Academy Responds to USPSTF
In December 2011, the U.S. Preventive Services Task Force (USPSTF) invited comments on their Screening for Hearing Loss in Older Adults draft recommendation statement. President Therese Walden submitted a response on behalf of the Academy.
How could the USPSTF make this draft Recommendation Statement clearer?
The statement is clear – there is a great need for evidence to support (or refute) the benefit of screening for hearing loss in adults without symptoms/report of hearing loss.
What information, if any, did you expect to find in this draft Recommendation Statement that was not included?
The statement was comprehensive. However, there was no information in the draft recommendation regarding mild or asymptomatic hearing loss which can masquerade as cognitive deficits or exacerbate cognitive problems in older adults. There are indeed groups of individuals who are at greater risk for undiagnosed hearing loss such as those with chronic medical conditions like diabetes1 and recent research has linked dementia with undiagnosed hearing loss2. Asymptomatic assumes no or mild hearing loss; it may be that some individuals are distracted from a mild or even a mild to moderate hearing loss because of other medical issues with which they are pre-occupied. An effective screening program, instituted for adults 50 years of age and older, may help to indentify loss in at-risk populations.
Based on the evidence presented in this draft Recommendation Statement, do you believe that the USPSTF came to the right conclusions? Please provide additional evidence or viewpoints that you think should have been considered.
The USPSTF did come to the right conclusions based on the available evidence/research which is described as 'insufficient to assess the balance of benefits and harm'. The research reported in the draft recommendation (Yueh et al, 2010) did indeed suggest that hearing screening was a catalyst in moving individuals from just a hearing loss to actually doing something about it (for those who self-perceived a loss/problem).3 If the outcome of the screening is normal then it still provides the individual with an increased awareness of the potential problem and could allow for the audiologist to provide the patient with information about the condition (pamphlets, websites, etc.). Awareness could lead to employment of preventative measures (e.g., the use of hearing protection in the presence of hazardous background noise) or more early detection of a problem should one develop. So, two benefits of a screening program are to provide information on the condition and to raise awareness.
What resources or tools could the USPSTF provide that would make this Recommendation Statement more useful to you in its final form?
The American Academy of Audiology will provide this information to our members and will encourage more systematic evaluation of the benefits of an effective screening program. Just like hearing screening is performed in elementary school-aged children because they are at risk for mild hearing loss, or unilateral hearing loss that could compound other learning disabilities, it is important to focus on the adult population who are at risk. This summary document from the USPSTF should help to fuel the need for more research funding in this area.
The USPSTF is committed to understanding the needs and perspectives of the public it serves. Please share any experiences that you think could further inform the USPSTF on this draft Recommendation Statement.
As indicated above, focusing a screening program for adults over 50 years of age to identify hearing loss as soon as possible and then treat/manage as needed will help to educate physicians and other healthcare providers. Waiting until a loss is more moderate may result in less effective treatment and as individuals age, their focus on other health problems may defer treatment of undiagnosed hearing loss. Comprehensive, preventative healthcare, such as exists in the military helps to preserve and maintain overall health and addresses health issues as soon as they occur as opposed to waiting for a disease state to escalate. We have found that education improves awareness and early treatment results in more long-term effective treatment.
The American Academy of Audiology is focusing its efforts in hearing and balance wellness – keeping the individual healthy in terms of hearing and balance care. Similar to the HHS Healthy People 2020 Initiative, this focus should result in improved outcomes as education and awareness helps the individual patient take more ownership of their healthcare.4
Do you have other comments on this draft Recommendation Statement?
Clearly there is a need for research in the area of benefit of screening protocols for potential hearing loss in adults over age 50 because of the established link between age and hearing loss and the documented effects of untreated hearing loss, especially in high-risk populations. A cost-effective screening program that helps to identify individuals with hearing loss (even a mild loss) and then provides education and information for the individual will help to identify hearing loss earlier for more effective treatment. Additionally, audiologists are unique positioned to develop and manage these screening programs, working with primary care providers, hospitals, skilled nursing facilities, retirement communities, etc. Although the suggested 'clinical' tests of whispered voice or finger rub have been around for a long time, they are fraught with all manner of subjectivity. Indeed, as suggested in the draft statement, asking the question, "Do you have difficulty hearing?" is a good beginning and could start the conversation. Beyond that, a brief questionnaire that helps to focus where the hearing problems might be, like the HHIE, is a good next step. If the results of the single question or the questionnaire are positive then referral to an audiologist is the most cost-effective measure as the audiologist will be the person who can educate the patient on treatment options – everything from assistive devices to help hear on the phone to the devices for the television and devices for use in public settings (churches, auditoriums, etc.) to enable improved hearing. Additionally the audiologist can advocate for the patient to improve hearing ability at places of employment and can help educate the patients on ways to protect their hearing from sustaining further damage.
Thank you for your work on this document and for the opportunity to comment on this draft Recommendation Statement.
- NIH News: Hearing Loss Is Common in People with Diabete
- John Hopkins Medicine: Hearing Loss and Dementia Linked in Study
- Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, et al. Long-term effectiveness of screening for hearing loss: the Screening for Auditory Impairment–Which Hearing Assessment Test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 2010;58(3):427-
- HealthyPeople.gov: Hearing and Other Sensory or Communication Disorders