'Insufficient' Evidence for Routine Hearing Tests, Experts Say ...

Hearing tests are cheap and effective. There are no known health harms. And they can identify older adults with compromised hearing who might benefit from using a hearing aid.

So why didn?t the United States Preventive Services Task Force?s new statement, published Monday in Annals of Internal Medicine, advise that adults age 50 and older be screened for hearing problems?

?We just don?t have enough evidence to show there would be a benefit,? said Dr. Albert Siu, a vice chairman of the task force and chairman of geriatrics at Mount Sinai School of Medicine. ?Hearing loss hasn?t been adequately addressed in the research literature.?

That?s an understatement. Although mild to severe hearing loss affects 27 million adults ages 50 and older, only one randomized controlled trial ? the gold standard of medical research ? has looked at the effect of screening for hearing problems in this population.

The results of that study, known as SAI-WHAT (Screening for Auditory Impairment-Which Hearing Assessment Test), found that adults who tested positively for hearing loss were more likely to use a hearing aid one year later. But the effects were modest, and the study had significant limitations. Notably, a sizable majority of participants reported some hearing problems before it began, so results can?t be generalized to older adults without symptoms ? the population addressed by the new task force recommendations.

This paucity of research is remarkable, given that hearing loss is the third most common health condition affecting older adults, behind hypertension and arthritis. But it?s not altogether surprising, given that this condition has traditionally been considered a natural consequence of aging and that it remains underdiagnosed and untreated in older adults.

The task force?s report ?really is a call to action to researchers? to investigate this topic in greater depth, said Jaynee Handelsman, vice president of the audiology practice at the American Speech-Language-Hearing Association. The organization recommends screening adults 50 and older every three years for hearing problems, but plans to review that position over the next year or so.

When the American Speech-Language-Hearing Association surveyed 2,232 older adults with AARP in September 2011, 68 percent said they believed their hearing health didn?t get adequate attention compared with other health concerns.

Although 76 percent said their hearing was of great importance to them, fewer than half had undergone a hearing test in the past five years. Nationally, fewer than 15 percent of seniors are thought to get the tests, which include brief questionnaires or physical examinations with otoscopes ? the instruments doctors stick in your ears to take a look around.

That may change as new research links hearing loss to poor cognitive functioning, falls and the onset of dementia in older adults. Now, the challenge is to determine whether early identification, and treatment with a hearing aid or other interventions, has an effect on those conditions or on older people?s quality of life, said Dr. Frank Lin, assistant professor of otology at Johns Hopkins University School of Medicine.

What?s already well established is that people who use hearing aids realize benefits, including improved ability to understand what other people are saying, communicate and negotiate social situations. Yet just over 14 percent of older adults with hearing loss use these expensive devices, which aren?t covered by Medicare or private insurance companies and which can require extensive fine-tuning, Dr. Lin reported in research published earlier this year in Archives of Internal Medicine.

Earlier this year this blog looked at reasons that seniors refuse to get hearing aids or chuck them in drawers, and found that the cost of the devices, denial and ignorance about the consequence of leaving problems unaddressed were all factors.

With its new ?I? recommendation, indicating insufficient evidence to recommend for or against hearing tests for older adults without symptoms, the preventive services task force leaves that decision up to individual physicians. Previously, in a 1996 statement, it endorsed periodic screening without specifying how often that should occur.

Given that the only detriments associated with hearing tests are ?some anxiety? and the unreimbursed medical costs patients incur, Dr. James Pacala, president of the American Geriatrics Society, said he planned to continue offering them to patients. ?I think we?ve oversold cancer screening, but in this case the harms are minimal to nonexistent, while the potential benefit is clear: When people are outfitted with hearing aids, they hear better.?

For his part, Dr. Glen Stream, president of the American Academy of Family Physicians, takes the opposite position. ?If people have symptoms or ringing in their ears or vertigo-type dizziness, they should talk to their doctors and consider hearing testing,? he said. ?But as a practicing physician, if my patient has no symptoms, am I going to be screening them for hearing loss going forward? The answer to that is no.?

In the meantime, the family physician organization has changed its position and no longer endorses periodic screening, as it had before the task force?s new recommendations.

Source: http://newoldage.blogs.nytimes.com/2012/08/14/in-testing-for-hearing-loss-how-often-is-too-often/

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