Why Family Doctors Don't Always Refer Adults for a Hearing Test: New Study

A new interview study suggests that whether an adult ever gets a hearing assessment can depend heavily on how their family doctor weighs symptoms, logistics, and even the doctor's own experience with hearing loss.

For most adults, the road to hearing care starts in a family doctor's office. A patient mentions trouble following conversation, or a spouse raises the volume complaint, and the physician decides whether a formal hearing assessment is worth pursuing. That single decision shapes everything that follows.

Yet surprisingly little research has examined how family physicians actually make that call. A new qualitative study from Australia's National Acoustic Laboratories set out to map the factors that push doctors toward, or away from, referring adult patients for hearing assessment.

Background: Why the Researchers Looked at This

Hearing loss is one of the most common chronic conditions in older adults, but many people who could benefit from hearing care never receive it. In most health systems, family physicians (also called general practitioners or primary care doctors) act as the gateway: they are usually the first clinician a person mentions hearing difficulty to, and their referral often determines whether that person ever sees an audiologist, a specialist trained in assessing and managing hearing.

The research team wanted to understand what actually influences these referral decisions. If some patients with genuine hearing difficulty are not being referred, knowing why is the first step toward fixing the gap.

The study used a qualitative design, meaning it gathered in-depth interview data rather than statistics from large samples. This approach is well suited to uncovering the reasoning behind clinical decisions.

How the Study Was Done

The researchers recruited nine family physicians with clinical experience ranging from 4 to 32 years, averaging about 25 years in practice. Each took part in a 30-minute semistructured interview, a format where the interviewer follows a planned set of topics but can explore answers in depth.

The interview schedule was developed using a topic schedule approach, and the transcripts were analyzed using reflexive thematic analysis, a method for systematically identifying recurring themes in what participants say while acknowledging the researchers' own role in interpreting the data.

What the Researchers Found

When deciding whether to refer an adult patient, the physicians described weighing a wide range of factors: the patient's overall health, the potential benefits and risks of a hearing assessment, reported symptoms, medical history, findings from physical examinations, and behaviors they observed in the consultation that suggested hearing loss, such as a patient repeatedly asking for things to be repeated.

External influences mattered too. Government and clinical protocols shaped referral habits, as did relevant education programs. Notably, physicians' personal experiences with hearing loss, in themselves or in people close to them, also influenced how readily they referred.

The doctors also described reasons they might hold back from referring. These included medical contraindications, doubts about the patient's motivation to act on the results, limited availability of specialist services, and logistical challenges for patients living in regional and remote areas, where reaching an audiology clinic can involve significant travel.

Finally, the physicians expressed a clear desire for change: they wanted audiologists more involved in primary care, and they wanted education on the hearing assessment process, how to interpret audiology results, and what rehabilitation options exist for patients.

What It Means for People with Hearing Loss

The findings suggest that whether an adult gets referred for a hearing assessment is not a simple, standardized decision. It depends on a chain of judgment calls, local service availability, and the individual doctor's exposure to hearing loss. Two patients with identical symptoms could have very different outcomes depending on who they see and where they live.

For adults who suspect their hearing has changed, the practical lesson is that a referral may not happen automatically. Raising the concern directly, asking specifically about a hearing assessment, and following up can make a difference. The study also highlights that people in regional and remote areas face extra hurdles, since distance to specialist services was one of the barriers physicians named.

When a Referral Never Comes: Lowering the Barrier to Hearing Help

Because this study highlights how referral bottlenecks and limited specialist services can delay hearing care, newer FDA-OTC hearing aids are designed to lower that barrier for adults. Panda Air is one such device, a self-fitting OTC hearing aid in a modern earbud-style design with 16-channel processing and multi-band adaptive noise reduction.

Air works out of the box, and for those who want a more tailored setup, an optional companion app can run a frequency-specific hearing check through the aid itself and personalize its output to the user's hearing profile. The app and test are entirely optional, so no clinic visit, referral, or smartphone is required to start using the device.

Practical details include a fast-charge case providing 60 hours of total listening time, Bluetooth for calls, TV, and music, a 5-year warranty, and a 45-day trial that begins when the product arrives. One caveat worth keeping in mind: OTC hearing aids are approved for mild-to-moderate hearing loss, and severe or profound loss still benefits most from clinical fittings. More on the device is available at pandahearing.com/products/panda-air.

Limitations of This Research

This was a small qualitative study of nine physicians in one country, so the themes it identifies cannot be assumed to represent all family doctors or all health systems. Qualitative findings describe the range of views that exist rather than how common each view is.

The authors themselves note that further research is needed to understand these factors more fully and to develop effective referral tools for family physicians. No funding or conflict-of-interest details were reported in the available abstract.

Where This Leaves Us

This study puts evidence behind something many patients have sensed: the path from noticing hearing difficulty to getting it assessed runs through a busy primary care office, and plenty can stall along the way. Better education for physicians, closer collaboration with audiologists, and more accessible entry points to hearing care could all help close a gap that currently leaves many adults waiting.

Tsiolkas J, Pang J, Kitterick P. Why Family Physicians Refer (or Don't) for Adult Hearing Assessment: A Qualitative Interview Study. American Journal of Audiology. 2026. Retrieved from PubMed. https://doi.org/10.1044/2026_AJA-25-00318