Q&A: Primary Care's Role in Diagnosing, Managing Hearing Loss, with Briana Scuderi, AuD

Hearing loss is one of the most prevalent chronic health conditions in the United States, affecting tens of millions of individuals and posing a growing public health challenge as the population ages.

National estimates indicate approximately 15% of US adults, which represents nearly 38 million people, report some degree of hearing difficulty, and objective testing suggests more than 50 million Americans have measurable hearing loss.¹

The burden increases substantially with age, affecting about one-third of adults aged 65 to 74 years and nearly half of those older than 75 years.¹ Despite this high prevalence, hearing loss frequently goes undiagnosed and undertreated, in part because symptoms often develop gradually and may be attributed to normal aging.

Beyond its effects on communication, hearing loss has emerged as an important risk factor for broader health consequences, particularly cognitive decline. Findings from the Lancet Commission on dementia prevention identified hearing loss as the single largest modifiable risk factor for dementia in midlife, contributing to an estimated 8% of global dementia cases.² Observational data also suggest hearing loss is associated with increased healthcare utilization, reduced quality of life, and greater functional impairment among older adults.³

As a result, clinicians are increasingly recognizing the importance of early detection and intervention. Because primary care providers have longitudinal relationships with patients and routinely perform preventive care, they are uniquely positioned to identify early signs of hearing impairment, initiate screening, and facilitate timely referral to audiology and specialty care.

To recognize World Hearing Day and explore the role of primary care in diagnosis, referral, and long-term care of people with hearing loss, Patient Care Online sat down with audiologist Briana Scuderi, AuD, of Horizon Audiology.

World Hearing Day 2026: Primary Care and Hearing Loss

Patient Care Online:
Can you discuss the scope of hearing loss as a public health burden and maybe why primary care may be uniquely positioned to sort of stem this tide?

Briana Scuderi, AuD:
Of course. I think that's a really good question, and I think primary care physicians are in a really good spot to help get patients the care they need for their hearing health care. With that said, I really highly encourage baseline hearing testing. Also, in the office, we can do hearing screenings. Primary care is positioned nicely because they continuously see these patients, so putting into their protocol, especially for well visits, doing hearing screenings and being able to see if patients are having challenges hearing is important.

We see a lot of research showing that around midlife, a high increase in hearing loss prevalence occurs, as you mentioned. So really ensuring that we're doing these screenings is important. Also, it's important to treat hearing impairment as a medical issue instead of looking at it like, “Oh, I'm just going to get something to help suffice my hearing loss over the counter,” for example.

There are many people and many types of options for hearing care. Unfortunately, a lot of people get caught up in more of a sales model. Sometimes, sales models are not the way we should treat hearing impairment—more of a medical model is appropriate. Again, involving a medical professional in the process is really important.

So again, doing screenings regularly and making sure that if a patient is showing risk factors of hearing impairment, such as saying things like, “I can hear but can't understand,” maybe even incorporating questionnaires to try to understand, and involving family members too to see if they have concerns about hearing impairment. But again, following best practice standards is really important for giving proper hearing care, I would say.

Patient Care Online: Can you discuss clear referral triggers for an audiologist or other specialists primary care should recognize as it relates to hearing loss?

Briana Scuderi, AuD: Yeah, so if you're talking more urgent, you need to get in immediately. If a patient comes in and says, “I have sudden onset of hearing decline,” that is an immediate referral, oftentimes to otolaryngology, because if it's a sudden decline in hearing, studies show that with quicker treatment, usually the outcome is better.

Also, things that are concerns for referral to otolaryngology would be things like pulsatile tinnitus—usually unilateral is more concerning than bilateral. Also, if someone comes in with aural drainage, so either blood or fluid, especially if it looks infected, that's a big concern.

Also, if someone has pain and is saying they're having major ear pain. When people come in and they are not passing screenings and feel that they're not hearing as well, then they should definitely come in for a comprehensive evaluation, which takes more time for hearing testing.

Patient Care Online: What is the role of primary care after diagnosis in terms of supporting adherence and monitoring progression of hearing loss?

Briana Scuderi, AuD: That's a good question. With the audiologist, say a patient comes in, has hearing loss, and receives treatment, we do follow the patient very closely. When I have my patients and fit them with the proper hearing aids, I routinely follow up with them.

