Table 1 Six concepts describing the role of the GP in managing age related hearing loss

Determine - Diagnose - Discuss

Clinical processes of evaluating hearing, determining the cause of hearing loss, and discussing the diagnosis with the patient.

29. Ensure a basic hearing assessment is conducted as part of age-related assessments (0.00)

80. Conduct such tests as may be possible with equipment generally available in GP surgeries (0.01)

16. Conduct some basic tests to determine extent of any issues (0.03)

82. Examine for ear canal and ear drum problems (0.03)

40. Have access to a basic Audiology Tool to assist diagnosis and management of hearing loss (0.03)

53. Identify hearing impairment (0.04)

81. Examine to ensure no physical cause, such as ear wax (0.04)

14. Check for physical causes of hearing loss, such as wax build up, ear drum health, etc. (0.04)

74. Routine assessment of hearing when performing +75yo health check (0.05)

66. Assess hearing as part of the test linked to maintaining a driver’s licence (0.05)

85. Screen for hearing loss annually (0.05)

91. Rule out sinister (not age-related) hearing loss (0.05)

21. Provide a diagnosis (0.06)

58. Implement a hearing questionnaire or similar at +75yo health check (0.07)

9. Conduct ENT examination to rule out things like wax or structural causes (0.08)

5. Investigate hearing problems (0.10)

7. Pick up hearing loss in patients (0.10)

94. Provide diagnosis (0.10)

73. Identify patients who may be suffering from a hearing impairment (0.11)

4. Recognise hearing problems (0.12)

49. Measure hearing levels at ALL health assessments, i.e. +75yo health assessments, 45-49yo Health Assessments and all Annual Health Checks (0.13)

37. Ask if the patient is having hearing difficulties (0.14)

62. Perform wax removal (0.15)

31. Enquire about and/or notice potential hearing loss particularly with at-risk patients (0.20)

70. Recommend regular hearing checks (0.22)

38. Open the discussion about hearing with people entering the age period when they are at-risk of hearing loss (0.24)

1. Provide help managing other issues related to hearing, such as wax issues, middle ear issues, or infections (0.24)

72. Ask whether the patient is managing their hearing. Many people get hearing checks at local audiology clinics and don’t bother talking to the GP about it. GPs need to ask these questions if they want to be informed of their patients’ health and health-related activities (0.27)

48. Have access to an Audiology Tool to measure hearing levels (0.33)

87. Recommend hearing assessment, promoting early intervention (0.43)

Ask – Assess - Act

Actively look for signs and symptoms of hearing loss, assess functional hearing and impact on daily activities, normalise discussions on hearing rehabilitation, and promote action. Actively make hearing loss part of the conversation, and be the catalyst for change.

42. Assist with early detection and intervention, as people have much better physical and social outcomes the earlier they receive treatment (0.16)

96. Assess for risks of untreated hearing loss, e.g. higher risk of falls (0.22)

83. Assess whether elderly patients hear and comprehend what is discussed in their consultation (0.24)

78. Be aware of the signs of hearing loss, such as asking for repeats, and patient reports of withdrawal from social situations (0.25)

43. Open the discussion on hearing loss (0.27)

30. Keep a closer eye on patients as they age, as the impacts of untreated hearing loss can be significant (0.30)

69. Talk about hearing loss with patients as they age. Discuss hearing loss each step of the way (0.31)

56. Ask the patient whether they have any concerns regarding there hearing (0.33)

84. Assist to help normalise the issue and suggest getting hearing checked (0.35)

36. Involve the patient in any procedures that they (the GP) may be conducting (0.36)

68. Get involved. GPs don’t currently raise hearing loss, but they should (0.38)

39. Normalise discussion about hearing loss and ensure it is on the radar for all adults over 60 years (0.49)

75. Advise patients on the importance of monitoring hearing (0.53)

67. Discuss the importance of hearing well to be safe when driving (0.60)

46. Especially in rural areas, it is essential that GPs and Practice Nurses are educated and enabled to do basic audiology checks and educate people (1.00)

Know - Refer - Coordinate

Refer patients for ear- and hearing-related services, and have knowledge of local specialists to assist making appropriate recommendations.

