Screening for Hearing Loss in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

ImportanceHearing loss is common in older adults and associated with adverse health and social outcomes. ObjectiveTo update the evidence review on screening for hearing loss in adults 50 years or older to inform the US Preventive Services Task Force. Data SourcesMEDLINE, Cochrane Library, EMBASE, and trial registries through January 17, 2020; references; and experts; literature surveillance through October 8, 2020. Study SelectionEnglish-language studies of accuracy, screening, and interventions for screen-detected or newly detected hearing loss. Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of screening test accuracy studies. Main Outcomes and MeasuresQuality of life and function, other health and social outcomes, test accuracy, and harms. ResultsForty-one studies (N=26386) were included, 18 of which were new since the previous review. One trial enrolling US veterans (n=2305) assessed the benefits of screening; there was no significant difference in the proportion of participants experiencing a minimum clinically important difference in hearing-related function at 1 year (36%-40% in the screened groups vs 36% in the nonscreened group). Thirty-four studies (n=23228) evaluated test accuracy. For detecting mild hearing loss (>20-25 dB), single-question screening had a pooled sensitivity of 66% (95% CI, 58%-73%) and a pooled specificity of 76% (95% CI, 68%-83%) (10 studies, n=12637); for detecting moderate hearing loss (>35-40 dB), pooled sensitivity was 80% (95% CI, 68%-88%) and pooled specificity was 74% (95% CI, 59%-85%) (6 studies, n=8774). In 5 studies (n=2820) on the Hearing Handicap Inventory for the Elderly-Screening to detect moderate hearing loss (>40 dB), pooled sensitivity was 68% (95% CI, 52%-81%) and pooled specificity was 78% (95% CI, 67%-86%). Six trials (n=853) evaluated amplification vs control in populations with screen-detected or recently detected hearing loss over 6 weeks to 4 months. Five measured hearing-related function via the Hearing Handicap Inventory for the Elderly; only 3 that enrolled veterans (n=684) found a significant difference considered to represent a minimal important difference (>18.7 points). Few trials reported on other eligible outcomes, and no studies reported on harms of screening or interventions. Conclusions and RelevanceSeveral screening tests can adequately detect hearing loss in older adults; no studies reported on the harms of screening or treatment. Evidence showing benefit from hearing aids on hearing-related function among adults with screen-detected or newly detected hearing loss is limited to studies enrolling veterans. This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on screening for hearing loss in older adults summarizes published evidence on the benefits and harms of screening and interventions for hearing loss in adults aged 50 years or older.

Automated summary

The systematic review provides evidence that several screening tests can adequately detect hearing loss in older adults. However, there is limited evidence on the benefits of screening and interventions for hearing loss, and no studies reported on the harms of screening or treatment.