Hearing loss: Help for the young and old

,; ,; ,

Applied Evidence

Hearing loss: Help for the young and old

J Fam Pract. 2012 May;61(5):268-277

PDF Download

References

1. National Institute on Deafness and Other Communication Disorders. Quick statistics. Available at: http://www.nidcd.nih.gov/health/statistics/Pages/quick.aspx. Accessed March 30, 2012.

2. American Speech-Language-Hearing Association. The prevalence and incidence of hearing loss in children. Available at: http://www.asha.org/public/hearing/disorders/children.htm. Accessed March 26, 2012.

3. The Children’s Hearing Institute. Frequently asked questions about hearing loss. Available at: http://www.childrenshearing.org/custom/faq_hearing_loss.html. Accessed April 11, 2012.

4. Sprinzl GM, Riechelmann H. Current trends in hearing loss in elderly people: a review of the technology and treatment options-a mini-review. Gerontology. 2010;56:351-358.

5. Mulrow CD. Association between hearing impairment and the quality of life of elderly individuals. J Am Geriatr Soc. 1990;38:45-50.

6. Meador HF, Zazove P. Health care interactions with deaf culture. J Am Board Fam Pract. 2005;18:218-222.

7. Steinberg AG, Barnett S, Meador HE, et al. Health care system accessibility: experiences and perceptions of deaf people. J Gen Intern Med. 2006;21:260-266.

8. Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J NY State Nurses Assoc. 2009;40:4-10.

9. Nelson HD, Bougatsos C, Nygren P. Universal newborn hearing screening: systematic review to update the 2001 U.S. Preventive Services Task Force recommendation. Pediatrics. 2008;122:e266-e276.

10. National Institute for Deafness and Communication Disorders. Age at which hearing loss begins. Available at: http://www.nidcd.nih.gov/health/statistics/Pages/begins.aspx. Accessed April 16, 2012.

11. Shargorodsky J, Curhan SG, Curhan GC, et al. Change in prevalence of hearing loss in US adolescents. JAMA. 2010;304:772-778.

12. Chao TK, Chen TH. Predictive model for progression of hearing loss: meta-analysis of multi-state outcome. J Eval Clin Pract. 2009;15:32-40.

13. Cohen-Mansfield J, Taylor JW. Hearing aid use in nursing homes. Part 1: prevalence rates of hearing impairment and hearing aid use. J Am Med Dir Assoc. 2004;5:283-288.

14. Wake M, Hughes EK, Collins CM, et al. Parent-reported health-related quality of life in children with congenital hearing loss: a population study. Ambul Pediatr. 2004;4:411-417.

15. Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA. 1988;259:2875-2878.

16. Centers for Disease Control and Prevention. Adolescent and school health. About hearing loss. Available at: http://www.cdc.gov/healthyyouth/noise/signs.htm. Accessed March 20, 2012.

17. Agrawal Y, Platz EA, Niparko JK. Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. Otol Neurotol. 2009;30:139-145.

18. American Speech-Language-Hearing Association. Causes of hearing loss. Available at: http://www.asha.org/public/hearing/Causes-of-Hearing-Loss. Accessed April 11, 2012.

19. Widen SE, Holmes AE, Johnson T, et al. Hearing, use of hearing protection, and attitudes towards noise among young American adults. Int J Audiol.. 2009;48:537-545.

20. Hoover A, Krishnamurti S. Survey of college students’ MP3 listening: habits, safety issues, attitudes, and education. Am J Audiol. 2010;19:73-83.

21. Centers for Disease Control and Prevention. Noise and hearing loss prevention. Noise meter. Available at: http://www.cdc.gov/niosh/topics/noise/noisemeter.html. Accessed April 11, 2012.

22. El Dib RP, Mathew JL. Interventions to promote the wearing of hearing protection. Cochrane Database Syst Rev. 2009;(4):CD005234.-

23. US Preventive Services Task Force Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement. Pediatrics. 2008;122:143-148.

24. Hall JW, 3rd, Smith SD, Popelka GR. Newborn hearing screening with combined otoacoustic emissions and auditory brainstem responses. J Am Acad Audiol. 2004;15:414-425.

