Audiologist or ENT: Who Should Check Hearing Loss?

Here's a number that stops most people mid-scroll: recent Australian modelling suggests that around one in five Australians — roughly 5.4 million people — now live with some degree of hearing loss, a big jump from the "one in six" figure most of us grew up hearing quoted . Sit with that for a second. On a packed train from Parramatta to Central, or in the queue at your local Woolies, one in every five people around you is missing part of the conversation.

And yet, hearing loss is often called the "invisible disability" — research published in the Australian Journal of Primary Health notes that adult-onset hearing loss remains under-recognised, with many people waiting years before doing anything about it. Most of us don't wake up one day suddenly deaf. Instead, the TV volume creeps from 12 to 18 to 24. Group dinners become exhausting. You start blaming everyone else for "mumbling." Your partner starts joking that you only hear what you want to hear — and then stops joking about it.

When you finally decide to act, you hit an unexpectedly confusing fork in the road: should you see an audiologist or an ENT for hearing loss? And do you need to see your GP first to get the referral sorted? For a country with a health system as good as ours, the pathway can feel surprisingly murky.

That's exactly what we're untangling today. At NextClinic, we're an Australian telehealth service, and our doctors write specialist referrals, prescriptions and medical certificates for people all over the country — so we spend a lot of our week helping Australians work out who they actually need to see and how to get in the door faster. In this guide, we'll explain what audiologists and ENT specialists each do, what a proper hearing test involves, the red-flag symptoms that mean you shouldn't wait even a week, and exactly how the hearing loss care pathway works here in Australia — including referral rules, Medicare rebates, and the government funding you might not know you're eligible for.

By the end, you'll know precisely which door to knock on. Let's get into it.

First, a 60-Second Anatomy Lesson (It Matters More Than You Think)

Before you can pick the right professional, it helps to know that "hearing loss" isn't one condition. It's a symptom with three broad flavours, and each one points to a different type of care.

Conductive hearing loss happens when sound can't physically get through to your inner ear. As Ear Science Institute Australia explains, this occurs when vibrations picked up by the outer or middle ear are blocked from reaching the cochlea — commonly due to wax, fluid, infection or structural problems. Think of it as a great sound system with a blanket thrown over the speaker. Conductive losses are often treatable and sometimes completely reversible.

Sensorineural hearing loss involves damage to the delicate hair cells of the inner ear or the hearing nerve itself. This is the kind caused by ageing, loud noise, certain medications and some illnesses. The speaker itself is damaged — and in most cases that damage is permanent, which is why prevention and early management matter so much.

Mixed hearing loss is, unsurprisingly, a combination of both.

Why does this matter for your appointment choice? Because conductive problems frequently need medical or surgical attention, while sensorineural loss is usually rehabilitated with devices and strategies. One of those leans ENT. The other leans audiology. Most of the time, though, you can't tell which you have without a test — which brings us neatly to the two professions.

What Does an Audiologist Actually Do?

An audiologist is a university-qualified allied health professional (typically a Master's degree in clinical audiology) who specialises in the assessment, diagnosis and non-medical management of hearing and balance problems. They are the hearing test specialist — the person who measures exactly what you can and can't hear, and what to do about it.

A good audiologist will:

• Perform diagnostic hearing assessments and produce an audiogram (that zig-zag graph of your hearing thresholds)
• Identify the type and degree of your hearing loss
• Fit, program and fine-tune hearing aids and other assistive listening devices
• Map and manage cochlear implants (in specialist clinics)
• Provide tinnitus assessment, education and management programs
• Assess balance and dizziness in some settings
• Support children with hearing difficulties, including school-aged listening and processing concerns
• Flag anything that looks medical and refer you onward

Crucially, you don't need a referral to see an audiologist in Australia. You can walk in off the street and book a hearing test. And the Ear Science Institute of Australia's clinical guidance is refreshingly practical here: for hearing loss, tinnitus, vertigo or ear infections, seeing an audiologist first is often the smartest move, because a hearing assessment helps determine whether an ENT referral is needed at all — and provides exactly the information an ENT will want to see.

