New hearing loss guidelines advise screening all adults aged 50 years or older

Key takeaways:

• The guidelines consist of 11 evidence-based key action statements on age-related hearing loss evaluation and treatment.
• A universal screening guideline could help destigmatize hearing loss, an expert said.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has released new clinical practice guidelines on identifying and treating patients with age-related hearing loss, or ARHL.

“Our primary care clinicians are often dealing with patients with untreated hearing loss, which may impact their ability to understand their own health care needs,” Betty S. Tsai Do, MD, chair of the Clinical Practice Guidelines Development Group, told Healio. “This guideline acknowledges the challenges of hearing loss and provides guidance on when and how to screen in order to identify these patients and intervene sooner. With a more universal screening guideline, it helps destigmatize hearing loss as patients may be embarrassed to bring it up as part of the annual physical exam.”

According to a press release, hearing loss is the most common sensory disorder in older populations, with one in three adults aged 65 to 74 years experiencing it.

ARHL has also been tied to various health risks — including dementia, depression and greater fatigue — and can be caused by both genetic and environmental factors like cigarette smoking, loud noises and medications harmful to ears, the release said.

The guidance, published in Otolaryngology-Head and Neck Surgery, consists of 11 evidence-based key action statements that were either strongly recommended, recommended or optional.

The guidelines strongly recommend that:

• if a screening suggests hearing loss, clinicians should obtain — or refer to a clinician who can obtain — an audiogram;
• clinicians should offer — or refer to a clinician who can offer — appropriately fit amplification to patients with ARHL; and
• clinicians should refer patients to an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding.

The guidelines recommend that:

• clinicians screen for hearing loss in patients aged 50 years and older during a health care visit;
• if a screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine for cerumen impaction or other infections;
• if a screening suggests hearing loss, clinicians should identify socioeconomic factors and patient preferences that influence access and utilization of hearing health care;
• clinicians should evaluate and treat — or refer to a clinician who can evaluate and treat — patients with asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing;
• clinicians should educate and counsel patients with hearing loss and patients’ families about the impacts of hearing loss on function, communication, safety, quality of life (QoL) and cognition;
• clinicians should counsel patients with hearing loss on communication strategies and hearing devices; and
• clinicians should determine if communication goals have been met and QoL has improved in a patient with hearing loss at a subsequent health care visit or at 1 year.

The guidelines stated that it is optional for clinicians to assess hearing at least every 3 years in patients with known hearing loss or concerns about changes in hearing.

“The guideline provides strategies that clinicians can implement to effectively communicate with patients with hearing loss,” Tsai Do said. “We know that patient compliance with care is largely dependent on how well they understand what they hear.”

References:

• New clinical practice guideline provides evidence-based recommendation for age-related hearing loss. https://www.entnet.org/resource/new-clinical-practice-guideline-provides-evidence-based-recommendations-for-age-related-hearing-loss-arhl/. Published April 30, 2024. Accessed April 30, 2024.
• Tsai Do B, et al. Otolaryngol Head Neck Surg. 2024;doi:10.1002/ohn.750.