USPSTF: Insufficient evidence to recommend screening older adults for hearing loss

The U.S. Preventive Services Task Force announced that the “balance of benefits and harms cannot be determined” in screening asymptomatic adults older than 50 years for hearing loss.

The I grade recommendation, published in JAMA, is based on 41 studies with 26,386 participants, according to the authors of a related evidence review. Eighteen of the studies were published since USPSTF’s 2012 identical recommendation in this clinical area.

The review authors wrote that “mild or worse speech-frequency hearing loss” occurs in approximately 14.1% of individuals aged 20 to 65 years and “increases significantly with age.” In the recommendation statement, the USPSTF reported that “sensorineural hearing loss” affects about 16% of all U.S. adults.

According to WHO, age-related hearing loss is expected to increase. The world health agency recently announced that without systematic changes such as increases in health care coverage and awareness campaigns, about 25% of the world’s population will have some type of hearing loss by 2050. Other research suggests that downstream consequences to hearing loss include symptoms of depression, cognitive decline and dementia.

The I grade recommendation does not necessarily mean hearing loss screenings should not occur; rather, clinicians should use “their judgement” to determine when screening is necessary, Chien-Wen Tseng, MD, MPH, MSE, a task force member and research director in the department of family medicine and community health at the University of Hawaii John A. Burns School of Medicine, said in a press release.

In a related editorial, Bevan Yueh, MD, MPH, a professor and the head of the department of otolaryngology, head and neck surgery at the University of Minnesota, and Jay F. Piccirillo, MD, FACS, a professor of otolaryngology, head and neck surgery at Washington University School of Medicine in St. Louis, wrote that the USPSTF recommendations “have important implications,” especially as more of the U.S. population grows older. They contended that hearing screening, when “grounded in clinical judgment,” is “potentially valuable.”

“Primary care physicians might find screening with either a single question or a tone-emitting device to be more effective if they follow up with an assessment of bother and motivation for seeking treatment,” they wrote. “Affirmative answers are more likely to identify older adults who would benefit most from a referral to hearing professionals for further diagnostic evaluation and possible treatment.”

References:

Feltner C, et al. JAMA. 2021;doi:10.1001/jama.2020.24855.

U.S. Preventive Services Task Force. JAMA. 2021;doi:10.1001/jama.2021.2566.

U.S. Preventive Services Task Force. Press release. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hearing-loss-older-adults-final-rec-bulletin.pdf. Accessed March 23, 2021.

WHO. World report on hearing. https://www.who.int/publications/i/item/world-report-on-hearing. Accessed March 23, 2021.

Yueh B, Piccirillo JF. JAMA. 2021;doi:10.1001/jama.2021.2020.