Entry of the hearing impaired into the health care system

The current system of referral of patients complaining of hearing loss usually requires a dual appointment with otolaryngology and audiology. Most of these patients have sensorineural hearing loss for which there is rarely surgical or medical treatment. This study tests the hypothesis that these patients would receive appropriate treatment and that health care dollars would be saved if an audiological assessment could identify those patients who require medical or surgical care. One hundred consecutive patients whose sole complaint was hearing loss were evaluated using audiograms and "hearing abilities questionnaires" by five audiologists using subjective and objective criteria to determine the need for referral to otolaryngology. Audiologists determined the need for referral with an accuracy of 55% and 72% utilizing subjective and objective criteria, respectively. The questionnaire was found to be of little value. Audiologists may be able to function as the entry point into the health care system for patients complaining of hearing loss. We are encouraged by the results of this preliminary study, but improvement in the system by which audiologists detect disease is necessary.