79. Refer patient to appropriate professional, such as audiologist or ENT (0.01)

57. Provide referral to specialists for tinnitus (0.01)

13. Coordinate audiology appointments (0.05)

17. Refer to specialist services as needed (0.09)

32. Just refer on to a reputable, knowledgeable hearing service that is not biased or specialised in one brand product only (0.13)

95. Arrange audiology testing and hearing aids (0.15)

92. Be a referral access point (0.17)

20. Provide referrals to hearing specialists (0.17)

64. Know the appropriate referral pathways for ear related disease. Patients should be referred to Audiology before ENT for hearing- and balance-related issues (0.18)

2. Assist the patient in accessing resources and/or services to optimise their hearing (0.19)

10. Refer patients to audiology (0.26)

28. Simply refer on to a hearing service/specialist (0.32)

86. Have knowledge of ear diseases and who to refer to for these specific problems (0.36)

55. Encourage use of audiology services (0.37)

27. Promote audiology services to improve the patient’s communication skills (0.42)

24. Provide information on available paths of care: ENTs, audiologists, psychologists, etc. (0.42)

35. Be informed on which hearing aid providers are acting ethically, not simply pushing the most expensive hearing aids (0.43)

33. Make sure the patient gets the most appropriate testing done as soon as possible (0.53)

47. Encourage patients to have full audiology testing, as early detection is key to better outcomes (0.66)

45. Work closely with their practice nurses to ensure they are providing hearing assistance (0.72)

Inform – Advise - Partner

Be an active part of the patient’s hearing rehabilitation, including understanding their personal journey, checking in to see how they are going, and interacting with their hearing healthcare team.

41. Have a good understanding of hearing loss (0.32)

63. Discuss balance issues (0.36)

98. Assist with management options (0.38)

97. Discuss prevention of further hearing loss (0.38)

65. Understand balance disorders, and have the skills to test and treat BPPV (a specific type of balance disorder, often easily managed with exercises) (0.39)

34. Fully explain the sensations experienced with tinnitus and vertigo, as they can be debilitating (0.41)

90. Listen to hearing concerns (0.41)

6. Advise and encourage patients to wear their hearing aids (0.45)

77. Check in with patients who have recently gotten hearing aids, to see how they are going with them and report any problems back to audiologist (0.46)

71. Recommend hearing aids, if needed (0.47)

88. Read correspondence from audiologists, and discuss with the patient. Acknowledge that they are trialling new hearing aids and ask how they are going (0.47)

89. Acknowledge that the patient has recently obtained hearing aids, and provide support, e.g. ask whether they are receiving benefit and recommend they discuss any concerns with their audiologist (0.49)

59. Provide support to those who need further assessment (0.50)

25. Be an informed “gatekeeper” for what is needed next (0.57)

Educate – Strategise - Encourage

Educating patients on the importance of managing hearing health, including intervention options available. Providing personalised practical support, including communication strategies and encouragement to seek specialist help.

54. Provide education (0.41)

61. Educate patients about the importance of hearing health as part of healthy ageing (0.43)

18. Provide some simple strategies to minimise the impact of the hearing loss (0.46)

51. Educate and encourage patients about the benefits of properly fitted hearing aids (0.49)

76. Advise patients on the importance of intervention for hearing loss (0.51)

8. Provide hearing loss education (0.63)

50. Educate and encourage patients about audiology services (0.66)

26. Give a person confidence to seek further audiology testing (0.75)

Reassure - Support - Empower

Being sympathetic to patient concerns, understanding the impacts of hearing loss and providing emotional support.

23. Be supportive and provide positive guidance (0.32)

22. Provide re-assurance that hearing loss isn’t “the end” of things (0.32)

15. Reassure patients if they’re anxious about the hearing rehabilitation process (0.33)

52. Provide trusted advice (0.40)

93. Provide support regarding the impact of hearing loss on other areas of the patient’s health (0.43)

60. Understand the impact of hearing loss on all areas of mental and physical health (0.45)

3. Understand that hearing is closely related to quality of life (0.45)

19. Provide strategies to cope with hearing loss (0.46)

44. Help the patient realise that while hearing loss is a normal part of ageing there are things can be done to help (0.48)

12. Explore the effects of hearing loss on quality of life (0.50)

11. Explore the impact of the hearing loss on health, e.g. depression (0.56)