Guidelines for preventive activities in general practice

Miscellaneous

Hearing

      1. Hearing

Miscellaneous | Hearing

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.

Screening

Recommendation Grade How often References
Screening for hearing loss is not recommended in asymptomatic adults aged ≥50 years. Generally not recommended N/A 5

Case finding

Recommendation Grade How often References
Assess hearing in patients who present with conditions that may be associated with hearing loss, such as: 
  • speech and behavioural concerns, chronic ear infections and glue ear in children
  • questions, concerns or perceived hearing loss in adults. 
Refer to Further information.
 
Practice point Opportunistically. 5,6

Preventive activities and advice

Recommendation Grade How often References
Advise the following to help prevent hearing damage: 
  • avoid loud or sustained excessive noise
  • use hearing protection in high-noise environments
  • use volume controls for personal devices as necessary
  • avoid exposure to cigarette smoke in children.
Practice point N/A 7
The following vaccinations may reduce incidence of acute otitis media and/or acquired hearing loss:
  • annual influenza vaccination (inactivated virus) is recommended in any person aged ≥6 months,
  • rubella, measles, Haemophilus influenzae type b, meningococcus in children younger than 15 years,
  • pneumococcal conjugate vaccination (13vPCV) during infancy.
Practice point N/A 8
Preventive activities for pregnant women
Offer testing for rubella immunity and syphilis serology to prevent infections that may lead to congenital hearing loss.
 
Practice point N/A 8

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

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

  1. Australian Institute of Health and Welfare (AIHW). Australia’s health 2016. Catalogue no. AUS 199. AIHW, 2016 [Accessed 31 January 2024].
  2. Department of Health and Aged Care. About ear health. Australian Government, 2022 [Accessed 28 March 2023].
  3. World Health Organization (WHO). Deafness and hearing loss. WHO, n.d - tab=tab_1 [Accessed 29 March 2023].
  4. Cunningham LL, Tucci DL. Hearing loss in adults. N Engl J Med 2017;377(25):2465–73. doi: 10.1056/NEJMra1616601.
  5. US Preventive Services Task Force. Screening for hearing loss in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(12):1196–201. doi: 10.1001/jama.2021.2566.
  6. The Royal Australian College of General Practitioners (RACGP). 2022 RACGP curriculum and syllabus for Australian general practice. RACGP, 2022 [Accessed 31 January 2024].
  7. World Health Organization (WHO). Make listening safe. WHO, n.d [Accessed 28 March 2023].
  8. National Aboriginal Community Controlled Health Organisation; The Royal Australian College of General Practitioners (RACGP). National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 3rd edn. RACGP, 2018 [Accessed 31 January 2024].
  9. Hearing Health Sector Committee. Roadmap for hearing health. Hearing Health Sector Committee, 2019 [Accessed 29 March 2023].
  10. Dehankar SS, Gaurkar SS. Impact on hearing due to prolonged use of audio devices: A literature review. Cureus 2022;14(11):e31425. doi: 10.7759/cureus.31425.
  11. Foundation House. Hearing, vision and oral health. Australian refugee health practice guide. Foundation House, 2024 [Accessed 30 March 2023].
  12. The Royal Children’s Hospital Melbourne (RCH). Education assessment. RCH, 2021 [Accessed 30 March 2023].
  13. Benson J, Mwanri L. Chronic suppurative otitis media and cholesteatoma in Australia’s refugee population. Aust Fam Physician 2012;41(12):978–80.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log

Related documents

  Lifecycle-chart.pdf (PDF 0.12 MB)

Advertising