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Finger rub test outperforms other hearing loss exams

When compared with hand-held audiometry, the finger rub test was most sensitive in distinguishing which older adults had hearing loss, according to findings recently published in the Journal of the American Geriatrics Society.

Hearing loss that interferes with comprehending what others are saying affects two-thirds of all patients in the U.S. aged 70 and older, according to researchers.

“Because many clinics do not have easy access to audiometers for testing and because we wished to identify an approach that could be used across settings serving a wide range of individuals with varying levels of resources as well as be concise given the limited time available for screening, we compared the effectiveness of four simple screening tests with results obtained using a hand-held audiometer,” William J. Strawbridge, PhD, and Margaret I. Wallhagen, PhD, both of the Institute for Health and Aging at the University of California, San Francisco wrote.

Strawbridge and Wallhagen recruited 125 patients aged 60 and older that came into a Northern California-based primary care clinic for standard procedures or tests, and had not worn hearing aids for at least 1 year. The mean age of the participants was 72.9 years, and 63% were female. Patients took four hearing tests:

•Direct questioning: Patients were asked if they felt they had difficulty hearing;

•Indirect questioning: Patients were asked whether anyone had ever told them that they had difficulty hearing;

•Whisper test: A medical professional recited a string of letters and numbers to the patient, who pulled on the tragus of the ear that was not being tested and attempted to correctly repeat what he or she had just heard.

•Finger rub test: A medical professional stood 70 cm behind each ear (instead of “nose to nose” as in the CALFRAST-Strong process) and rubbed her fingers together. (5)

Strawbridge and Wallhagen found that at 91%, the finger rub test had the highest sensitivity. This test also had 68% specificity, 88% positive predictive value and 74% negative predictive value. The direct question’s sensitivity was 89%, its specificity was 41%, positive predictive value was 80% and negative predictive value was 56%. Indirect questioning had 85% sensitivity, 56% specificity, 84% positive predictive value and 58% negative predictive value. The whisper test had 79% sensitivity, 91% specificity, 96% positive predictive value and 62% negative predictive value.

Researchers acknowledged that hearing loss discussions with patients can sometimes be difficult and provided some suggestions for getting the conversation started.

"Many people may hesitate to undergo formal testing because of the perceived expense of obtaining hearing aids and concerns about appearance and problems with their daily use,” Strawbridge and Wallhagen wrote. “Practitioners can emphasize the value of further assessment because hearing is important for an individual’s overall health and well-being. Furthermore, hearing aids are now highly sophisticated, even though they cannot fully restore hearing and require adjustments to provide maximum benefit. Written materials can [also] be made available in the office providing additional resources for persons who are referred.”

The CDC recently released suggestions for primary care physicians to pass along to their patients for protecting their hearing. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.