Hearing Loss Screening for Older Adults

There's not enough evidence to recommend screening all older adults in the United States for hearing loss, the most recent recommendations to come from the US Preventive Services Task Force, or USPSTF, and published in Annals of Internal Medicine, state.  Yet as Rick and I review in PodMed, abundant research, much of it from Johns Hopkins, does establish risks related to hearing loss in older people, especially social isolation, dementia, and falls.  Just how much evidence is needed to make hearing loss screening routine?  As we reveal in the podcast, evidence needs to accumulate that once hearing loss is identified, it can be effectively managed and that such managements lessens or averts adverse outcomes.  Could be some time before that happens, so for now, what evidence did the task force use to make its recommendations?

The task force reviewed all the literature published between 1950 and January 2010 on sensorineural hearing impairment screening in adults 50 years of age and older, who did not already have a diagnosis of hearing loss in a primary care setting.  This was limited to subjects who did not self-report a hearing problem.  Evidence was examined on any association of screening with improved health outcomes, accuracy of screening methods, benefit of early detection rather than symptomatic detection of hearing loss, effectiveness of treatment, and harms and benefits associated with screening and treatment. 

Screening tests are largely effective in identifying hearing loss in this population, the USPSTF found, and many of them can be easily administered in a primary care setting. One issue remains a working definition of exactly what constitutes a hearing loss because of variability in frequency and intensity thresholds used for testing, but population-based estimates indicate that some 20-40% of adults older than 50 have some hearing impairment, and that percentage rises to 80% of those 80 years of age and older.  Another problem is that since hearing loss is usually subtle and incremental, the subject himself may fail to recognize or deny any hearing compromise.

Once a hearing problem is identified, studies reviewed for these recommendations underscored the sad fact that the vast majority of people aren't willing to use a hearing aid, in fact, in the few studies included for review that number was less than 10%.  Clearly, attempting to determine whether hearing aid use ameliorated outcomes or improved quality of life was fruitless.  As Rick and I opine in the podcast, we really need public education efforts to improve the image of hearing aids and teach people that there is a learning curve associated with their use so improvement is not immediate.  In addition, manufacturing standards  and insurance coverage would likely encourage more widespread employment of hearing aids. Subsequently, assessing more hard outcomes with regard to managing hearing loss would be possible.

So what about the potential harms of screening?  Since testing is noninvasive, such harms are nonexistent.  How about overdiagnosis and overtreatment?  Hard to assess with current evidence, but seems less likely than say, harms relative to prostatectomy.  In sum then, right now the evidence to clearly persuade anyone of the positive aspects of routine screening for hearing loss among older adults is lacking, but in my mind, it's a lot like that old adage about you can't get a job without experience but how do you get experience without a job? 

Other topics this week include, also in Annals, factors related to the effectiveness of screening colonoscopy, lead and gout in the same issue, and a CDC warning on use of pain medications in kids after tonsillectomy.  Until next week, y'all live well.


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Improving Hearing Loss With Hearing Aids | Healthy Man
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U might have a hearing loss if… | All Things Audiology
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{ 7 comments… read them below or add one }


Abby Hardey July 29, 2017 at 10:41 am

Having a hearing loss is hard, especially if you're in the mid-30s where you need to hear instructions clearly in your workplace. Hearing Aids today is getting more advanced, and some have a micro size that you won't even notice that it's there. I've got my hearing aids just recently, and I couldn't be happier.


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symptoms of stds March 6, 2013 at 3:10 am

Thanks for sharing your thoughts on hearing aids. Regards


Nicole Renee January 14, 2013 at 6:15 pm

This is an interesting blog post to me for one reason. My boyfriend's father just got a hearing aid after he decided to get a routine check/ He never had any problem with his hearing and it would have been worse if he did not get it checked now. I think it is extremely important to get a routine hearing checkup once you are older! thank you for sharing this post. - Hearing Aids Colorado


Steve Brown November 5, 2012 at 4:49 am

Internal medicine will definitely help those who loss their hearing. Hearing aids are one of the remedy in order a person can hear better. Although, it's better to have it checked by internal medicine specialist.


hearing aids atlanta August 29, 2012 at 3:56 am

Hearing aids technology depends on the patient's problem and ear loss injuries. Hearing aids can be easily carried by the patient and can be fitted over the top of the ear.


Elizabeth Tracey August 29, 2012 at 8:50 am

Thanks for your comment; as you know, there are many issues with hearing aids, especially their cost and lack of standardization. Also, people who are motivated to use them should be apprised that there is a learning curve to using them, so they need to be patient.


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