Hearing Loss: Screening--Older Adults


General

Grade: I The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

Specific Recommendations

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults aged 50 years or older. This recommendation applies to asymptomatic adults aged 50 years or older. It does not apply to persons seeking evaluation for perceived hearing problems or for cognitive or affective symptoms that may be related to hearing loss. These persons should be assessed for objective hearing impairment and treated when indicated.

Frequency of Service

No information available.

Risk Factor Information

Aging is the most important risk factor for hearing loss. Presbycusis, a gradual, progressive decline in the ability to perceive high-frequency tones due to degeneration of hair cells in the ear, is the most common cause of hearing loss in older adults. However, hearing loss may result from several contributing factors. Other risk factors include a history of exposure to loud noises or ototoxic agents, including occupational exposures; previous recurring inner ear infections; genetic factors; and certain systemic diseases, such as diabetes.


Clinical

Patient Population

This recommendation applies to asymptomatic adults aged 50 years or older. It does not apply to persons seeking evaluation for perceived hearing problems or for cognitive or affective symptoms that may be related to hearing loss. These persons should be assessed for objective hearing impairment and treated when indicated.

Risk Assessment

Aging is the most important risk factor for hearing loss. Presbycusis, a gradual, progressive decline in the ability to perceive high-frequency tones due to degeneration of hair cells in the ear, is the most common cause of hearing loss in older adults. However, hearing loss may result from several contributing factors. Other risk factors include a history of exposure to loud noises or ototoxic agents, including occupational exposures; previous recurring inner ear infections; genetic factors; and certain systemic diseases, such as diabetes.

Screening Tests

Available screening tests include physical diagnostic tests, such as the whispered voice, finger rub, and watch tick tests (bearing in mind that many modern watches no longer audibly tick); single-question screening or longer patient questionnaires; and handheld audiometers. All are relatively accurate and reliable screening tools for identifying adults with objective hearing loss. In addition, self-administered questionnaires, such as HHIE-S, can identify adults with perceived (or subjective) hearing difficulty. Not all adults with perceived hearing difficulty have objective hearing loss.

Treatment

Before a person receives a hearing aid, diagnosis of objective hearing loss should be confirmed with a pure-tone audiogram. Fair evidence from studies in highly selected populations shows that hearing aids can improve self-reported hearing, communication, and social functioning for some adults with age-related hearing loss.

Suggestions for Practice Regarding I Statement

Potential preventable burden. Finding objective hearing loss indicates eligibility for a hearing aid but does not convincingly identify persons who will find the devices helpful and wearable and will use them. One subgroup analysis of a randomized, controlled trial found that in older adults who did not have self-perceived hearing loss at study entry, screening and receipt of a free hearing aid did not increase use after 1 year compared with an unscreened control group (and overall use was low, at 0% to 1.6%). However, health-related quality of life is improved for some adults with moderate to severe hearing loss who use hearing aids compared with those who do not. Cost.The cost of screening varies according to the test. The cost of a questionnaire consists of the time required of both the patient and clinician. In-office clinical techniques (whispered voice, finger rub, or watch tick tests) and audiometry are quick to perform; however, handheld audiometers have up-front equipment costs. Diagnostic confirmation of a positive screen is typically done with a pure-tone audiogram, which requires a soundproof booth and trained personnel to administer the test and takes approximately 1 hour to complete. The cost of a hearing aid is a barrier to use for many older adults because it is not covered by Medicare and many private insurance companies.

Other Considerations

Research Needs and Gaps

Future studies should concentrate on patients older than 70 years and examine whether there are differential effects of treatment on outcomes at different ages (for example, older than 70 or 80 years). Adequately powered studies are needed to better evaluate the effect of screening for hearing loss on health outcomes, such as emotional and social functioning, communication ability, and cognitive function, rather than intermediate measures, such as hearing aid use or satisfaction, particularly among adults without self-perceived or established hearing loss at baseline. The incremental benefits and costs of screening asymptomatic adults compared with only testing and treating those who seek treatment of perceived hearing impairment are unknown. Knowledge of specific factors or patient characteristics associated with increased and sustained use of hearing aids, once prescribed, could permit testing and treatment targeted to those most likely to benefit.

Rationale

No information available.


Others

The American Speech-Language-Hearing Association recommends that adults be screened once per decade and every 3 years after age 50 years. The American College of Obstetricians and Gynecologists recommends that female patients aged 13 years or older be evaluated and counseled on hearing as part of the periodic health assessment. The American Academy of Family Physicians is in the process of updating its recommendation.


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