US task force unconvinced of case for hearing tests in elderly

By Sarah Guy, MedWire Reporter

A US Preventive Services Task Force (USPSTF) review of screening for hearing impairment in older, asymptomatic adults concludes that there is insufficient evidence to assess whether or not the benefits outweigh the harms.

As reported in the Annals of Internal Medicine, the statement updates the 1996 USPSTF recommendations that older adults (≥50 years) should be periodically questioned about their hearing, counseled about the availability of hearing aids, and referred where appropriate.

The current review of evidence published between 1950 and 2012 indicates some accuracy for clinical tests including the finger-rub, whispered words, and watch-tick tests, but data were from limited numbers of studies.

One trial that randomized individuals aged 50 or older to hearing-loss screening or none showed that those in the screening groups were more likely to wear hearing aids after 1 year than their unscreened counterparts, but that hearing aid use was very low among those without initial perceived hearing impairment.

Participants of another study who were observed for the effect of a hearing aid after establishing hearing loss via screening, showed emotional and functional improvements in quality of life that were sustained at 12 months.

However, the results of three further trials found no clear differences between treatment of hearing loss with hearing aids, with assisted listening devices, both, and even neither.

The USPSTF team reports no trial or study evidence at all for potential adverse effects associated with screening for hearing loss, or treatment of hearing loss with hearing aids.

"Aging is the most important risk factor for hearing loss," writes Virginia Moyer on behalf of the USPSTF, Rockville, Maryland, adding that the onset of sensorineural hearing loss is subtle.

"Without additional study, the relative value and likelihood of success of detecting and treating hearing loss in persons who are not aware of a problem before screening or have not sought care for perceived hearing loss are unclear," the task force suggests.

The USPSTF does highlight that clinicians should "understand the evidence but individualize decision making to the specific patient or situation," since clinical decisions involve more considerations than evidence alone.

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