One quick clarification that trips people up: an audiologist is not the same as an audiometrist. Audiometrists complete a vocational qualification and are trained to test hearing and fit hearing aids for straightforward adult cases, and they do excellent work in that scope. Audiologists have broader diagnostic scope, including complex paediatric and neurological assessment. For a simple "I think I need hearing aids" situation, either can help. For anything unusual, one-sided, sudden or involving a child, ask for an audiologist.

What Does an ENT Specialist Do?

An ENT — ear, nose and throat specialist, or otolaryngologist if you want to impress someone at a barbecue — is a medical doctor who has completed medical school plus years of surgical specialty training. Some sub-specialise further in otology or neuro-otology, focusing purely on the ear and balance system.

ENTs handle the medical and structural side of hearing:

• Diagnosing and treating ear infections that aren't settling, chronic discharge or perforated eardrums
• Managing cholesteatoma, otosclerosis and other structural disease — otosclerosis, for example, typically begins in early adulthood and can cause progressive hearing loss, tinnitus and dizziness, with hearing aids, surgery or implants all on the table
• Investigating sudden or one-sided hearing loss, including ordering MRI scans when a tumour such as a vestibular schwannoma needs to be excluded
• Prescribing medication (steroids, antibiotics, antifungals)
• Performing surgery: grommets, tympanoplasty, stapedotomy, mastoid surgery, cochlear implantation
• Assessing complex vertigo alongside neurologists and audiologists

An ENT does not typically spend their day fitting hearing aids — that's audiology territory. Think of it this way: an audiologist measures and manages your hearing; an ENT diagnoses and treats your ears. They're teammates, not rivals, and the best outcomes almost always involve both.

So — Audiologist or ENT for Hearing Loss? A Simple Decision Guide

Here's the practical framework we use when patients ask us this on a telehealth call.

Start with an audiologist if: your hearing has declined gradually over months or years, it affects both ears fairly evenly, you're finding noisy restaurants hard, you're over 50 and noticing the TV creeping up, you've worked around noise for decades, or you suspect you might benefit from hearing aids.

Start with your GP (in person or via telehealth) if: your ear hurts, there's discharge, you've had recurrent infections, you suspect wax, you're on medications that might affect hearing, or you simply want someone to triage the whole thing and write you a referral for the right destination.

You need an ENT referral if: the hearing loss is sudden, one-sided or clearly worse in one ear; there's persistent ear pain or discharge; there's a suspected perforation or structural problem; you have unexplained vertigo; a child has recurrent glue ear affecting speech and learning; or an audiologist has found something on your audiogram that needs medical investigation.

Go to an emergency department if: you have sudden hearing loss with facial weakness, severe vertigo with vomiting, a significant head injury, or a rapidly worsening ear infection with fever and swelling behind the ear.

The Red Flags: When Hearing Loss Is a Genuine Emergency

This is the section we'd underline twice if we could, because it's the one that changes outcomes.

Sudden sensorineural hearing loss (SSNHL) — losing hearing in one ear over hours to a few days, often noticed on waking or during a phone call — is a medical emergency, not a "let's see if it settles" situation. The international clinical practice guideline on sudden hearing loss emphasises time to treatment, with corticosteroids offered early and intratympanic steroid salvage therapy recommended within two to six weeks of onset if initial treatment fails. Every day of delay reduces the chance of recovery. Too many people wait a fortnight assuming it's wax or a leftover cold — and by the time they're seen, the window has narrowed.

Other symptoms that warrant prompt, same-week attention:

• Hearing loss in one ear only, or a clear asymmetry between ears
• Pulsatile tinnitus — a whooshing that beats in time with your heartbeat
• Blood or foul-smelling discharge from the ear
• Ear pain with fever, or swelling and tenderness of the bone behind the ear
• Facial weakness or numbness on the same side
• Vertigo that comes with hearing changes
• Hearing loss after head trauma, barotrauma (diving, flying) or a loud blast
• Any concern about a child's hearing, speech development or school performance

If any of these apply to you, don't queue up a hearing test in three weeks' time. Get medical review now.

The Australian Hearing Loss Care Pathway, Step by Step

Here's how it actually works on the ground in Australia.

Step 1: Notice and self-check. Healthdirect notes that routine hearing checks aren't recommended for people without symptoms, but that testing is worthwhile once you notice changes — and points to free online screening tools such as the government-backed Know Your Noise hearing check as a starting point. These are screeners, not diagnoses, but they're a useful nudge.

Step 2: See a GP or an audiologist. Both are legitimate front doors. Audiology needs no referral. But a GP can look in your ears, exclude the easy stuff (hello, impacted wax), review your medications, and — importantly — write referrals.

Step 3: The referral, if you need one. To claim a Medicare rebate on a specialist ENT consultation in Australia, you need a valid referral from a medical practitioner. And in good news for hearing care access, Audiology Australia reports that since 1 March 2023 the rebated referral pathway expanded, so a Medicare rebate for a hearing service can be claimed after referral by any medical practitioner — not just a narrow subset of specialists.

Referral timing genuinely affects your wallet, so it's worth understanding the rules. A standard GP-to-specialist referral is generally valid for 12 months from the date of your first specialist appointment — not from the date it was written — while specialist-to-specialist referrals typically last three months. We've broken this down in detail in our guide to how long a specialist referral lasts in Australia, and explained what should be inside the letter in Specialist Referral Letters in Australia.

Step 4: Diagnostic testing. Whether it happens before or after your ENT appointment, you'll almost certainly have a formal hearing assessment. Expect otoscopy (a look at your ear canal and drum), pure-tone audiometry in a soundproof booth with those familiar beeps, bone-conduction testing to distinguish conductive from sensorineural loss, tympanometry to check middle-ear pressure and eardrum movement, and speech testing — because understanding words in noise is what real life demands. Babies and young children may have otoacoustic emissions or auditory brainstem response testing instead.

Step 5: Treatment and rehabilitation. This might mean antibiotics, steroids, grommets or surgery on the ENT side; hearing aids, assistive devices, communication training or tinnitus therapy on the audiology side; or a cochlear implant assessment where hearing aids no longer provide enough benefit.

Step 6: Follow-up. Hearing changes over time. Devices need adjusting. Reviews matter.

Money Talk: What Hearing Care Costs in Australia

Let's be honest — cost is why a lot of people delay.

The Australian Government's Hearing Services Program provides subsidised hearing services and devices to eligible Australians, generally including pensioner concession card holders, DVA clients and certain other groups. There's also a specialist stream for more complex needs — the eligibility criteria include, for example, a three-frequency average hearing loss of 80 dB or more in both ears. If you're an older Australian or a veteran and you haven't checked your eligibility, please do. It's one of the most underused entitlements in the country.

Children and young Australians are generally well covered through Hearing Australia. The NDIS may fund supports for eligible participants with significant permanent hearing loss. In the public system, ENT clinics are free but waitlists in many states are long. Privately, you'll pay a gap — and you can research typical specialist fees on the federal government's Medical Costs Finder before you book. We walk through more of these tactics in How to Fast-Track Your Specialist Referral and How to Skip the 6-Month Wait.

Four Everyday Australian Scenarios

The tradie at 45. Twenty years of angle grinders and compressors. High-frequency loss on the audiogram, trouble with women's and children's voices. This is textbook noise-induced hearing loss — and it's alarmingly common. A life-table modelling study published in IJERPH estimated that at current occupational noise exposure levels, more than 80,000 Australian male workers and over 31,000 female workers would develop occupational noise-induced hearing loss over a decade of exposure. Safe Work Australia's exposure standard sits at an eight-hour average of 85 decibels, and historical data shows thousands of workers' compensation claims for industrial deafness. Pathway: audiologist first, plus a conversation about workplace protection and compensation.

The three-year-old with glue ear. Speech is behind, she's turning up the iPad, and she's had four ear infections since childcare started. Pathway: GP → audiology → ENT if fluid persists or speech is affected. Winter makes this worse; don't wait out a third season.

The 30-year-old with muffled hearing after a music festival. Ringing that lasted two days and hasn't fully cleared. Pathway: prompt GP or audiology review — and if hearing dropped suddenly and significantly in one ear, treat it as urgent.

The 68-year-old who's stopped going to family lunches. Withdrawal is one of the most under-appreciated signs. It's also why treating hearing loss is about far more than volume, which brings us to the biggest reason not to put this off.

