Synopsis
Identify reversible and time-critical sensory loss, assess how hearing and vision affect cognition, communication, falls and medicines, and connect treatment, rehabilitation, environmental adaptation and community follow-up without attributing impairment to age.
- Hearing and sight loss are not diagnoses of normal ageing; establish onset, laterality, progression, fluctuation, functional impact and red flags.
- First-line hearing assessment includes otoscopy, medication and noise history, communication needs and audiology; tuning forks can help separate conductive from sensorineural loss.
- NICE requires immediate 24-hour specialist assessment for sudden hearing loss over three days or less within 30 days when not explained by outer or middle-ear disease.
- First-line visual assessment records corrected distance and near acuity, pupils, fields, eye movements, red reflex and symptom-directed retinal and pressure evaluation.
- Sudden visual loss, flashes with a curtain, painful red eye or giant-cell-arteritis features requires same-day or immediate specialist action.
- Always provide clean working glasses and hearing aids, batteries and communication adaptations during hospital or care transitions.
- Hearing aids should be offered for hearing loss affecting communication, with bilateral aids when both ears have aidable loss and the person accepts them.
- Cataract referral follows functional impairment and shared surgical benefit rather than denying surgery from visual-acuity thresholds alone.
- Home adaptation includes lighting, contrast, large print, talking labels, visual or vibrating alarms, captioning, telephone aids and falls-safe layout.
- Assess cognition and capacity only after maximising communication; sensory impairment can invalidate a rushed interview or cognitive score.
Key red flags
Sudden hearing loss developing over three days or less within the past 30 days, without an external or middle-ear cause, requires immediate ENT assessment within 24 hours.
Sudden painless monocular loss, curtain, flashes and new floaters requires same-day retinal or vascular assessment.
Painful red eye with reduced vision, haloes, headache, nausea or a fixed mid-dilated pupil suggests acute angle closure.
New visual loss, diplopia or hearing change with focal weakness, ataxia or severe headache requires acute neurological assessment.
Jaw claudication, scalp tenderness or polymyalgic symptoms with visual disturbance suggests giant cell arteritis and requires immediate treatment and referral.
Unilateral hearing loss, persistent unilateral tinnitus, facial weakness or asymmetric neurological signs requires expedited specialist investigation.
Rapid unexplained unilateral or bilateral hearing loss requires urgent ENT assessment even when pain is absent.
Curtain and flashes or painful red eye with haloes and nausea requires immediate eye assessment.
Investigation priorities
Identify conductive disease before referral.
Management branches
Hearing, vision or communication has changed.
- Establish onset, laterality, associated ear, eye and neurological symptoms and urgent red flags.
- Perform otoscopy or corrected visual and focused examination and review medicines, aids and functional consequences.
- Treat a reversible cause or refer to audiology, ENT, optometry or ophthalmology with urgency matched to the syndrome.