An international group of audiology and hearing science experts has published updated best practice guidelines for managing adults with severe and profound hearing loss, incorporating recent research, advances in hearing technology, and expanded recommendations for clinical care.
Published October 26, 2026, in Seminars in Hearing, the updated guidelines build on the original 2020 recommendations and provide a comprehensive framework for audiologists and other hearing care professionals working with patients whose needs often extend beyond conventional hearing aid fitting.
The publication, titled Updated Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss, was developed by an international group of 18 contributors, including audiologists, hearing scientists, and other specialists.
The guidance focuses primarily on adults aged 19 and older with severe or profound sensorineural hearing loss in the better ear, defined using World Health Organization classifications of 61–80 dB HL and 81 dB HL or greater, respectively.
Why Were the Guidelines Updated?
The authors explain that the update was necessary to reflect new scientific evidence, technological developments, and evolving patient needs since the original guidelines were published in 2020.
Although clinical approaches for mild-to-moderate hearing loss are well established, individuals with severe and profound hearing loss frequently require more specialized assessment, amplification strategies, counseling, and rehabilitation.
These patients may have substantially reduced residual hearing, restricted dynamic ranges, poor frequency resolution, and limited speech understanding even when sounds are made audible. Consequently, increasing amplification alone may not adequately address communication difficulties.
The updated recommendations incorporate evidence published through the first quarter of 2026 and expand the original guidance into several areas that have gained clinical importance, including cochlear implantation, remote hearing aid services, Auracast broadcast audio, electrophysiological assessment, and emerging genetic therapies.
The authors also acknowledge that research specifically involving adults with severe and profound hearing loss remains limited. As a result, the guidance combines available scientific evidence with expert consensus where direct research is insufficient.
Key Changes and Expanded Recommendations
More Comprehensive Audiological Assessment
The updated guidelines place greater emphasis on individualized assessment that considers both auditory function and the patient’s broader communication needs.
In addition to behavioral audiometry and speech recognition testing, the guidance discusses objective measures such as otoacoustic emissions, electrocochleography, auditory steady-state responses (ASSR), and cortical auditory evoked potentials.
For patients whose behavioral thresholds cannot be reliably established, the authors recommend considering ASSR rather than relying exclusively on auditory brainstem response testing, particularly when estimating thresholds in the severe-to-profound range.
The guidelines also emphasize assessing communication goals, psychosocial concerns, and factors such as cognition, vision, dexterity, and general health when developing treatment plans.
Hearing Aid Fitting and Verification
The revised guidance reinforces the importance of carefully prescribed and verified amplification, particularly given the limited residual dynamic range and greater risk of distortion experienced by many patients with severe and profound hearing loss.
Recommendations include the use of multichannel wide-dynamic range compression, appropriate output limiting, custom earmolds, and verification using probe microphone or coupler measurements.
The authors also recommend initially leaving frequency lowering disabled and activating it only when needed, using validated fitting procedures and the minimum effective strength.
The updated document expands its discussion of music listening, recognizing that hearing aid settings optimized for speech may not necessarily provide satisfactory music perception.
Cochlear Implant Evaluation and Bimodal Hearing
Cochlear implantation receives expanded attention in the 2026 guidelines, including candidacy assessment, clinical effectiveness, and the benefits of combining a cochlear implant with contralateral acoustic amplification.
The recommendations reinforce the importance of discussing cochlear implantation as part of comprehensive treatment planning rather than waiting until conventional amplification is no longer useful.
The guidance also recognizes the importance of individualized decision-making, including patients’ communication goals, preferences, and expectations.
Auracast, Assistive Technology, and Remote Care
One of the more notable additions is a dedicated discussion of Auracast broadcast audio and its potential role in improving access to sound in public environments.
The guidelines also address remote microphone systems, assistive listening technologies, mobile applications, and alerting devices as components of comprehensive hearing rehabilitation.
Remote hearing aid fitting and follow-up receive expanded consideration, including clinical limitations, accessibility requirements, safety, and the additional challenges associated with managing severe and profound hearing loss remotely.
Accessibility, Sign Language, and Emerging Therapies
The 2026 edition includes expanded recommendations for supporting adults who use sign language, emphasizing culturally responsive care and the importance of recognizing different communication preferences and goals.
Accessibility recommendations address interpreter services, visual communication tools, staff training, and practical modifications to clinical environments.
The guidelines also introduce discussion of genetic hearing loss and emerging gene therapies, reflecting growing research interest in treatments that may eventually address certain underlying causes of hearing loss.
These developments are presented within the context of evolving clinical research rather than as established treatment alternatives for the broader adult population.
Implications for Hearing Care Professionals
Beyond its updated recommendations, the publication includes evidence tables, practical toolkits, and clinical checklists intended to help professionals evaluate their current practices and identify opportunities for improvement.
A central message throughout the document is that successful management of severe and profound hearing loss requires more than appropriately fitted hearing aids. Comprehensive care may involve assistive technologies, cochlear implant evaluation, communication strategies, psychosocial support, and ongoing rehabilitation.
For clinicians, the updated guidelines provide an opportunity to review existing assessment and treatment protocols against current evidence and expert recommendations, particularly as new technologies and therapeutic approaches continue to expand the options available to patients.
Reference: Turton L, Timmer BHB, Hockley NS, et al. Updated Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss. Seminars in Hearing. 2026;47:175–276. Published online October 26, 2026. https://doi.org/10.1055/s-0046-1827039
