Concern	Description	Evaluation	Implementation
Sudden hearing loss (idiopathic sudden sensorineural hearing loss)	Development of ≥ 30 dB hearing loss at three consecutive frequencies over 72 hours or less	Rule out conductive hearing loss or readily identifiable cause	Identify hearing loss by in-office tests and directed history and physical examination; urgent referral (within one week) to otolaryngologist
Cerumen impaction	Occlusive cerumen causing hearing loss	Otologic examination	Canal irrigation with or without cerumenolytics or manual extraction of cerumen
Auditory rehabilitation	Training and treatment to improve the hearing environment	Determine patient's and family members' current habits and knowledge	Provide information about improving environment and communication strategies*
Education	Information for the patient and his or her family about hearing loss, evaluation, hearing protection, and management	Determine patient's knowledge, beliefs, and stage of change	Provide resources on hearing protection and expectations, benefits, and use of hearing aids
Assistive devices	Technology to augment hearing, including over-the-counter assistive devices	Determine whether patient is a candidate for over-the-counter assistive devices or audiologic assessment for hearing aids	Patients with mild sensorineural hearing loss may try over-the-counter devices initially; instruct patients on other technologies (e.g., television and telephone amplification)
Medications	Evaluating and mitigating medications with ototoxicity	Determine current and past use of ototoxic medications	Discontinue or avoid unnecessary ototoxic medications (eTable A); mitigate ototoxicity by assuring adherence to protocols when such drugs are needed