Start Screening at Age 50 for Age-Related Hearing Loss

Clinical guidelines on age-related hearing loss (ARHL), published in Otolaryngology–Head and Neck Surgery, highlight referral recommendations for all clinicians, including primary care doctors, who often are the first clinicians to screen for and address the condition.

Betty S. Tsai Do, MD, with the Department of Head & Neck Surgery at Kaiser Permanente in Walnut Creek, California, is the first author for the guidelines, which recommend screening patients 50 years or older at the time of a healthcare encounter. They also detail when to test and refer.

Three ‘Strong Recommendations’

Three of the action points are labeled “strong recommendations.” They are:

  • If screening suggests hearing loss, clinicians should conduct an audiogram or refer to a clinician who can conduct one.
  • Clinicians should offer, or refer to a specialist who can offer, appropriately fit amplification, such as hearing aids.
  • If patients have appropriately fit amplification and still have trouble with hearing and understanding speech, clinicians should refer patients to see if they are good candidates for a cochlear implant.

The authors note that ARHL is the most common sensory deficit seen in older patients, but it is underdiagnosed and undertreated. “Between ages 65 and 74, one in three adults experience hearing loss and almost 50% of those 75 years of age or older will report hearing loss according to the National Institute on Deafness and Other Communication Disorders.” Consequences of the untreated deficit, in addition to limiting ability to communicate, include higher risk of dementia, cardiovascular disease, depression, falls, and workplace marginalization.

Until now, there have been no evidence-based clinical guidelines on when to screen, test, and refer. Though previously proposed quality improvement measures have defined ARHL as starting at age 60, these guidelines include those 50 and older to promote earlier detection.

Guidelines Only Part of the Solution

While the guidelines are a step in the right direction, they won’t address some persistent barriers to changing practice, said Michael McKee, MD, MPH, a family medicine physician and co-director of the Center for Disability Health and Wellness at the University of Michigan in Ann Arbor, who was not part of the guideline team.

“I think [the guidelines] will raise the awareness on why it’s important to address hearing loss,” he says. “Many primary care providers don’t elevate hearing loss as a priority topic. The problem is that we’re struggling with getting things in place to have a more supportive system to carry out those recommendations.”

Lack of Training and Support

The problems include lack of training on hearing loss for physicians, starting with medical school. Another complication is time: A conversation about hearing loss adds to the multitude of conversations a primary care provider is expected to have with their patients in a short visit.

Additionally, when hearing loss is suspected, an audiologist may be hard to find to perform the audiogram, Dr McKee says. If patients agree to see an audiologist and that specialist finds hearing loss, patients may not want to wear a device due to stigma or may not be able to afford a device that will fit properly and truly benefit them because Medicare does not cover hearing aids.

“Only about 20-plus percent of those eligible for hearing aids get them,” he said. Hearing aids available over the counter help some people but may be difficult to fit properly and may be hard for some to use correctly, he added.

“That comes back to the primary care provider, so it’s unfortunately a very unsatisfying course,” he said.

‘Primary Care Providers Do Value Guidelines’

However, “Primary care providers do value guidelines. They do value strong recommendations,” he said. We are trying to figure out how we can support people with unaddressed hearing loss in the primary care setting, Dr McKee said. “Once we get there, we need to advocate for an expansion of coverage,” he said.

The authors note that the messages in the guidelines are important for all clinicians.

“The impact of hearing loss and screening should not be the sole responsibility of an audiologist, an otolaryngologist, nor primary care provider. Any time and place that a patient interacts with the healthcare system is an opportunity for preventive healthcare, such as hearing screening, to occur,” they write.

Funding for this research was provided by the American Academy of Otolaryngology–Head and Neck Surgery Foundation. Dr Do and Dr McKee report no relevant financial relationships. Full disclosures of the co-authors are listed with the full text of the paper.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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