Information For Physicians:

Cerumen (Earwax) Management & Interprofessional Collaboration

Clear ear canals are essential for accurate and reliable audiologic testing. Excessive or impacted cerumen can obstruct the ear canal, potentially affecting test results and contributing to symptoms such as tinnitus, vertigo, ear discomfort, itching, external otitis, or chronic cough.

While over-the-counter cerumenolytic agents may be appropriate for mild cases, some patients present with more significant impaction that may benefit from medical management. In these instances, collaboration with a physician or other qualified medical provider helps ensure optimal conditions for evaluation and patient care.

When cerumen occlusion is identified prior to testing, referral for removal is appreciated to support the accuracy of diagnostic results. Please note that cerumen removal is not a billable service within our audiology scope, which is why coordinated care is especially important.

We value our partnership with referring providers and appreciate your role in helping us deliver the highest standard of care to our shared patients.

Importance of Comprehensive Hearing Evaluations

A comprehensive audiologic evaluation assesses hearing sensitivity and the function of the outer, middle, and inner ear. It provides important diagnostic information and establishes a baseline for monitoring future changes. Baseline testing can be particularly helpful before chemotherapy, initiation of potentially ototoxic medications, or after trauma, accidents, or significant noise exposure, allowing clinicians to identify treatment or injury related changes over time. Many individuals may not perceive a decline in hearing, but report difficulty understanding speech, especially in noisy environments or group conversations. A comprehensive audiologic evaluation can help identify these concerns early and guide appropriate management.

Common Reasons for Audiology Referral

Patients are commonly referred for audiologic evaluation due to:

Hearing loss or communication difficulties
Tinnitus (e.g., ringing, humming, hissing, roaring, clicking, pulsatile, or musical sounds)
Dizziness, vertigo, imbalance, or other vestibular symptoms
Chronic or recurrent ear infections
Ear fullness or pressure
Sound sensitivity
Baseline hearing assessment as part of a routine exam or before certain medications or treatments.
Sudden hearing loss
Pre-operative or post-operative hearing assessment

Pediatric referrals are often prompted by

Speech or language delay
Articulation difficulties
Recurrent otitis media
Learning or behavioral concerns

Medical Conditions Associated with Hearing Loss

Audiologic evaluation may be beneficial for patients with certain medical conditions or risk factors, including:

Cognitive Decline, Dementia, or Alzheimer’s Disease
Cardiovascular disease, Rheumatoid Arthritis, Lupus, Autoimmune Disorders
Diabetes, Chronic Kidney disease, Osteoporosis, Vertigo, Cogan's syndrome
Meningitis, Measles, Mumps, cytomegalovirus(CMV), Syphilis, Zika, Flu, Covid-19, Severe Cold, Otitis Media, Eustachian Tube Dysfunction, Tinnitus, Otosclerosis, perforated eardrum, Multiple Sclerosis, Stroke
Hyperlipidemia, Hypertension, or Obesity
Cancer patients due to ototoxic treatments such as radiation, and Chemotherapy

Additional indications may include sudden hearing changes, persistent ear pressure, head injuries, ear trauma, damage to eardrum, swimmer's ear, difficulty hearing in noise, telephone communication difficulties, academic concerns, dizziness or imbalance, tinnitus, hyperacusis, misophonia, phonophobia, recurrent ear infections, or tympanic membrane pathology.

Mild Hearing Loss Should Not Be Overlooked

Even mild hearing loss can significantly affect speech understanding, particularly in back ground noise or when listening at a distance. High frequency hearing loss often affects speech clarity rather than volume, leading patients to report that they can “hear but not understand.” Communication difficulties are often first noticed by family members due to frequent repetition or misunderstandings. Early identification and management can help support communication, reduce listening effort, and maintain auditory stimulation.

Delayed treatment may contribute to auditory deprivation, in which reduced auditory input over time affects the brain’s ability to process sound. As with mild vision changes that benefit from corrective lenses, addressing mild hearing loss can help preserve communication, cognitive engagement, and overall quality of life. It is also worth noting that hearing difficulties may not be apparent during face-to-face conversations, as visual cues and quiet environments can make communication easier than in everyday listening situations.

Comprehensive Hearing Testing for Sudden Hearing Loss: An urgent priority

Sudden hearing loss requires prompt diagnostic evaluation. Early hearing assessment plays an important role in identifying patients who may require immediate medical treatment or ENT referral. Doctors of Hearing, provides rapid access diagnostic hearing testing for patients experiencing sudden hearing changes. We work collaboratively with physicians, hospitals, and urgent care clinics to help ensure patients receive timely hearing evaluations and appropriate follow-up care.

Why Rapid Hearing Evaluation

Sudden hearing loss may occur within hours or over a period of up to three days and can sometimes be mistaken for earwax, congestion, or middle ear pressure. However, in some cases, it may represent sudden sensorineural hearing loss (SSNHL), which often requires urgent medical evaluation and treatment. Prompt audiologic testing can help determine:

Presence and severity of hearing loss
Whether the hearing loss is conductive or sensorineural
Need for urgent medical management
Appropriate referral to otolaryngology (ENT)

Diagnostic Services Provided

Urgent evaluations may include:

Comprehensive Audiometric Testing
Otoacoustic Emissions (Inner Ear Testing "to check for cochlear damage")
Tympanometry (Middle ear assessment)
Comparison of asymmetrical hearing findings
Comprehensive clinical report for physicians
Doctors of Hearing will promptly connect patients with an ENT specialist within the critical treatment window