiologic rehabilitation 2, 3, 4, 5

Regular monitoring at least every 3 years for known hearing loss is recommended, with follow-up audiometry at the conclusion of treatment and within 6 months 1, 2, 4
Referral to otolaryngology is recommended for sudden sensorineural hearing loss, asymmetric sensorineural hearing loss, conductive or mixed hearing loss, poor word recognition scores, and sensorineural hearing loss not improving with hearing aids 1, 4