Overcoming Barriers
Dr. Lin said he is not surprised by the fact that making hearing loss in older patients a public health focus is proving to be such a challenge. “Fifty years ago, there was a great deal of evidence that smoking was bad for you…. What finally changed was two generations of constant public health badgering, with cigarette ads banned from television and magazines, smoking taken off of movie screens and educational initiatives started in our schools—all of those things were needed to change perception and behavior over time.”
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May 2013Dr. Lin gave another example—one that actually holds some hope for a more rapid uptake of the message regarding hearing loss in older patients. In the early 1990s, he noted, isolated systolic hypertension was routinely ignored, because the condition was a very common part of aging, thought to be benign. Then a large randomized controlled trial showed that treating the condition with diuretics lowered the risk for strokes by more than 40 percent, “and fairly quickly, it became the standard of care,” he said (JAMA. 1991;265:3255-3264).
Dr. Lin said that if clinicians could view hearing loss in older adults with the same degree of urgency as smoking and isolated systolic hypertension, then the condition would soon become more of a priority. Or perhaps an even stronger paradigm shift is needed—viewing age-related hearing loss as though it were the pediatric variety. “We all know the data showing a strong correlation between hearing and the development of learning and social skills in kids,” he said. “And so we act accordingly, with aggressive screening and treatment. Where are the similar efforts for our older population?”
Craig A. Buchman, MD, chief of the division of otology, neurotology and skull base surgery, department of otolaryngology-head and neck surgery at the University of North Carolina at Chapel Hill, agreed that, because pediatric screening and treatment programs are better developed in children than those in adults, “it stands to reason that there is a great opportunity for improvement in the elderly.”
Dr. Buchman also echoed Dr. Lin’s concerns about the lack of urgency and attention that has stalled such efforts. “Hearing loss among adults is definitely an under-appreciated problem,” he said. “It has the potential for having a serious negative impact on both cognitive and psychosocial functioning, economics and quality of life.” Thus, “broad messaging and adult screening are needed to help better identify affected and at-risk individuals so that early preventive and corrective measures can be undertaken.”