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Hearing test benefits unknown in older adults: panel

By Andrew M. Seaman

Reuters

5:04 PM EDT, August 13, 2012

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NEW YORK (Reuters Health) - There's not enough evidence to say whether older adults should be screened for hearing loss if they don't have any symptoms, according to a new statement from a government-backed panel.

The recommendation, released on Monday, should not stop people over 50 years old from telling their doctor about hearing problems, according to the U.S. Preventive Services Task Force (USPSTF). It also shouldn't stop doctors from screening patients with symptoms of hearing loss.

"If you have a hearing problem, you should absolutely bring it up with your doctor," said Dr. Albert Siu, of the Mount Sinai School of Medicine in New York and co-vice chair of the USPSTF.

"This is not about fancy audiometric screenings," he told Reuters Health. "This is just about simple screenings that doctors and clinicians can do in the office."

Those office-based screenings can be as simple as asking whether a person is having trouble hearing or testing whether the patient can hear a whisper or the tick of a watch from a specific distance. They can also involve longer questionnaires or handheld testing devices.

Despite the lack of a recommendation from the USPSTF, Dr. Ronald A. Hoffman, medical director of the New York Eye and Ear Infirmary's Ear Institute, said he thinks doctors should still ask whether patients are having trouble hearing, ringing in their ears or trouble balancing.

"If you don't ask, you won't find out," he said.

It's estimated that hearing loss affects between 20 percent to 40 percent of people 50 years old and older, and almost 80 percent of people over 80 years old.

One of the problems with screening older adults, however, is that there's no guarantee they'd wear hearing aids or seek treatment for hearing loss they didn't know they had - especially since hearing aids can be costly and are often not covered by insurance.

"Ask them how they're doing. If they say they're fine, just leave it there," said Ellen O'Neil, associate director of audiology at the Massachusetts Eye and Ear Infirmary in Boston.

If they say they're having problems hearing, however, the person should be referred to an ear, nose and throat doctor or a licensed audiologist, Hoffman said.

The USPSTF statement, published Monday in the Annals of Internal Medicine, says more studies are needed to see whether screening of everyone over 50, even those without symptoms, would lead to improved health for older adults.

Very few studies have assessed whether "treatment" for a hearing problem detected by screening - typically in the form of a hearing aid - leads to significant benefits like improved social interaction, communication or cognitive function, the panel noted.

"I think the recommendation is nothing more than a call to action for researchers," said Jaynee A. Handelsman, vice president of audiology practice for the American Speech-Language-Hearing Association (ASHA).

"The gist of the recommendation is that there is not sufficient evidence to say whether we are or we're not supposed to be screening adults 50 years old and older," she told Reuters Health.

ASHA currently recommends that adults be screened for hearing loss every decade, and every three years after their 50th birthday.

Unlike some forms of mass screening, such as cancer screening, which can lead to unnecessary procedures and treatments, the USPSTF concluded that the possible harms of screening for hearing loss are probably negligible.

Besides cost, which can vary depending on the type of screening tests used, the USPSTF said "there are probably little to no adverse effects of screening for hearing loss."

SOURCE: http://bit.ly/Ms1ZbQ Annals of Internal Medicine, online August 13, 2012.