When deciding whether to refer a patient for a hearing assessment, family physicians take into account a range of factors, including symptoms, examination results, overall health, patient barriers, and access to specialists. A new study published in the American Journal of Audiology provides insight into the decision-making process of nine family physicians, who shared their approaches during 30-minute interviews.
Key Considerations in Referral Decisions
In evaluating patients for potential hearing loss, doctors consider a multitude of factors, including the patient’s medical history, physical examination findings, and symptoms. They also assess the patient’s behaviors that may indicate hearing loss, as well as any cost or geographic barriers that may impact access to care.
Primary care screening can be particularly beneficial for certain populations, such as older adults, individuals with a history of noise exposure, or those presenting with cognitive concerns. According to Dr. Fernando Carnavali, chief of the Division of General Internal Medicine at Mount Sinai Morningside and Mount Sinai West, primary care physicians should address any physical causes of impaired hearing, such as impacted cerumen or a foreign body, before referring a patient to an audiologist.
Dr. Carnavali emphasized the importance of incorporating prompts for high-risk visits into routine appointments and framing discussions around broader outcomes, such as cognition, mood, social isolation, and daily function. By connecting hearing health to overall independence, physicians can more effectively engage patients. Dr. Carnavali is also an associate professor of Medicine at Icahn School of Medicine in New York City.
Collaboration and Education Needs
The study found that patients who received treatment for hearing issues experienced improvements in communication and overall quality of life. Lead author Jessica Tsiolkas, a research audiologist at Australia’s National Acoustic Laboratories, noted that stronger collaboration between audiologists and primary care physicians could lead to better referral decisions, interpretation of audiology results, rehabilitation planning, and follow-up care. The study also highlighted the challenges faced by family physicians in referring patients, including individual barriers, such as low motivation or logistical challenges, and systemic issues, such as limited specialist availability and financial constraints. These systemic barriers are particularly pronounced in rural or remote areas, where access to specialists is limited.
Physicians participating in the study expressed a desire for greater collaboration with audiologists in primary care, as well as more education on the hearing assessment process, interpretation of audiology test results, and hearing rehabilitation options. As Vince J. Catalfamo, an attending physician with Mount Sinai Health System in New York, explained, “Engagement between primary care clinicians and audiologists needs to run both ways.” Dr.
Catalfamo suggested that education for family physicians would be most effective if it covered topics such as quick office screening questions, simple physical exams, and how to read audiograms. “At the same time, audiologists need to meet us halfway,” Dr. Catalfamo said. “Getting back an overly dense, purely technical report doesn’t help us, or the patient. If audiology notes included plain-language functional summaries, concrete monitoring intervals, and next steps, it would do as much to improve care as traditional continuing medical education (CME) alone.”
Addressing Stigma and Follow-Up
Family physicians are often the first point of contact for patients experiencing hearing loss. Dr. Doug Spotts, a member of the American Academy of Family Physicians’ Board of Directors, noted that family physicians are well-positioned to intervene and refer patients to proper care. “Because we know our patients, their health histories, and what is normal for them, we are often able to identify changes that may affect their daily lives, including communication, cognition, and overall well-being,” Dr. Spotts added. He also emphasized that family physicians can play a key role in managing hearing and cognitive health, guiding patients through next steps and connecting them with appropriate hearing health services.
Dr. Carnavali agreed with study participants that primary care physicians should address physical reasons for impaired hearing before making a referral to audiology. He also stressed the importance of follow-up care, saying, “We need to check back in, address stigma, make sure the devices are actually being worn, and verify that day-to-day communication and quality of life have actually improved.”
Disclosures: Tsiolkas is currently employed by the National Acoustic Laboratories, which receives funding support from the Australian Government Department of Health, Disability and Ageing. Drs. Carnavali, Catalfamo, and Spotts reported no conflicts of interest.© 2026 HealthCentral LLC. All rights reserved.