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Draft Recommendation Statement


Note: This draft Recommendation Statement is not the final recommendation of the U.S. Preventive Services Task Force. This draft is distributed solely for the purpose of pre-release review. It has not been disseminated otherwise by AHRQ. It does not represent and should not be interpreted to represent an AHRQ determination or policy.

This draft Recommendation Statement is based on an evidence review that was published on March 1, 2011 (available at http://www.uspreventiveservicestaskforce.org/uspstf/uspshear.htm).

The USPSTF makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service, and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decisionmaking to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

This draft Recommendation Statement is available for comment from October 4 until November 1, 2011 at 5:00 PM ET. You may wish to read the entire Recommendation Statement before you comment.



Screening for Hearing Loss in Older Adults: U.S. Preventive Services Task Force Recommendation Statement
DRAFT

Summary of Recommendation and Evidence

The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults ages 50 years and older (I statement).

Go to Clinical Considerations for suggestions for practice regarding the I statement.

Rationale

Importance

Age-related sensorineural hearing loss is a common health problem among adults ages 50 years and older. Hearing loss can impact social functioning and quality of life.

Detection

There is convincing evidence that screening tools can reliably and accurately identify adults with objective hearing loss. Clinical tests used to screen for hearing impairment include testing whether a person can hear a whispered voice, a finger rub, or a watch tick at a specific distance. Perceived hearing loss can be assessed by asking a single question (e.g., "Do you have difficulty with your hearing?") or with a more detailed questionnaire, such as the Hearing Handicap Inventory for the Elderly–Screening Version (HHIE-S). A handheld screening instrument consisting of an otoscope with a built-in audiometer can also be used.

Benefits of Detection and Early Intervention

Due to a paucity of directly applicable trials, there is inadequate evidence to determine whether screening for hearing loss improves health outcomes in persons who are unaware of their hearing loss, or who have perceived hearing loss but have not sought care for it. One good-quality study showed that hearing aids can improve self-reported hearing, communication, and social functioning for some adults with age-related hearing loss. This study nearly exclusively evaluated white male veterans with moderate hearing loss and moderate-to-severe perceived hearing impairment, more than one third of whom had been referred for evaluation of hearing problems; as such, these findings were of limited applicability to a hypothetical asymptomatic, screened population. The only randomized trial that directly evaluated the impact of screening for hearing impairment—rather than the effect of treatment alone—was not primarily designed nor had sufficient statistical power to detect differences in clinical outcomes. The USPSTF concludes that the evidence is inadequate to assess the benefit of screening and early treatment in an unselected screening population.

Harms of Detection and Early Intervention

Due to a lack of studies, there is inadequate evidence to determine the magnitude of harms of screening for hearing loss in older adults; however, given the noninvasive nature of both screening and associated diagnostic evaluation, these harms are likely no greater than small. There is adequate evidence that the harms of treatment of hearing loss in older adults are no greater than small.

USPSTF Assessment

The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for hearing loss in adults ages 50 years and older cannot be determined.

Clinical Considerations

Patient Population Under Consideration

This recommendation applies to asymptomatic adults ages 50 years and older. It does not apply to persons seeking evaluation for perceived hearing problems; these individuals should be assessed for objective hearing impairment and treated when indicated.

Assessment of Risk

Increasing age is the most important risk factor for hearing loss. Presbycusis, a gradual, progressive decline in the ability to perceive high-frequency tones due to degeneration of hair cells in the ear, is the most common cause of hearing loss in older adults. However, hearing loss may result from multiple contributing factors. Other risk factors include a history of exposure to loud noises or ototoxic agents, previous inner ear infections, genetic factors, and certain systemic diseases such as diabetes mellitus.

Screening Tests

Available screening tests include physical diagnosis tests, such as the whispered voice, finger rub, and watch tick tests, single-question screening or longer patient questionnaires, and handheld audiometers. All are relatively accurate and reliable screening tools for identifying adults with objective hearing loss. Additionally, self-administered questionnaires, such as HHIE-S, can identify adults with subjective hearing difficulty. Not all adults with subjective hearing difficulty, however, have objective hearing loss.

Treatment

Before receiving a hearing aid, diagnosis of objective hearing loss should be confirmed with a pure-tone audiogram. There is fair evidence from studies in highly selected populations that hearing aids can improve self-reported hearing, communication, and social functioning for some adults with age-related hearing loss.

