My Pennsylvania state license to test hearing and dispense hearing aids requires that I stop an appointment and refer that patient out for a medical examination under certain circumstances. Some symptoms require pointing them to an ear, nose and throat doctor. Other symptoms can be seen by their primary physician. Here are some reasons for urgent and immediate referral to an ENT.

Sudden or Rapidly Worsening Hearing Loss: Immediate medical attention is needed for hearing loss that occurs suddenly (within three days) or worsens rapidly (within 4 to 90 days). Recent onset of this hearing loss indicates it is not from a gradual process, but something dramatic has happened to cause this hearing loss. A doctor needs to find out why it has happened.

Unilateral or Asymmetric Hearing Loss: A noticeable difference in hearing between your ears or hearing loss in only one ear warrants a medical referral. Both ears have been exposed to the same life. If one is drastically different in loss from the other ear, law requires a referral out for a medical evaluation.

Symptoms Accompanying Hearing Loss: If hearing loss occurs with ear pain, discharge from the ear or dizziness, this requires immediate medical attention.

Focal Neurological Signs: Hearing loss in one ear associated with neurological symptoms needs urgent assessment. Neurological problems such as dizziness, memory loss and other possible emotional irregularities.

History of Trauma or Infection: Hearing loss after a head or neck injury or a severe ear infection is a red flag. If I hear of this during my intake interview with a patient, I am to refer for medical evaluation. There are other reasons to see a doctor that are not generally classified as urgent. An Air-Bone gap score. Bone conduction testing measures a patient’s response to vibrations outside on the mastoid bone behind the ear. Air conduction tones measure the patient’s response to tones played into the ear. It is complicated so just let me say, if the gap is too big between the bone conduction scores and the air conduction score, the patient should see a doctor. A gap of 15 decibels or more at 500, 1,000 and 2,000 Hz on a hearing test indicates a conductive or mixed hearing loss that may require medical or surgical treatment.

History of certain conditions like tuberculosis, HIV, Meniere’s disease or autoimmune disorders increases the need for a medical referral. Unexplained hearing loss from something other than heredity, noise exposure or aging could be a sign of a more serious underlying condition, requiring referral to an ENT for further investigation. Very few of the patients I see need to see a doctor about their hearing but it is always mandatory for me to refer them when factors that are listed above are present.

If you have hearing loss, make an appointment with a hearing care professional soon to test your hearing and guide you through the options of hearing better.

— — — —

Jeff Bayliff is owner of Hear the Birds Hearing Aid Center.