Age related hearing loss has different entry thresholds across the country, this is locally defined by your CCG and can be found in section B of the CCG’s service specification. Referrals falling outside the specified age limit will be returned to the referrer.

Contra-indications which should not be referred into or treated by the Direct Access Adult Hearing Service


• Persistent pain affecting either ear (defined as earache lasting more than 7 days in the past 90 days before appointment);

• History of discharge other than wax from either ear within the last 90 days Sudden loss or sudden deterioration of hearing (sudden=within 1 week, in which case send to A&E or Urgent Care ENT clinic)

• Rapid loss or rapid deterioration of hearing (rapid=90 days or less)

• Fluctuating hearing loss, other than associated with colds

• Unilateral or asymmetrical, or pulsatile or distressing tinnitus lasting more than 5 minutes at a time

• Troublesome, tinnitus which may lead to sleep disturbance or be associated with symptoms of anxiety or depression

• Abnormal auditory perceptions (dysacuses)

• Vertigo (Vertigo is classically described hallucination of movement, but here includes dizziness, swaying or floating sensations that may indicate otological, neurological or medical conditions)

• Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds; possibly having problems with sound localization, or difficulty following complex auditory directions.

Ear examination:

• Complete or partial obstruction of the external auditory canal preventing proper examination of the eardrum and/or proper taking of an aural impression.

• Abnormal appearance of the outer ear and/or the eardrum (e.g., inflammation of the external auditory canal, perforated eardrum, active discharge).


• Conductive hearing loss, defined as 25 dB or greater air-bone gap present at two or more of the following frequencies: 500, 1000, 2000 or 4000 Hz.

• Unilateral or asymmetrical sensorineural hearing loss, defined as a difference between the left and right bone conduction thresholds of 20 dB or greater at two or more of the following frequencies: 500, 1000, 2000 or 4000 Hz.

• Evidence of deterioration of hearing by comparison with an audiogram taken in the last 24 months, defined as a deterioration of 15 dB or more in air conduction threshold readings at two or more of the following frequencies: 500, 1000, 2000 or 4000 Hz.


• British Academy of Audiology Guidelines for Referral to Audiology of Adults with Hearing Difficulty (2009)

BSHAA Protocol and Criteria for Referral for Medical or other Specialist Opinion (2011)