Suggestions for Practice Regarding I Statement

Potential preventable burden. Some, but not all, persons with moderate-to-severe hearing loss may be helped by the use of a hearing aid. The finding of objective hearing loss indicates eligibility for a hearing aid, but it does not convincingly identify persons who will find the devices helpful and wearable and who will use them. One randomized, controlled trial found in a subgroup analysis that in older adults who did not have self-perceived hearing loss at study entry, screening and receipt of a free hearing aid did not increase hearing aid use after 1 year compared with an unscreened control group (and overall usage was low at 0% to 1.6%).

Cost. The cost of screening varies depending upon the test chosen. The cost of a questionnaire consists of the time required of both the patient and clinician. In-office clinical techniques (whispered voice, finger rub, or watch tick tests) and handheld audiometry are quick to perform; however, an audiometer has an upfront equipment cost. Diagnostic confirmation of a positive screen is typically performed with pure-tone audiogram, which requires a soundproof booth and trained personnel to administer the test, which takes approximately 1 hour to complete. The cost of hearing aids can be a barrier to use for older adults, as Medicare and many private insurance companies do not cover their purchase.

Other Considerations

Research Needs and Gaps

Future studies should concentrate on patients older than age 70 years and examine if there are differential effects of treatment on outcomes at different ages (e.g., >70 years, >80 years). Adequately powered studies are needed to better evaluate the effect of screening for hearing loss on clinical health outcomes—such as emotional and social functioning, communication ability, and cognitive function—rather than intermediate measures such as hearing aid use or satisfaction, particularly among adults without self-perceived or established hearing loss at baseline.

The incremental benefits and/or costs of screening asymptomatic adults compared with only testing and treating those who seek treatment for perceived hearing impairment are currently unknown. Knowledge of specific factors or patient characteristics associated with increased and sustained use of hearing aid devices, once prescribed, could permit targeted testing and treatment to those most likely to benefit.

Discussion

Burden of Disease

The normal human ear can process sound frequencies from 20 to 20,000 Hz, with 500 to 4,000 Hz being the most important range for speech processing. There is no universally accepted definition for hearing loss, as frequency and intensity thresholds vary depending on the reference criteria used. However, commonly employed definitions for mild and moderate hearing loss are the inability to hear frequencies associated with speech processing at <25 or <40 dB of volume, respectively (1, 2).

The prevalence of hearing loss varies depending upon the definition used, but population-based estimates range from 20% to 40% in adults older than age 50 years to more than 80% in adults ages 80 years and older (1, 2). Sensorineural hearing loss has a subtle onset, and individuals may therefore not recognize or report symptoms to their health care providers; comorbidities such as cognitive impairment may also impair acknowledgement of hearing deficits (3). Additionally, underreporting of symptoms may occur if the individual fears social stigma as a result of diagnosis. As such, the prevalence of this condition may be underestimated.

Hearing loss can negatively impact an individual’s quality of life and ability to function independently (4). Persons with hearing loss may have difficulty with speech discrimination and localization of sounds (5). Hearing impairment has been shown to be associated with increased social isolation and emotional dysfunction among older adults (6, 7).

Scope of Review

The USPSTF reviewed randomized, controlled trials and controlled observational studies published between 1950 and January 2010 on screening for age-related sensorineural hearing impairment in adults ages 50 years and older without diagnosed hearing loss in the primary care setting. The USPSTF examined evidence on the following topics: the association of screening with improved health outcomes, the accuracy of screening methods, the incremental benefit of early (rather than symptomatic) detection, the effectiveness of treatment, and the harms of screening and treatment. Congenital hearing loss, conductive hearing loss, and hearing loss due to occupational exposure or acute trauma were not included in this review.

Accuracy of Screening Tests

There are multiple screening exams for hearing loss that can be used in primary care settings, including clinical testing methods (e.g., whispered voice, finger rub, and watch tick tests), single-question screening (e.g., asking "Do you have difficulty with your hearing?") or multiple-item patient questionnaires (e.g., HHIE-S), and handheld audiometers. Twenty studies, including seven of good quality and 13 of fair quality, evaluated the diagnostic accuracy of various screening modalities compared with pure-tone audiogram for the detection of hearing impairment in older adults. Six good-quality studies directly compared the accuracy of different screening modalities for hearing impairment in older adults (1, 2).