So, encouraging primary care physicians to ask, “Are you wearing your hearing aids? Are you consistently wearing them and doing well with them?” is important. Also involving family care, so caregivers or family members in general, is important.

Something I want to acknowledge too is that this is not just an issue that affects the individual, but it affects other people surrounding them, such as a mother, sister, brother, child, husband, or wife. So that's another important factor.

Patient Care Online: Can you touch on the importance of primary care in the early recognition and referral around early signs of hearing loss?

Briana Scuderi, AuD: Yeah, again, that's a great question too. Oftentimes, within the past 10 to 20 years, there has been a lot more research on how cognition and hearing impairment go hand in hand.

A lot of this research identifies that hearing loss is one of the biggest modifiable risk factors for causing cognitive decline to happen quicker. And it's not just with moderate to severe hearing loss—this is starting even at mild hearing loss.

A lot of people are realizing this more and more. So getting that education to patients is really important, because earlier care is really important to this whole process with proper hearing.

When we look at the studies, we can see that hearing loss is independently associated with cognitive decline risk. It's a modifiable risk factor, and because we know the two are connected, some studies show that specifically memory and executive function are impacted.

Something I like to implement with my patient care too is when I do a comprehensive evaluation, I also do a cognitive screener. An FDA-approved piece of equipment we use is called Cognivue, and with this we can get a really nice breakdown.

Sometimes primary care providers will refer patients just to have that testing done, the cognitive screener, to see if there are certain areas patients are struggling in. By understanding the true correlation between cognitive decline and hearing impairment, primary care physicians can really educate patients, stress the importance of getting this figured out, and recommend further testing to pinpoint exactly what the patient is struggling with.

Patient Care Online: As we celebrate World Hearing Day in 2026, what are some of the largest barriers to optimal hearing care in the US, and what type of role can primary care play in addressing those barriers?

Briana Scuderi, AuD: I think a really large barrier is that patients, or people, are inundated with different options. I think there's a lot of poor education on the internet.

What I see is that sometimes there are people who follow more of a sales model, which isn't necessarily the best for the patient's hearing health care.

Another thing I see often is that technology is really advanced. It's better than ever with hearing devices. But patients will come in and say, “I'm not getting hearing treatment because my grandmother wore hearing aids 20 years ago, and I remember they whistled and it was just a nightmare.”

Understanding that the technology has changed quite a bit for the better is important, and there's really a lot you can do with hearing prescriptive devices now.

Again, my key point is following the medical model and not more of that sales model. Going to a professional—someone who's studied hearing health care in and out at a doctorate level—is really important.

Also, not getting mixed up in over-the-counter devices can be an issue. They're intended for only a small population, but they really limit a patient's ability to succeed with the instruments. Oftentimes, they're not prescriptive, and we can't really verify and program the devices. So you're taking the medical side out of the equation, which could be not only hazardous, but not give the patient the proper care they need.

Patient Care Online: Do you have any other final messages for primary care or care providers in other specialties as we conclude World Hearing Day?

Briana Scuderi, AuD: Yeah, I think screening is a big one in offices, and bringing attention and education to proper hearing health care.

I find great success in finding out who your local audiologist is and building a relationship with them. I'm on the phone with local primary care providers giving feedback and making sure patients are well cared for.

Also, finding a protocol that works for your office is important. Some primary care physicians do the whisper test, where they have a patient cover an ear and whisper to see if they can hear, and if not, that's a referral.

But one of the best screeners you can do is using headphones, where a nurse or staff member presents tones at 500, 1000, 2000, and 4000 hertz at a standard 25-decibel level. If the patient fails—or we refer to it as “refer”—in any ear at any pitch, that would be an automatic transition to getting a comprehensive evaluation with an audiologist.

So basically, education is huge—understanding the risk factors with hearing impairment and how this can affect not only psychosocial parameters but also cognitive parameters.

Then building a nice protocol so we don't miss these patients and don't miss out on a problem that is really prevalent, and giving patients the best health care possible while following that medical model.

References:

1. National Institute on Deafness and Other Communication Disorders. Quick statistics about hearing. National Institutes of Health. Updated September 20, 2024. Accessed March 2, 2026. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

2. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446. doi:10.1016/S0140-6736(20)30367-6

3. Mahmoudi E, Zazove P, Meade M, McKee MM. Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss. JAMA Otolaryngol Head Neck Surg. 2018;144(6):498–505. doi:10.1001/jamaoto.2018.0273