Age-related hearing loss is typically bilateral and symmetrical. An asymmetrical sensorineural loss, unilateral tinnitus, or sudden loss in one ear needs a different pathway: sudden sensorineural loss warrants urgent assessment, and persistent asymmetry calls for imaging to exclude a vestibular schwannoma or other retrocochlear lesion.
Before fitting aids for presumed presbycusis, check the audiogram for asymmetry and ask about onset, tinnitus and vertigo. This is the point at which a GP or audiologist can catch what a hearing aid would mask.
- Check the audiogram for asymmetry before attributing hearing loss to age.
- Refer sudden sensorineural hearing loss urgently.
- Arrange MRI for persistent asymmetrical sensorineural loss or unilateral tinnitus, as local criteria advise.
- Ask about vertigo, ear discharge and onset at every first hearing assessment.
Why it matters
A hearing aid can hide a lesion that needed imaging.
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