Studies used different thresholds and criteria to define hearing impairment, making comparisons between modalities somewhat challenging, but evidence is consistent that common screening tests are useful in identifying individuals at increased risk of hearing loss. Simple screening modalities, such as the whispered voice test and single-question screening, appear to be nearly as accurate for detecting hearing loss as more detailed questionnaires or handheld audiometer devices (1, 2). Negative findings on handheld audiometers may be particularly helpful in ruling out hearing loss of >40 dB.

Median positive likelihood ratios (LRs) among the screening tests at >25 or >30 dB were in the range of 3.0 to 5.1 for single-question screening, HHIE-S, and whispered voice test at 2 feet (in ascending order). Negative LRs ranged from 0.03 to 0.52 for whispered voice test, single-question screening, and HHIE-S. The median positive LR at >40 dB for the AudioScope audiometer (Welch Allyn, Skaneateles Falls, NY) was 5.8 (range, 1.7–4.9), and the median negative LR was 0.05 (range, 0.03–0.08) (1, 2). Finger rub and watch tick tests had substantially stronger positive LRs (10 and 70, respectively) compared with other screening modalities, but they were only evaluated in a single study (8) and the confidence intervals (CIs) were very wide (2.6–43 and 4.4–1120, respectively). Negative LRs for the finger rub and watch tick tests were 0.75 (95% CI, 0.68–0.84) and 0.57 (95% CI, 0.46–66), respectively.

Effectiveness of Early Detection and Treatment

Direct evidence of the effect of screening for hearing loss on clinical outcomes is limited. Only one fair-quality randomized, controlled trial examined the impact of screening on hearing aid usage. The Screening for Auditory Impairment–Which Hearing Assessment Test (SAI-WHAT) trial (9) randomized 2,305 predominately male veterans ages 50 years and older to hearing loss screening with a tone-emitting otoscope (AudioScope), the HHIE-S questionnaire, or combined testing versus a control group of no screening. The primary outcome was hearing aid use 1 year after screening. The mean age of participants was 61 years; three fourths reported self-perceived hearing loss at baseline. A total of 18.6% of participants in the AudioScope arm, 59.2% in the HHIE-S arm, and 63.6% in the combined modality arm had a positive screening exam. Individuals in any screening arm were more likely to wear a hearing aid 1 year after screening compared with controls: hearing aid use was 6.3% in the AudioScope arm, 4.1% in the HHIE-S arm, and 7.4% in the combined arm versus 3.3% in controls (p=0.003 for test of equality across all four arms). Post-hoc analysis showed that use of a hearing aid was more common among participants reporting self-perceived hearing loss, but regardless of screening status, hearing aid use was very low among those without baseline perceived hearing impairment (0% to 1.6%). A secondary outcome of the trial was the effect of hearing aid use on quality of life, as measured by the Inner Effectiveness of Aural Rehabilitation Scale. No statistically significant differences in scores were observed across the study arms after 1 year; however, the trial was powered to detect differences in hearing aid use rather than clinical outcomes, so this finding does not definitively rule out a potential beneficial effect. The generalizability of these results is limited, as this study was composed of relatively young older male veterans with a high prevalence of perceived hearing loss who were eligible for free treatment services.

A good-quality trial (10) randomized 194 male veterans (mean age, 72 years) with screen-detected (two thirds of participants) or previously established (one third of participants) hearing loss to immediate receipt of a free hearing aid or a wait-list control group. Screening—when performed as part of the eligibility assessment—was with the AudioScope; a positive result was defined as hearing impairment of >40 dB in the better ear, with confirmation by pure-tone audiogram. The outcome of interest was quality of life improvements—including social, affective, cognitive, and physical domains—at 4 months, as measured by a battery of self-administered instruments, including the HHIE, Quantified Denver Scale of Communicative Function (QDS), Short Portable Mental Status Questionnaire (SPMSQ), Geriatric Depression Scale (GDS), and Self-Evaluation of Life Function (SELF). At study entry, 63% of participants reported experiencing severe effects on hearing-related social and emotional quality of life and functioning (as defined by an HHIE score of ≥42); the mean HHIE score for all participants was 50. Moderate communication difficulties were reported by 85% of participants (as defined by a QDS score of >30). At 4 months followup, HHIE and QDS scores were unchanged in the control group, but in the group that received hearing aids, mean HHIE scores improved from 49 to 15 and mean QDS scores improved from 59 to 36. Mean between-group differences in HHIE and QDS scores at 4 months were 34 and 24, respectively. A followup study found that improvements in HHIE and QDS scores in the intervention group persisted at 12 months (11). There were also statistically significant differences in changes in GDS and SPMSQ scores between the hearing aid and control groups, but the absolute effects were very small (<1 point difference), and baseline scores did not indicate substantial levels of depression or cognitive dysfunction in this population. The trial’s source population of white male veterans, the high prevalence of moderate-to-severe hearing loss at study entry, and the inclusion of a relatively large proportion of participants with established (rather than screen-detected) hearing impairment restricts the generalizability of these findings.

