Hearing Testing Falls Short
A lack of hearing testing can also be problematic. Although the majority of babies born in hospitals are screened for hearing loss at birth, parents in socioeconomically depressed areas may be less likely to obtain follow-up testing for infants who failed screening, Dr. Palmer said. This can be due to transportation, time, or financial challenges preventing access to pediatric audiological care. If diagnostic testing reveals a significant hearing loss, ongoing appointments will be required to fully assess a baby’s hearing as they mature, as well as fittings and reprograming hearing aids or cochlear implants as they grow, in addition to medical management provided by a pediatric otologist.
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May 2021The majority of adults aren’t screened for hearing loss regardless of their socioeconomic status. According to HealthyPeople.gov, 20% of adults under age 70 have had a hearing test in last five years. For adults older than 70, about 40% have had a hearing test in the last five years. An objective of the government’s Healthy People 2020 initiative is to increase that percentage by over 10% over the next decade.
A hearing screening is meant to be included in an initial Medicare visit, but oftentimes this isn’t accomplished, Dr. Palmer said. Although hearing loss is expected in older adults, it isn’t without consequence; data indicate that less than 50% of adults accurately identify that they have hearing loss when asked (Gerontol Nurs. 2020;46(6):34-42). This finding suggests that a screening would be necessary to identify individuals who need treatment.
Furthermore, many insurance carriers and Medicare won’t reimburse for screening adults for hearing loss because it isn’t a national standard for PCPs to do so, Dr. Bush said. In children, even though hearing evaluation is often a part of school entry or pediatrician visits, this kind of evaluation may be given inconsistently for children living in rural settings.
Community leaders should encourage the public to participate in hearing assessment and address particular community needs. —Ana H. Kim, MD
Although there is evidence that hearing loss is more prevalent among adults living in rural communities compared with those living in urban settings (J Rural Health. 2002;18:521-535; Am J Epidemiol. 1998;148:879-886), there aren’t any national data on hearing loss specific to rural or remote areas. Dr. Bush estimates that about half of the number of adults in socioeconomically depressed or rural areas have their hearing tested compared to the general population. That would amount to about 10% of adults under the age of 70 and only 20% of adults older than the age of 70 who have had a hearing test in the last five years.
“That’s significant, because, overall, 28 million Americans have hearing loss,” Dr. Bush said. “Based on those numbers, some people aren’t getting diagnostic testing and likely aren’t getting treated.”
The American Speech-Language-Hearing Association recommends adults be screened at least every decade through age 50 and at three-year intervals thereafter. Additional governing bodies such as the U.S. Preventive Services Task Force, the American Academy of Family Physicians, and the American Academy of Audiology lack specific hearing screening recommendations for adults, Dr. McGrath said (JAMA. 2021;325:1196-1201).
A 2008 study found that up to 86% of general physicians don’t routinely screen their patients’ hearing (Am J Epidemiol. 1998;148:879-886). This lack of identification is a contributing reason to the fact that fewer than 20% of adults with confirmed hearing loss obtain intervention. Unfortunately, the small percentage of patients who do seek intervention have an even lower likelihood of adoption of and adherence to treatment recommendations, especially if they’re from socioeconomically depressed areas, Dr. McGrath said (J Health Care Poor Underserved. 2016;27:1812-1818).
In another study, only about 15% of the total U.S. population reported having a hearing screening during their last physical exam (The Hearing Review. 2009;16:12-31). This is consistent with another study of the National Health and Nutritional Examination Surveys (NHANES), which found that 40% of respondents had a hearing test in the past four years (J Aging Health. 2016;28:68-94), said Jennifer Alyono, MD, MS, clinical assistant professor, otolaryngology–head and neck surgery at Stanford University. While the NHANES study did not find that income level correlated with the rate of hearing testing, researchers did find that Black individuals were less likely to use hearing aids, even though they were more likely to report recent hearing testing than White individuals (J Aging Health. 2016;28:68-94).
Based on nationally representative data, Carrie Nieman, MD, MPH, assistant professor of otolaryngology–head and neck surgery at Johns Hopkins University School of Medicine in Baltimore, has seen higher reports of recent hearing testing among minority older adults. Specifically, she said that approximately 43% of Black older adults report recent hearing screening versus 39% of White older adults.
“The reason for this difference is unclear,” Dr. Nieman said. “One possibility is that Medicare generally covers hearing testing and can serve to attenuate disparities in care among older adults. The difference may also be due to differences in geographic access, stigma, or referral rates between groups. Among Black older adults, recent hearing testing was associated with increased healthcare use and may reflect greater access and/or use of healthcare in general (J Aging Health. 2016;28:68-94).