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Level III – Hearing Loss Screening

Level III Services: Preventive services that clinicians and care systems could provide to patients, but only after careful consideration of the costs and benefits. Providing these services is left to the judgment of individual care systems, clinicians and their patients.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “The current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults age 50 years or older.”
(USPSTF Last Revised 2012)
Grade of Recommendation:
  1. I Statement

Level of Certainty:

  1. Insufficient
“Benefits:
Because of a paucity of directly applicable trials, evidence is inadequate to determine whether screening for hearing loss improves health outcomes in persons who are unaware of hearing loss or have perceived hearing loss but have not sought care. 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 effect 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 hearing-related function. The USPSTF concludes that the evidence is inadequate to assess the benefit of screening and early treatment in an unselected screening population.
Harms:
Because of a lack of studies, evidence to determine the magnitude of harms of screening for hearing loss in older adults is inadequate; however, given the non-invasive nature of both screening and associated diagnostic evaluation, these harms are probably small to none. Adequate evidence shows that the harms of treatment of hearing loss in older adults are small to none.
Benefits-Harms Assessment:
The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for hearing loss in adults age 50 years or older cannot be determined.”
Relevant Resources:
http://www.uspreventiveservicestaskforce.org/uspstf/uspshear.htm
Clinical considerations:
No studies have directly demonstrated a relationship between hearing screening and improved hearing function, hearing-related quality of life or activities of daily living. However, it is recognized that inadequately correcting hearing could become a barrier to care. Single-question screening is nearly as effective as the whisper-voice test or the handheld audiometric device (Chou, 2011; Bagai, 2006). The prevalence of uncorrected hearing loss in the elderly is approximately 25% (Popelka, 1998; Mulrow, 1990; Koike, 1989; Lichtenstein, 1988).
Implementation Tools and Strategies:
Screening for Hearing Loss in Older Adults