Screening For Hearing Loss In Adults Ages 50 Years And Older

Author : Cynthia Feltner
Publisher :
ISBN 13 :
Total Pages : 163 pages
Book Rating : 4.:/5 (127 download)

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Download or read book Screening for Hearing Loss in Older Adults written by Cynthia Feltner and published by . This book was released on 2021 with total page 163 pages. Available in PDF, EPUB and Kindle. Book excerpt: PURPOSE: To systematically review the evidence on (1) benefits and harms of screening for hearing loss in adults age 50 years or older, (2) accuracy of screening tools, and (3) benefits and harms of interventions for hearing loss that was screen detected or recently diagnosed for populations and settings relevant to primary care in the United States. DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, Embase, and trial registries through January 17, 2020; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through November 20, 2020. STUDY SELECTION: English-language controlled trials for hearing loss screening or evaluating interventions for screen-detected or newly detected hearing loss and studies of screening test accuracy. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. DATA SYNTHESIS: One randomized, controlled trial (RCT) enrolling veterans (2,305 participants) found that screening for hearing loss was not associated with improvements in hearing-related function at 1 year, although screening was associated with increased hearing aid use. Thirty-four studies (reported in 35 articles) evaluated the diagnostic accuracy of clinical tests, a single question, a questionnaire, a handheld audiometric device, or a mobile-based audiometric application for identifying hearing loss in older adults. For detecting mild hearing loss (>20 to 25 dB), single-question screening had a pooled sensitivity of 66 percent (95% confidence interval [CI], 58% to 73%) and a pooled specificity of 76 percent (95% CI, 68% to 83%) (10 studies, 12,637 participants); for detecting moderate hearing loss (>35 to 40 dB), the pooled sensitivity was 80 percent (95% CI, 68% to 88%) and the pooled specificity was 74 percent (95% CI, 59% to 85%) (6 studies, 8,774 participants). Too few studies reported sufficient data to pool accuracy of the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) for detecting mild hearing loss (>25); across four studies (7,194 participants), sensitivity of HHIE-S ranged from 34 to 58 percent, and specificity ranged from 76 to 95 percent. For detecting moderate hearing loss (>40 dB), the pooled sensitivity of HHIE-S was 68 percent (95% CI, 52% to 81%), and the pooled specificity was 79 percent (95% CI, 69% to 86%) (5 studies; 2,820 participants). In four studies (411 participants) assessing the AudioScope for detecting moderate hearing loss (>40 dB), sensitivities were high (range: 94% to 100%) and specificity varied widely (range: 24% to 80%). Other screening questionnaires, clinical tests (e.g., watch tick, whispered voice), and technology were assessed by few studies each, and results were often inconsistent and imprecise. Six trials (853 participants) evaluated benefits of amplification compared with no amplification among populations with screen-detected or recently detected, untreated age-related hearing loss over 6 weeks to 4 months. Five trials reported on the HHIE (838 participants), a self-report tool designed to measure perceived effects of hearing loss in older adults; four (758 participants) found statistically significant benefit in favor of hearing aids. Three of the four trials that found statistically significant benefit enrolled veterans and reported differences in HHIE scores that were greater than the minimal important difference of 18.7. One RCT (154 participants) enrolling community volunteers found statistically significant benefit on the HHIE in favor of two different hearing aids vs. a placebo device; however, differences between groups did not meet the level considered to be clinically meaningful. Four studies reported on general quality of life or function; few studies reported on the same measure. One RCT (194 participants) enrolling veterans with screen-detected hearing loss found significant benefit in favor of the intervention on the Short Portable Mental Status Questionnaire (difference between groups in change from baseline: −0.28 points [95% CI, 0.08 to 0.48]; p=0.008) and Geriatric Depression Scale (difference between groups in change from baseline: −0.80 points [95% CI, 0.09 to 1.51]; p=0.03) in addition to the HHIE. No studies of interventions reported on harms. LIMITATIONS: The one trial of screening was not designed to measure hearing-related function. There has been little reproducibility in testing specific screening tests in primary care populations; most studies of screening test accuracy enroll populations from audiology or other high-prevalence settings. Trials showing clinically meaningful benefit in hearing-related function among groups receiving hearing aids vs. controls all enrolled veterans with a relatively high prevalence of hearing loss. CONCLUSIONS: Several screening tests can adequately detect hearing loss in adults age 50 years or older. One trial of screening that enrolled veterans with a relatively high prevalence of self-perceived hearing loss did not find a benefit for hearing-related function. No controlled studies reported on the harms of screening or treatment among adults with screen-detected or newly detected hearing loss. Evidence showing benefit for hearing-related function associated with hearing aids among adults with screen-detected or newly detected hearing loss is limited to studies enrolling veterans with a high prevalence of hearing loss.