Two fair-quality trials and one poor-quality trial of treatment for hearing loss with hearing aids were also reviewed by the USPSTF. One trial found no clear difference between an assistive listening device and no treatment in veterans ineligible for free hearing aids (12); one found no difference between a hearing aid, assistive listening device, or both and no amplification in a subset of patients who had mild baseline hearing loss and were not using hearing aids at enrollment (13); and the third did not report outcomes with sufficient detail for reliable interpretation (14).

Potential Harms of Early Detection and Treatment

No randomized trials or controlled observational studies evaluated potential adverse effects associated with screening or treatment of hearing impairment using hearing aids. In community-based and primary care settings, rates of false-positive tests, using >25 dB as a threshold for a positive screen, ranged from 5% to 41% (1, 2), depending on the screening test used and the population evaluated. Screening could also potentially be associated with anxiety, labeling and stigma, or other psychosocial effects, but no studies were available to estimate these outcomes. According to case reports, treatment with hearing aids may be associated with cerumen impaction, dermatitis, accidental retention of molds, otitis externa, and associated middle ear problems (1, 2). As screening and confirmatory testing for hearing impairment are noninvasive and serious harms of treatment are rare, the adverse effects of screening for hearing loss are likely no greater than small.

Estimate of Magnitude of Net Benefit

A fair-quality randomized trial that directly evaluated the impact of screening for hearing impairment demonstrated a statistically significant increase in the use of hearing aids among screened groups after 1 year; however, no conclusions could be drawn about the effect of screening on health outcomes, such as improved quality of life and ability to function. One good-quality randomized trial of treatment showed that hearing aids can improve communicative ability and social function for some older adults with known hearing impairment. In both of these trials, however, the study population was essentially limited to white male veterans with self-perceived or established moderate-to-severe hearing loss; as such, the applicability of the findings to a broader asymptomatic population is unclear. Furthermore, adherence to hearing aid use among participants diagnosed with hearing impairment in the SAI-WHAT trial was low, particularly in those individuals that did not report self-perceived hearing loss at baseline. Although studies have consistently demonstrated that a variety of screening tests—including clinical exams, single- or multiple-item questionnaires, and handheld audiometers—can successfully identify individuals with objective hearing loss, it is less clear how to recognize those individuals who will adhere to—and thus derive benefit from—treatment. The incremental value of screening and diagnosing asymptomatic older adults with hearing impairment in advance of presentation with symptoms is therefore unclear.

Given unknown efficacy in a general, asymptomatic population, the USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for hearing loss in older adults.

How Does Evidence Fit With Biological Understanding?

Although sensorineural hearing loss is a relatively common consequence of aging, presbycusis has a gradual onset, so many older adults may not recognize that they have an impairment or may not perceive their sensory deficits to be a problem. Some individuals may simply alter their daily activities to adapt to the loss. Additionally, some older adults may be resistant to seeking treatment for hearing impairment or adhering to use of a hearing aid due to fear of social stigma or a feeling of loss of independence. Limited evidence suggests that, when used and adhered to, hearing aids can improve quality of life and ability to function in select populations with moderate-to-severe hearing loss; sustained hearing aid use appears to be most associated with the presence of self-perceived hearing impairment or a greater magnitude of hearing loss. Without additional study, the relative value and likelihood of success of detecting and treating hearing loss in individuals that are not aware of a problem prior to screening or who have not sought care for perceived hearing loss is unclear.