25. Norton SJ, Gorga MP, Widen JE, et al. Identification of neonatal hearing impairment: a multicenter investigation. Ear Hear. 2000;21:348-356.

26. Korver AM, Konings S, Dekker FW, et al. DECIBEL Collaborative Study Group. Newborn hearing screening vs later hearing screening and developmental outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304:1701-1708.

27. American Academy of Pediatrics Joint Committee on Infant Hearing Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898-921.

28. Vogel I, Brug J, Hosli EJ, et al. MP3 players and hearing loss: adolescents’ perceptions of loud music and hearing conservation. J Pediatr. 2008;152:400-404.

29. Verbeek JH, Kateman E, Morata TC, et al. Interventions to prevent occupational noise induced hearing loss. Cochrane Database Syst Rev. 2009;(3):CD006396.-

30. Bade PF. Hearing impairment. In: Pacala JT, Sullivan GS, eds. Geriatrics Review Syllabus. 7th ed. New York, NY: American Geriatrics Society; 2010:197-206.

31. Yueh B, Shekelle P. Quality indicators for the care of hearing loss in vulnerable elders. J Am Geriatr Soc. 2007;55(suppl 2):S335-S339.

32. Chou R, Dana T, Bougatsos C, et al. Screening adults aged 50 years or older for hearing loss: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;154:347-355.

33. Yueh B, Collins MP, Souza PE, 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;58:427-434.

34. Gates GA, Murphy M, Rees TS, et al. Screening for handicapped hearing loss in the elderly. J Fam Pract. 2003;52:56-62.

35. Burton MJ, Doree C. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. 2009;(1):CD004326.-

36. McDermott AL, Williams J, Kuo M, et al. Quality of life in children with a bone-anchored hearing aid. Otol Neurotol. 2009;30:344-349.

37. Fitzpatrick EM, Olds J, Gaboury I, et al. Comparison of outcomes in children with hearing aids and cochlear implants. Cochlear Implants Int. 2012;13:5-15.

38. National Institute on Deafness and Other Communication Disorders. Hearing aids. How can I adjust my hearing aid? Available at: http://www.nidcd.nih.gov/health/hearing/pages/hearingaid.aspx#hearingaid_08. Accessed March 27, 2012.

39. National Institute for Health and Clinical Excellence (NICE). Cochlear implants for children and adults with severe to profound deafness. London, UK: NICE; 2009:41.

But what impact does screening actually have on patients’ quality of life? The evidence is mixed. One study in which asymptomatic individuals >50 years (mean age=61 years) underwent hearing screening found that, although screening increased hearing aid use at one year, it did not lead to an improvement in quality of life.^32,33 Another study with a significantly older population (mean age=72 years) found that screening did positively affect quality of life.¹³

Screening tools—and a question
Several testing techniques have about the same accuracy rates in diagnosing hearing loss in adult patients. These include:

the whisper test (which should be administered from a distance of 2 feet)
handheld audiometry testing (with frequencies of 500-4000 Hertz [Hz] at 40 dB, these devices are 94% sensitive and 72% specific for detecting hearing loss)¹⁵
the 10-question Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S), available at http://www.asha.org/docs/html/GL1997-00199-T19.html.

The HHIE-S takes <5 minutes to administer and can be used in conjunction with audiometry testing for increased accuracy in diagnosing hearing loss. An alternative is to ask just one question:

“Do you have a hearing problem now?” This question alone appears to be as effective as the HHIE-S in identifying older patients with hearing loss,³⁴ and is likely to be the most efficient screening method for busy primary care physicians.

FAST TRACK

Asking “Do you have a hearing problem now?” appears to be as effective as a formal hearing screen in identifying hearing loss in older adults.

Consultation is needed when hearing loss is suspected
An audiology consultation should be considered when a patient’s caregiver or family member—or the patient himself—expresses concern about hearing loss. A positive result on a hearing screen, as well as clinical expression of hearing loss, also indicates a need for referral.

