Screening for Hearing Loss in Adults Ages 50 Years and Older: A Review of the Evidence for the U.S. Preventive Services Task Force [Internet]

Excerpt

Background: Hearing loss is common in older adults. Screening could identify untreated hearing loss and lead to interventions to improve hearing-related function and quality of life.

Purpose: To update the 1996 U.S. Preventive Services Task Force evidence review on screening for hearing loss in primary care settings in adults ages 50 years and older.

Data Sources: We searched Ovid MEDLINE from 1950 to July 2010, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials through the second quarter of 2010 to identify relevant articles. We supplemented electronic searches with reviews of reference lists of relevant articles and solicited additional citations from experts.

Study Selection: We selected randomized trials and controlled observational studies that directly evaluated effects of screening for hearing loss in older (ages ≥50 years) adults. To evaluate indirect evidence on screening, we also included studies on the diagnostic accuracy of screening tests for hearing loss used in primary care settings, and randomized trials and controlled observational studies that reported clinical outcomes associated with use of amplification.

Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the U.S. Preventive Services Task Force.

Data Synthesis: Evidence on benefits and harms of screening and treatments for hearing loss was synthesized qualitatively. One large (n=2305) randomized trial found that screening for hearing loss was associated with increased hearing aid use at 1 year, but screening was not associated with improvement in hearing-related function. There is good-quality evidence from 20 studies on diagnostic accuracy that common screening tests for hearing loss can help identify patients at higher risk for hearing loss. The whispered voice test at 2 feet and a single question regarding perceived hearing loss were comparable with a more detailed screening questionnaire or a hand-held audiometric device for identifying at least mild (>25 dB) hearing loss. Negative results using a hand-held audiometric device may be the most useful finding for ruling out at least moderate (>40 dB) hearing loss. One good-quality randomized trial found that immediate hearing aids were effective compared with wait-list control for improving hearing-related quality of life and function in patients with mild or moderate hearing loss and severe hearing-related handicap. We did not find direct evidence on harms of screening or treatments with hearing aids, but harms are likely to be small based on the non-invasive nature of screening and treatment, with no known serious adverse events.

Limitations: We excluded non-English language studies, included studies of diagnostic accuracy in high-prevalence specialty settings, and did not construct outcomes tables.

Conclusions: Additional research is needed to understand effects of screening compared with no screening on health outcomes, and to confirm benefits of treatment under conditions likely to be encountered in most primary care settings.