Update of Previous USPSTF Recommendation

This recommendation replaces the 1996 recommendation, in which the USPSTF recommended periodically questioning older adults about their hearing, counseling them about the availability of hearing aids, and making referrals when appropriate (15). This conclusion was based upon the best available evidence at that time, which was indirect in nature and largely limited to studies of diagnostic accuracy and the treatment of individuals with established or perceived hearing loss. The previous Task Force noted that there were no controlled trials that could prove the effectiveness of screening asymptomatic older adults for hearing impairment. Screening and diagnostic evaluation are two distinct activities, and treatments may vary in effectiveness depending upon how the condition is identified. There may be important differences between an individual who presents with subjective hearing complaints and is diagnosed with objective impairment as a result of symptoms and someone without self-perceived hearing difficulties who undergoes routine and automatic application of a screening exam to detect a personally inapparent, but objectively identifiable, decline in hearing function.

Since the 1996 recommendation was published, direct evidence from a randomized, controlled trial evaluating the impact of screening itself—rather than treatment alone—has become available (9). Although this trial found that screening was associated with an increase in hearing aid use, the benefit appeared to be limited to individuals who had self-perceived loss of hearing at baseline; no difference in use was observed for asymptomatic individuals with objective hearing loss detected via screening. Of note, screening was not found to have a discernable impact on hearing-related quality of life; however, the trial was not primarily designed nor had sufficient statistical power to detect clinical health outcomes, so additional research would be helpful to draw more definitive conclusions. Therefore, the Task Force now concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults ages 50 years and older (I statement).

Recommendations of Others

The American Speech-Language-Hearing Association recommends that adults be screened once per decade and every 3 years after age 50 years (16). The American Academy of Family Physicians recommends that clinicians question older adults about hearing impairment and counsel them regarding the availability of treatment when appropriate (17). The American Congress of Obstetricians and Gynecologists recommends that women ages 13 years and older be evaluated and counseled on hearing as part of the periodic health assessment (18).

Appendix: U.S. Preventive Services Task Force

Members of the U.S. Preventive Services Task Force* at the time this recommendation was finalized are Virginia A. Moyer, MD, MPH, Chair (Baylor College of Medicine, Houston, Texas); Michael L. LeFevre, MD, MSPH, Co-Vice Chair (University of Missouri School of Medicine, Columbia, Missouri); Albert L. Siu, MD, MSPH, Co-Vice Chair (Mount Sinai School of Medicine, New York, New York); Kirsten Bibbins-Domingo, PhD, MD (University of California, San Francisco, California); Susan J. Curry, PhD (University of Iowa College of Public Health, Iowa City, Iowa); Glenn Flores, MD (University of Texas Southwestern, Dallas, Texas); Adelita Gonzales Cantu, RN, PhD (University of Texas Health Science Center, San Antonio, Texas); David C. Grossman, MD, MPH (Group Health Cooperative, Seattle, Washington); George J. Isham, MD, MS (HealthPartners, Minneapolis, Minnesota); Rosanne M. Leipzig, MD, PhD (Mount Sinai School of Medicine, New York, New York); Joy Melnikow, MD, MPH (University of California Davis, Sacramento, California); Bernadette Melnyk, PhD, RN (Ohio State University College of Nursing, Columbus, Ohio); Wanda K. Nicholson, MD, MPH, MBA (University of North Carolina School of Medicine, Chapel Hill, North Carolina); Carolina Reyes, MD, MPH (Virginia Hospital Center, Arlington, Virginia); J. Sanford Schwartz, MD, MBA (University of Pennsylvania Medical School and the Wharton School, Philadelphia, Pennsylvania); and Timothy J. Wilt, MD, MPH (University of Minnesota Department of Medicine and Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota). Diana Petitti, MD, MPH, a previous Task Force member, also made significant contributions to this recommendation.

* Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.uspreventiveservicestaskforce.org/members.htm.

Table 1: What the Grades Mean and Suggestions for Practice

Grade Definition Suggestions for Practice
A The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer/provide this service.
B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Offer/provide this service.
C The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small. Offer/provide this service only if other considerations support offering or providing the service in an individual patient.
D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service.
I Statement The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read "Clinical Considerations" section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.


Table 2: Levels of Certainty Regarding Net Benefit

Level of Certainty Description
High The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by factors such as:
  • the number, size, or quality of individual studies;
  • inconsistency of findings across individual studies;
  • limited generalizability of findings to routine primary care practice; or
  • lack of coherence in the chain of evidence.