The Bigger Picture: Hearing, Brain Health and Isolation

If you needed one more reason to book that test, this is it. The 2024 Lancet Commission on dementia prevention identified 14 modifiable risk factors across the life course — and hearing loss features prominently among them, with research summarising the Commission's findings describing hearing loss as the largest modifiable risk factor for dementia from mid-life. The relationship is complex and still being unpicked, but the practical message is simple: looking after your hearing is looking after your brain, your mood and your relationships.

Rural and regional Australians face an extra hurdle. The National Rural Health Alliance reports that hearing loss is more prevalent outside major cities, with studies in rural Victoria and Western Australia showing elevated rates — partly due to occupational noise, partly due to access. If that's you, telehealth for the referral and triage stage can save you an entire day of driving.

Protecting the Hearing You've Got

Prevention isn't glamorous, but it's undefeated. Healthdirect's hearing loss prevention advice includes protecting your ears from loud sound with earmuffs or plugs at noisy workplaces and concerts, limiting time in loud environments, looking after your general health and quitting smoking.

We'd add: use the 60/60 rule with headphones (60% volume, 60 minutes, then a break), choose over-ear noise-cancelling headphones so you're not cranking volume to beat background noise, never use cotton buds in your ears, dry your ears properly after summer swimming to reduce swimmer's ear, and get a baseline hearing test if you work around noise so future changes can be tracked.

How We Can Help at NextClinic

Working out who to see is one problem. Getting in to see them is another — and that's where we come in.

We're an Australian telehealth platform with Australian-registered doctors available around the clock. If you've decided you need an ENT referral in Australia, you can request one through our online specialist referral service without waiting weeks for a GP appointment. You complete a clinically designed questionnaire about your symptoms and history, one of our doctors reviews it and calls you to discuss, and where it's clinically appropriate we issue a referral letter — usually within about an hour of the consultation. We've explained the full process in How to Skip the GP Waiting Room for a Specialist Referral.

We also issue online medical certificates if an ear infection, vertigo or a post-operative recovery means you need time off work or study, and prescriptions where appropriate. Our consultations are privately billed rather than Medicare-rebated, but the referral we provide is a standard, valid referral — so your Medicare rebate at the specialist's rooms is unaffected.

Two important caveats, because we'd rather be useful than salesy. First, telehealth is brilliant for triage, referrals, certificates and follow-up — but if your ear needs to be physically examined or your hearing measured, you'll need to be seen in person, and we'll tell you that. Second, if you have any of the red-flag symptoms above, particularly sudden one-sided hearing loss, please seek urgent in-person care rather than waiting on any online service.

You'll find plenty more practical health navigation guides over on our blog.

The Bottom Line

Let's bring it home. Audiologists measure and manage hearing — no referral needed, and they're usually the right first stop for gradual, both-sided hearing loss and hearing aids. ENT specialists diagnose and treat the ear itself — they need a referral for your Medicare rebate, and they're essential for sudden, one-sided, painful, discharging or structurally abnormal ears. Your GP (in the clinic or on a screen) is the traffic controller who can send you to the right place and hand you the paperwork. Remember the red flags, especially sudden hearing loss in one ear, which needs treatment in days, not weeks. Check whether you're eligible for the government's Hearing Services Program before you assume you can't afford help. And know that referral timing rules — 12 months from your first specialist visit — can quietly cost or save you money.

Most of all, remember the one-in-five statistic we opened with. Hearing loss isn't a niche problem or an "old person's problem." It's a mainstream Australian health issue that we collectively ignore for far too long, at real cost to our relationships, our work and our long-term brain health.

So here's your challenge for this week. Pick just one action from this post and actually do it. Book a hearing test. Take a free online hearing screen. Check your Hearing Services Program eligibility. Request that ENT referral you've been putting off since last winter. Buy a decent pair of earplugs for the worksite or the next gig. Or — and this one's free — ring the parent or mate who's been withdrawing from noisy gatherings and gently suggest they get their hearing checked.

Then tell us about it in the comments: which one did you choose, and what happened? Did the audiogram surprise you? Did you find out you were eligible for subsidised care? Your story might be the exact push another reader needs to stop turning up the volume and start actually hearing again.

This article is general information only and isn't a substitute for personalised medical advice. If you're worried about your hearing, speak with a doctor or audiologist. For urgent symptoms, contact your GP, call healthdirect on 1800 022 222, or in an emergency call 000.

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