It is estimated that 3.6 million Australians have some level of hearing loss (somewhat higher in men than women¹), with 1.3 million Australians living with a hearing condition that could have been prevented.² Although the prevalence of hearing loss tends to increase with age, it can affect people of all ages, with significant consequences on the physical, functional and mental health of the individual.

Causes of hearing loss are varied and include:^2–4

• age-related hearing loss
• exposure to loud environments, including occupational environments (eg construction sites, concert venues, bars, nightclubs)
• congenital or early onset childhood hearing loss
• complications from diseases such as measles, meningitis, rubella and mumps
• genetics
• ototoxic drugs that damage the inner ear
• smoking.

GPs are well placed to detect, diagnose and provide advice to help prevent hearing loss.

Newborn screening

Each Australian state has an infant hearing screening program, which includes a test that is typically completed in hospital after the baby is born.

Ensure parents of newborn infants are aware of the universal neonatal hearing screening program in their relevant state and territory and have had their newborn screened for congenital hearing impairment.⁸ For further information, please refer to the chapter Developmental delay and autism. 

Hearing assessment

It is important to assess hearing in patients who present with conditions that may be associated with hearing loss, such as speech or behavioural concerns in children, or perceived hearing loss in adults.⁶ Audiometry is best practice for a thorough assessment. However, hearing loss can also be assessed through:⁵

• single-question screening, asking ‘Do you have difficulty with your hearing?’
• longer patient questionnaires, for example the Hearing handicap inventory – screening (HHIE-S) questionnaire for the elderly.

Hearing assessments such as whispered voice and finger rub are no longer recommended. This is because the results can be variable, as they are user-dependent.⁵

High rates of persistent otitis media in infancy and childhood are associated with hearing loss across the life course for Aboriginal and Torres Strait Islander people.

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to Hearing loss in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

People at greater risk of hearing loss include:^2,5,8-13

• older people (presbycusis)
• people who work in loud environments, such as construction sites, farms, factories, hospitality, concert venues
• people who listen to loud music and use headphones for music or gaming
• Aboriginal and Torres Strait Islander children (refer to Chapter 7: Hearing loss in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people for hearing recommendations in this population)
• people with a family history of hearing loss
• people from refugee-like backgrounds. In Australia, rates of chronic suppurative otitis media and cholesteatoma are much higher in the adult refugee population than in the broader Australian population.¹¹ In addition, refugee children and adolescents may have missed screening for hearing problems.

Guidelines on the prevention, diagnosis and management of all forms of otitis media for Aboriginal and Torres Strait Islander children (RACGP-endorsed clinical guideline):
Otitis media guidelines (app) for Aboriginal and Torres Strait Islander children | Menzies Health 

Screening questionnaire for the elderly:
Hearing handicap inventory – screening (HHIE-S) questionnaire