As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.

Low The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:
  • the limited number or size of studies;
  • important flaws in study design or methods;
  • inconsistency of findings across individual studies;
  • gaps in the chain of evidence;
  • findings not generalizable to routine primary care practice; or
  • a lack of information on important health outcomes.

More information may allow an estimation of effects on health outcomes.

The U.S. Preventive Services Task Force defines certainty as "likelihood that the USPSTF assessment of the net benefit of a preventive service is correct." The net benefit is defined as benefit minus harm of the preventive service as implemented in a general, primary care population. The USPSTF assigns a certainty level based on the nature of the overall evidence available to assess the net benefit of a preventive service.

References

  1. Chou R, Dana T, Bougatsos C, Fleming C, Beil T. 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(5):347-55.
  2. Chou R, Dana T, Bougatsos C, Fleming C, Beil T. Screening for Hearing Loss in Adults Ages 50 Years and Older: A Review of the Evidence for the U.S. Preventive Services Task Force. Evidence Synthesis No. 83. Rockville, MD: Agency for Healthcare Research and Quality; 2011. Accessed at http://www.ncbi.nlm.nih.gov/books/NBK53864/ on 6 September 2011.
  3. Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care: scientific review. JAMA. 2003;289(15):1976-85.
  4. Mulrow CD, Aguilar C, Endicott JE, Velez R, Tuley MR, Charlip WS, et al. Association between hearing impairment and the quality of life of elderly individuals. J Am Geriatr Soc. 1990;38(1):45-50.
  5. Gates GA, Mills JH. Presbycusis. Lancet. 2005;366(9491):1111-20.
  6. Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech Hear Res. 1982;25(4):593-9.
  7. Carabellese C, Appollonio I, Rozzini R, Bianchetti A, Frisoni GB, Frattola L, et al. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc. 1993;41(4):401-7.
  8. Boatman DF, Miglioretti DL, Eberwein C, Alidoost M, Reich SG. How accurate are bedside hearing tests? Neurology. 2007;68(16):1311-4.
  9. 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):427-34.
  10. Mulrow CD, Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, et al. Quality-of-life changes and hearing impairment: a randomized trial. Ann Intern Med. 1990;113(3):188-94.
  11. Mulrow CD, Tuley MR, Aguilar C. Sustained benefits of hearing aids. J Speech Hear Res. 1992;35(6):1402-5.
  12. Yueh B, Souza PE, McDowell JA, Collins MP, Loovis CF, Hedrick SC, et al. Randomized trial of amplification strategies. Arch Otolaryngol Head Neck Surg. 2001;127(10):1197-204.
  13. Jerger J, Chmiel R, Florin E, Pirozzolo F, Wilson N. Comparison of conventional amplification and an assistive listening device in elderly persons. Ear Hear. 1996;17(6):490-504.
  14. Tolson D, Swan I, Knussen C. Hearing disability: a source of distress for older people and carers. Br J Nurs. 2002;11(15):1021-5.
  15. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. 2nd ed. Washington, DC: U.S. Department of Health and Human Services; 1996. Accessed at http://www.ncbi.nlm.nih.gov/books/NBK15435/ on 6 September 2011.
  16. American Speech-Language-Hearing Association. Guidelines for Audiologic Screening. Rockville, MD: American Speech-Language-Hearing Association; 1996. Accessed at http://www.asha.org/docs/html/GL1997-00199.html on 6 September 2011. Exit Disclaimer
  17. American Academy of Family Physicians. Clinical Preventive Services: Hearing Difficulties. Leawood, KS: American Academy of Family Physicians; 1996. Accessed at http://www.aafp.org/online/en/home/clinical/exam/hearing.html on 6 September 2011. Exit Disclaimer
  18. American Congress of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 483: primary and preventive care: periodic assessments. Obstet Gynecol. 2011;117(4):1008-15.

AHRQ Publication No. 11-05153-EF-2
Current as of October 2011


Internet Citation:

U.S. Preventive Services Task Force.Screening for Hearing Loss in Older Adults: Draft Recommendation Statement. AHRQ Publication No. 11-05153-EF-2. http://www.uspreventiveservicestaskforce.org/draftrec2.htm


 


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