March 1, 2011 — A US Preventive Services Task Force (USPSTF) recommendation to routinely assess hearing loss in patients aged 50 years and older is effective, according to a review published February 28 in the Annals of Internal Medicine. A final update based on the findings has not yet been released but is said to be imminent.
Between 20% and 40% of adults in that population have diminished hearing. Many fail to notice hearing loss because of mild onset or because of its progressive nature. Among older adults with auditory deficits, only 10% to 20% have worn hearing aids.
“Screening could identify untreated hearing loss and lead to interventions to improve hearing-related function and quality of life,” write Roger Chou, MD, form the Oregon Evidence-Based Practice Center, Oregon Health and Science University, Portland, and colleagues.
USPSTF issued its recommendation to screen those aged 50 years and older in 1996. In 2009, the task force began reviewing evidence regarding screening and hearing loss in an effort to revise the screening statement, if warranted. The investigators examined randomized trials, controlled observational studies, and research on diagnostic accuracy, rating the data as good, fair, or poor.
Primary sources for data were the Ovid MEDLINE from 1950 through July 2010, and the Cochrane Systematic Reviews and Central Register of Controlled Trials though the second quarter of 2010.
The investigators considered the effect of screening on those aged 50 years and older by focusing on 5 questions:
- Does screening those with no symptoms produce better health results?
- How precise are screening tools?
- When there is detected hearing loss, how effective is treatment?
- Are there any negative effects of screening, and if so, what are they?
- What, if any, are the negative effects of treatment?
No Negative Effects Found, but More Study Needed
At least 1 fair- and 1 good-quality study demonstrated positive effects of screening:
- A randomized trial of 2305 patients showed that the primary outcome — hearing aid use at 1 year — was 6.3% in a faction tested by AudioScope, 4.1% in a cohort assessed by the Hearing Handicap Inventory for the Elderly-Screening Version, 7.4% in a combined category, and 3.3% in the control group (P = .03 for between-group difference).
- The same study, however, demonstrated that screening was not associated with improvements in hearing-related function.
- Also, a good-quality randomized study consisting of 194 participants found that beginning hearing aid use immediately after screening was more effective than waiting for mild, moderate, and severe hearing loss.
No evidence of harm was found to result from screening or hearing aids, but the investigators noted that more research is needed, especially concerning the effect of hearing aids.
“No study has tested the hypothesis that hearing aid use might lead to further deterioration in patients with severe to profound hearing loss due to the increased amplification required,” the authors write.
The paucity of evidence for benefits and harms of screening and treatments was stated as a limitation to the research. The exclusion of non-English-language studies and the inclusion of diagnostic accuracy trials in populations recruited from specialty settings were also cited as limitations.
Public Comments Will Shape Recommendation Revisions
The researchers stopped short of making a new recommendation based on their findings.
A draft recommendation statement will be soon be posted for public comment on the USPSTF Web site. Subsequently, a final statement will include a summary of changes made following input.
In conclusion, the investigators noted that further research is needed in several areas: the result of screening in primary care offices, the optimum age at which to begin screening, and the amount of hearing loss that would indicate the use of hearing aids.
“Because the effectiveness of any hearing screening strategy will depend on how likely persons who might benefit from hearing aids are to actually use them, research is needed on effective methods for enhancing follow-up rates and uptake of recommended treatments (including more effective treatments or increased usability of hearing aids) after screening,” the authors write.
The Agency for Healthcare Research and Quality supported the study.