Screening and Management of
Adult Hearing Loss in Primary Care

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Hearing loss is the third most prevalent chronic condition in older Americans, after hypertension and arthritis; between 25% and 40% of the population aged 65 years or older is hearing impaired. The prevalence rises with age, ranging from 40% to 66% in patients older than 75 years 5-7 and more than 80% in patients older than 85 years. Alternative definitions of hearing loss would raise estimates of prevalence even higher.

In addition, the impact of hearing loss on society will increase not only because the population is aging, but also because the prevalence of age-adjusted hearing loss has increased significantly since the 1960s. The diminished ability to hear and to communicate is frustrating in and of itself, but the strong association of hearing loss with depression and functional decline adds further to the burden on individuals who are hearing impaired. Hearing loss in older patients strongly correlates with depression.

Given the prevalence and disease burden of undetected hearing impairment in older persons and the availability of effective treatments, it is important for primary care physicians to screen, recognize, treat, and appropriately refer patients with hearing impairment.

Only 9% of internists offer hearing testing to patients aged 65 years or older. Hearing loss also is undertreated: only 25% of patients with aidable hearing loss receive hearing aids. The underdetection and undertreatment of hearing loss are discouraging, because strong evidence supports that the treatment of hearing loss improves quality of life.

In the meantime, it seems reasonable to provide hearing screening to older patients using either the audioscope or Hearing Handicap Inventory for the Elderly or HHIE-S. Many cases of hearing loss are treatable in the primary care setting, and prompt recognition of sudden hearing loss may prevent further deterioration or permanent deafness.