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Hearing loss in the elderly often is undetected and frequently goes untreated in the primary-care setting, according to a systematic review of articles published from 1985 to 2001. This is true even though hearing loss can be recognized through simple screening methods, and treatment is available for many conditions.
Dr. Bevan Yueh and his colleagues conducted the review, published in the April 16 issue of the Journal of the American Medical Association (JAMA). Yueh is associate professor of otolaryngology/head and neck surgery and staff surgeon at the Veterans Affairs Puget Sound Health Care System.
Hearing loss is the third most prevalent chronic condition in older Americans, after hypertension and arthritis. An estimated 25 percent to 40 percent of the population aged 65 years or older is hearing impaired. The prevalence of hearing loss increases with age, affecting more than 80 percent of patients older than 85.
An impaired ability to hear and communicate can, by itself, be frustrating. According to the JAMA article, hearing loss also can lead to social isolation, depression, poor self-esteem, and functional decline.
The two major forms of hearing loss are sensorineural (nerve deafness) and conductive disorders. In the United States, sensorineural loss is the most common cause of impaired hearing. In older people, this condition is called presbycusis and is most frequently treated with amplification devices, such as hearing aids.
A conductive hearing loss generally has a mechanical cause such as a perforated eardrum, fluid in the middle ear, or earwax impaction. Treatment typically is surgery or simple procedures to drain or clean the ear.
Treatments for both sensorineural and conductive hearing loss have been shown to improve quality of life in hearing-impaired patients.
Tools that reliably screen for hearing loss include audioscopes, a portable otoscope that emits tones, and a self-administered questionnaire called the Hearing Handicap Inventory for the Elderly, Screening Version.
Yueh recommends that primary-care physicians ask their older patients about possible hearing loss and look for common symptoms of hearing impairment such as difficulty communicating and social withdrawal. Identifying hearing loss early may prevent further deterioration or permanent deafness.
The next step? Yueh and his colleagues are conducting a randomized trial of more than 2,000 veterans to determine whether screening for and detection of hearing loss actually leads to steps that benefit the daily lives of hearing-impaired individuals. The study will help to determine if hearing-loss detection in primary-care settings results in visits to audiologists and otolaryngologists, the prescription and use of hearing aids, and improvements in the patients' quality of life.
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