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Insufficient Evidence for Routine Hearing Loss Screening in Older Adults: USPSTF


NEW YORK (Reuters Health) – There is not enough evidence to recommend for or against screening for hearing loss in asymptomatic adults ages 50 and older, according to a draft recommendation from the U.S. Preventive Services Task Force (USPSTF). The draft is available for public comment through October 5, 2020.

“We know that commonly used screening tests can detect hearing loss, but unfortunately, the evidence is not clear about whether or not it’s helpful to identify hearing loss in people who have not reported hearing issues,” Task Force member Dr. John Epling of the Virginia Tech Carilion School of Medicine in Roanoke told Reuters Health by email.

“We identified several areas where more research is needed to assess the benefits and harms of screening for hearing loss in older adults who have not noticed any issues with their hearing,” he said. “In particular, we need more studies on whether or not screening impacts health outcomes such as quality of life and function. We would also like to see more studies that include the general adult population, and more research that examines the potential harms of screening and treatment.”

As posted on the USPSTF website, the recommendation statement – and accompanying evidence review – acknowledge that hearing loss is a “common problem” that affects 43% of adults ages 70 and older, and that it can negatively impact quality of life and functional independence. People with hearing loss may have problems with speech discrimination and localization of sounds, according to the statement. Further, hearing loss has been associated with increased social isolation, raising the risk of cognitive decline.

The evidence review focused on English-language controlled trials evaluating hearing loss screening, interventions for screen-detected or newly detected hearing loss, and screening test accuracy, as identified on PubMed/MEDLINE, the Cochrane Library, Embase, and trial registries.

“Several screening tests can adequately detect hearing loss in adults age 50 years or older,” according to the evidence review. “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.”

Because of a lack of evidence, the USPSTF concluded that the benefits and harms of screening for hearing loss in asymptomatic older adults are uncertain.

As Dr. Epling noted, although commonly used screening tests, including the whispered voice and asking a single question about hearing, can detect hearing loss, it’s not clear from the evidence whether it is helpful to identify hearing loss in people who don’t report symptoms, according to the statement.

The statement is similar to the Task Force’s 2012 final recommendation on the same topic and applies only to asymptomatic adults ages 50 and older with age-related hearing loss.

Dr. Epling said, “It is certainly possible that older adults may be unaware of hearing loss because it is mild and progresses slowly, or because they suffer from additional health conditions such as cognitive impairment. In addition, some people may suspect that they are losing their hearing but choose not to raise their concern with their provider.”

“Both situations point to the need for more research that would allow us to make a strong, evidence-based recommendation about whether or not it is beneficial to routinely screen older adults who have not reported or noticed any issues with their hearing,” he concluded.

Dr. Kurt Kroenke, Director of Education and Training programs at the Regenstrief Institute and a professor at the Indiana University School of Medicine, commented in an email to Reuters Health, “It is interesting that a single question about trouble hearing and checking how well the patient hears the clinician’s whispered voice are nearly as accurate as longer questionnaires and handheld devices to check hearing. It seems a practical approach would be to ask older adults – especially those 60 years and older – if they have trouble hearing and possibly see if they have trouble hearing what is whispered a couple feet away.”

“Formal hearing testing by an audiologist can probably be reserved for those who acknowledge hearing problems or fail the whisper test,” he said. “One other indication for audiologic testing might be reports by family members of the patient not hearing well, although this has not been formally studied.”

Comments on the draft statement can be submitted from September 8, 2020, through October 5, 2020, at https://bit.ly/3i6Kkb7.

SOURCE: https://bit.ly/35hLxZr and https://bit.ly/2FaDcfD U.S. Preventive Services Task Force, online September 8, 2020.

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