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Normal hearing tests: is a further appointment really necessary?

We read the article ‘When a normal hearing test is just the beginning’, by Kennedy et al., with great interest.1 The authors mention King Kopetzky syndrome, which is both a rare diagnosis and a diagnosis by exclusion. Patients complaining of repeated hearing loss but with normal pure tone audiogram should have their social and psychological issues explored rather than being labelled as suffering from this syndrome. Patients with a normal pure tone audiogram without any audio-vestibular symptoms need no follow up. 
 
Our department examines 4000 patients a year complaining of hearing loss. Ten per cent of these patients have normal pure tone audiometry. Each follow up appointment costs £65-£70.2 At present, when so many NHS trusts are in debt, regular follow up or open appointments for patients with normal pure tone audiograms are not cost effective. It is our departmental policy that such patients should return to their General Practitioner for a new referral to the local ENT department if they develop further hearing loss or new symptoms.