Long-Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment-Which Hearing Assessment Test (SAI-WHAT) Randomized Trial

OBJECTIVES To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans. DESIGN Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care. SETTING Veterans Affairs Puget Sound Health Care System. INTERVENTIONS The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools. MEASUREMENTS Hearing aid use 1 year after screening. RESULTS Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P <.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P <.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P <.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability. CONCLUSION In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids.