Screening and Management of Adult Hearing Loss in Primary Care: Scientific Review

Abstract

Context: Hearing loss is the third most prevalent chronic condition in olderadults and has important effects on their physical and mental health. Despitethese effects, most older patients are not assessed or treated for hearingloss. Objective: To review the evidence on screening and management of hearing loss ofolder adults in the primary care setting. Data Sources and Study Selection: We performed a search from 1985 to 2001 using MEDLINE, HealthSTAR, EMBASE,Ageline, and the National Guideline Clearinghouse for articles and practiceguidelines about screening and management of hearing loss in older adults,as well as reviewed references in these articles and those suggested by expertsin hearing impairment. Data Extraction: We reviewed articles for the most clinically important information,emphasizing randomized clinical trials, where available, and identified 1595articles. Data Synthesis: Screening tests that reliably detect hearing loss are use of an audioscope,a hand-held combination otoscope and audiometer, and a self-administered questionnaire,the Hearing Handicap Inventory for the Elderly-Screening version. The valueof routine screening for improving patient outcomes has not been evaluatedin a randomized clinical trial. Screening is endorsed by most professionalorganizations, including the US Preventive Services Task Force. While mosthearing loss in older adults is sensorineural and due to presbycusis, cerumenimpaction and chronic otitis media may be present in up to 30% of elderlypatients with hearing loss and can be treated by the primary care clinician.In randomized trials, hearing aids have been demonstrated to improve outcomesfor patients with sensorineural hearing loss. Nonadherence to use of hearingaids is high. Prompt recognition of potentially reversible causes of hearingloss, such as sudden sensorineural hearing loss, is important to maximizethe possibility of functional recovery. Conclusion: While untested in a clinical trial, older adults can be screened forhearing loss using simple methods, and effective treatments exist and areavailable for many forms of hearing loss.