An otolaryngology consult is required for complicated presentations, including persistent cerumen impaction, foreign bodies, otosclerosis, cholesteatoma, tympanic membrane perforation, and asymmetrical hearing loss, which could be caused by a tumor.

Treating hearing loss in patients of all ages

Cerumen can contribute to hearing loss in children and adults alike, and can often be treated in an outpatient setting. A recent Cochrane review of various means of cerumen removal found the strongest evidence for irrigation, followed by cerumenolytic treatment and manual removal.³⁵ The use of cerumenolytic agents appears to be more effective than no treatment, but there is no evidence favoring one product over another. (To learn more about self-removal, see “Wax removal: Help patients help themselves” (J Fam Pract. 2011;60:671-673).

Hearing aids are first-line treatment
Hearing aids should be considered as first-line treatment for children and adults with hearing loss in which easily treatable etiologies such as cerumen impaction have been excluded. They have been shown to improve the ability to understand speech and environmental sounds, as well as the quality of life, for patients of all ages.³⁶ Even infants can be fitted with hearing aids, which are appropriate for mild, moderate, and severe hearing loss.³⁷ But only about 20% of older patients who could benefit from hearing aids ever buy them—and an estimated 25% to 40% of those who have hearing aids use them only occasionally, stop using them completely, or continue to wear them despite receiving limited benefit.⁴

Cost is one potential barrier to greater use. Hearing aids range in price from about $1000 to $4000 or more for a pair. And, while insurance coverage varies from one health plan to another, hearing aids are not covered by Medicare.

What’s more, elderly patients sometimes have difficulty adjusting to hearing aids (see “Hearing aids don’t work if patients don’t wear them”).³⁸ Cognitive deficits, difficulty manipulating hearing aids, and embarrassment often contribute to suboptimal use of hearing aids.

Hearing aids don’t work if patients don’t wear them— tips for overcoming 6 objections

According to the National Institute on Deafness and Other Communication Disorders, only one out of 5 people who could benefit from hearing aids actually wears them. The use of hearing aids is relatively low even among those who own them: It is estimated that 25% to 40% of older people who have hearing aids wear them only occasionally—or not at all—or wear hearing aids that are of lim-ited benefit (eg, because they’re not adjusted properly, fit poorly, or do not provide adequate amplification).

Here’s some help in overcoming 6 common objections to their use:

“They hurt my ears.” Explain that discomfort is not unusual at first but often resolves in time. Advise the patient to wear the hearing aids for short periods initially, and then use them for longer periods of time once he or she gets used to them.
“My voice sounds too loud.” This is known as an “occlusion effect.” It occurs because of the trapping of bone-conducted sound vibrations between a hearing aid and tympanic membrane, and is usually self-limiting. If the problem persists, tell the patient to ask the audiologist to adjust the hearing aids.
“The hearing aids whistle.” Feedback, such as a whistling noise, is an indication of a poorly fitting hearing aid, cerumen impaction, or fluid in the ear. If you inspect the patient’s ears and find no problem (and the whistling continues), recommend that the patient ask the audiologist for a hearing aid adjustment.
“I’m bothered by background noise.” Explain that hearing aids may not be able to totally block background sounds, but that they can be adjusted to minimize this effect. Recommend a visit to the audiologist if the problem persists.
“They don’t work with my cell phone.” Suggest that the patient bring the phone on the next visit to the audiologist and ask that the hearing aids be adjusted, as needed, to minimize interference.
“I’m embarrassed to wear them.” Tell patients who are embarrassed by the need for hearing aids or don’t want to be seen wearing them that many hearing aids can be concealed, and advise them to discuss this with the audiologist. You might also point out that many people find it more embarrassing not to wear hearing aids, because they have to keep asking friends and family to repeat themselves. You might also refer them to “Guess who wears a hearing aid”—a blog with a lengthy list of actors, politicians, athletes, and even a former Miss America, who have worn hearing aids (http://newgenerationhearing.wordpress.com/2010/03/01/guess-who-uses-hearing-aids/).

Adapted from: National Institute on Deafness and Other Communication Disorders. Hearing aids.³⁸