When To Refer

The Importance of Routine Hearing Asssessments

Below you will find information on how often adults should have their hearing assessed and common health conditions that may warrant a trip to the audiologist. Please note, your patients do not need a referral to have their hearing assessed.


Changes in hearing sensitivity are often gradual and go unnoticed for several years. Therefore, it is important that adults go beyond the baseline hearing assessment and have their hearing assessed routinely as part of their regular healthcare.

  • Adults aged 18 to 54 without a known hearing loss and without any known risk factors for hearing loss should have routine hearing assessments every 5-10 years. 
  • Adults aged 55+ should have routine hearing assessments every 2-years.
Female doctor with male patient
Male doctor with female patient


  • Difficulty hearing in noise
  • The perception that everyone is mumbling 
  • Bluffing – pretending to hear by nodding one’s head 
  • Asking frequently for repetition 
  • Difficulty hearing the television and/or on the telephone
  • Difficulty hearing women, children and high-pitched voices
  • Becoming withdrawn, impatient, irritable or frustrated
  • Avoiding social occasions, family gatherings, and noisy places

Below is a list of health conditions that are associated with hearing loss and may warrant a referral to a certified audiologist for a comprehensive hearing evaluation.

Sudden Sensorineural Hearing Loss

Family physicians are often the first point of contact for patients suffering from sudden hearing loss. Sudden sensorineural hearing loss (SSNHL) is defined as a sudden decrease in hearing of 30 dB or more at three consecutive frequencies. In most cases, the cause of sudden sensorineural hearing loss is idiopathic.

  • Acute onset of hearing loss over a window of 72 hours
  • Usually unilateral but can be bilateral 
  • Typically noticed upon waking or when using the telephone 
  • 70% of cases also experience tinnitus 
  • 50% of cases also experience vertigo 



Our clinics will always prioritize potential SSNHL cases and have your patient assessed the same day. If a SSNHL is diagnosed, immediate referral to ENT is recommended unless the referring physician can provide corticosteroid therapy at their discretion.


Please follow the link below for current evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SSNHL:

Additional SSNHL Information >


Health Conditions Associated With Hearing Loss


Tinnitus, also known as ringing in the ears, is the perception of sound (ringing, hissing, buzzing, whooshing, etc.) in one’s ears and/or head without the presence of an actual sound. Tinnitus is often a symptom of a disorder of the auditory system and therefore warrants an audiological assessment by a registered audiologist.

Tinnitus can be associated with:

  • Disorders of the outer ear (Excessive ear wax, foreign object in the ear canal, perforated eardrum)
  • Disorders of the middle ear (ear infections, otosclerosis, benign tumors)
  • Disorders of the inner ear (hearing loss, noise exposure, Meniere’s Disease)
Man suffering from tinnitus

Patients referred to our clinic for further investigation of tinnitus will first receive a comprehensive hearing evaluation. If deemed necessary by the audiologist, a tinnitus evaluation may also be recommended. All tinnitus patients are counselled on tinnitus coping, management and sleeping strategies and are provided with a tinnitus management booklet.

More information on causes of tinnitus >


Vertigo typically occurs due to a disorder of the vestibular system in the inner ear, on the vestibular nerve or in the brainstem.

While referral to an ear, nose and throat specialist and/or a neurologist may be warranted, a comprehensive hearing evaluation and case history should also be completed by a certified audiologist any time a patient presents with vertigo. Also, most ear, nose and throat specialists require a hearing assessment by an audiologist before examination.

Following your patient’s referral to our clinic, you will be provided with a detailed audiological report outlining recommendations for further medical referral, if necessary.



A direct causal relationship between untreated hearing loss and dementia has been observed. It is believed that untreated hearing loss leads to decreased stimulation of the auditory nerve resulting in decreased stimulation of the of the auditory cortex and consequently an increased risk of dementia. Research also suggests that treatment of hearing loss via amplification reduces one’s risk of dementia to that of an individual with normal hearing. More information on hearing loss and dementia.


Research is starting to suggest that high blood glucose levels associated with diabetes may cause damage to the blood vessels and nerves of the inner ear similarly to how diabetes can be damaging to many other parts of the body. More information on hearing loss and diabetes.



The inner ear is highly-vascularized making it especially sensitive to blood flow and any abnormalities in the cardiovascular system. Low-frequency hearing loss has been associated with cardiovascular diseases such as cerebrovascular and peripheral arterial disease. More information on hearing loss and cardiovascular disease.



Individuals suffering from untreated hearing loss are found to be more susceptible to anxiety, sadness and feelings of insecurity. Also, communication challenges resulting from untreated hearing loss can lead to social isolation and decreased confidence and self-esteem. More information on hearing loss and depression.


Wax Removal

Our clinics offer wax removal services through the use of microsuction and curettage. Microsuction is a method of wax removal that allows for constant observation of the ear canal and does not involve the use of water. When necessary, our clinicians will also use a tool called a curette to remove wax from the ear canal. 

Ear wax softening by use of drops is required before wax removal appointments. Audiologist's Choice ear drops (active ingredient: 6.5% carbamide peroxide) is the drops we recommend and can be purchased from either of our clinics. Wax removal drops are not recommended for clients with perforated (a hole) eardrums. 

Contraindications for wax removal via irrigation:

  • Signs or symptoms of current infection or a history of recurrent infections 
  • Current or history of tympanic membrane perforation 
  • Presence of myringotomy tubes 
  • History of ear surgery 
  • History of systemic diseases increasing one’s risk of infection
wax removal
Did you know ...

Most people with hearing loss can hear okay in quiet environments such as a doctor's office. This means it can be almost impossible for a doctor to recognize the extent of someone’s hearing problem during appointments.  

Learn About Our Hearing Aid Services 


Did you know ...

We are proud to say that we are one of few hearing aid clinics in Atlantic Canada offering a complimentary Aural Rehabilitation Program to our hearing aid patients. Our program is offered in both clinics every spring and fall.

Learn More About Our Aural Rehab Program