Hearing impairment screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

## Overview

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The different recommendations for screening for hearing loss, at what age, and also describes the various methods for screening including whisper, hand rub, audiometer, different questionnaire and using smartphones.

## Screening

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Who should be screened

There are different recommendations for who should be screened for deafness, at what different age and presence of risk factors:[1]

* The general rule is; screening should be carried for at-risk adults, little benefit exists on universal screening of adults or suggested interval screening in any group without being in danger for the hearing disorder. [2]

* There is insufficient evidence to screening among asymptomatic adults aged 50 years or older by U.S. Preventive Services Task Force [3]

* Medicare mandates screening as a part of the annual wellness examination for adults older than 65 years.

* Screen all adults once every decade until age 50 years and each 3 years afterward by the American Speech-Language-Hearing Association.

How to screen? [4]

* Studies showed that screening with simple tests on a clinic visit, like the whisper test, audio-scope, an otoscope, and audiometer, or a self-assessment questionnaire, results in easy screening with successful therapeutic or compensatory treatment.

Finger rub | Whisper test | Handheld audiometer[5] | Self-assessment questionnaire  | Mobile apps and smartphones[6]

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Examiner gently rubs fingers together close to the patient's ear.
| Examiner stands at arm's length (approximately 24 inches) behind the patient. The patient blocks 1 ear himself. Examiner whispers 5-6 letters/number combinations.
| Examiner holds device in patient's ear one at a time. The patient indicates an awareness of each tone.  | They are often used in practice but have limitations.

Single question: Do you believe you have hearing loss? (yes/no). Self-reported hearing difficulty changes by the degree of hearing loss ( mild/moderate, severe/profound) and sociodemographic characteristics and is typically difficult to select during a person with a light degree of deafness.

| The advancement of science has led to the development of mobile technology-based screening options, such as the use of different mobile apps (for example, uHear, Mimi) and smartphone or tablet-based portable audiometers that can be connected to conduct screening for hearing impairment.
A positive result's a failure to spot rub in ≥2 of 6 attempts.  | The positive result is failure to repeat ≥3 of the 6 combinations  | Positive result's failure to spot either the 1000- or 2000-Hz frequency in both ears or the 1000- and 2000-Hz frequencies in 1 ear.  | There are multiple questionnaire assessment tests, for instance, Hearing Handicap Inventory for the Elderly Screening Version. It has a 10-item questionnaire with three options of “absent,” “present” and “sometimes,”  | They generally require special supra-aural headphones for monitoring.

* Single question: Do you believe you have hearing loss? (yes/no). Self-reported hearing difficulty changes by the degree of hearing loss ( mild/moderate, severe/profound) and sociodemographic characteristics and is typically difficult to select during a person with a light degree of deafness [7][8] There are multiple questionnaire assessment tests for instance Hearing Handicap Inventory for the Elderly Screening Version. It has a 10-item questionnaire with three options of “absent,” “present” and “sometimes,”

* The Weber and Rinne tests should not be used for general screening as they have little sensitivity for the detection of hearing loss. Elderly adults who know they have hearing impairment require audiometry for confirmation, while those who don't know about their hearing should be screened with the whispered-voice test as described in the table. Elderly adults who perceive the whispered voice require no further testing, while those unable to perceive the voice require audiometry for screening.[9][10]
* The advancement of science has led to the development of mobile technology-based screening options, such as the use of different mobile phone apps (for example, uHear, Mimi) and smartphone or tablet-based portable audiometers that can be connected to conduct screening for hearing impairment. They generally require supra-aural headphones for monitoring.[11]
* After deafness is diagnosed, the Weber and Rinne test can be conducted to differentiate whether it's a conductive, sensorineural, or mixed type hearing loss.
* All patients with hearing loss should be offered a referral to an audiologist or an otolaryngologist. Worrisome symptoms accompanying hearing loss like headache, weight loss, bleeding, etc. need urgent referral to an otolaryngologist for further investigations.

### Genetic tests

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* Genetic testing may be considered to be a significant tool for diagnosing hearing impairment in children. The genetic screening test is defined as the analysis of human DNA in order to detect heritable-related mutations in children as early as possible, to prevent cognitive impairment in kids.

## References

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1. ↑ Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check `|pmid=` value (help).
2. ↑ "Integrated Care for Older People: Guidelines on Community-Level Interventions to Manage Declines in Intrinsic Capacity". WHO Guidelines Approved by the Guidelines Review Committee. 2017. PMID 29608259.
3. ↑ Moyer VA, U.S. Preventive Services Task Force (2012). "Screening for hearing loss in older adults: U.S. Preventive Services Task Force recommendation statement". Ann Intern Med. 157 (9): 655–61. doi:10.7326/0003-4819-157-9-201211060-00526. PMID 22893115.
4. ↑ Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check `|pmid=` value (help).
5. ↑ Strawbridge WJ, Wallhagen MI (2017). "Simple Tests Compare Well with a Hand-held Audiometer for Hearing Loss Screening in Primary Care". J Am Geriatr Soc. 65 (10): 2282–2284. doi:10.1111/jgs.15044. PMC 5641245. PMID 28799200.
6. ↑ Sandström J, Swanepoel de W, Carel Myburgh H, Laurent C (2016). "Smartphone threshold audiometry in underserved primary health-care contexts". Int J Audiol. 55 (4): 232–8. doi:10.3109/14992027.2015.1124294. PMID 26795898.CS1 maint: Multiple names: authors list (link)
7. ↑ Yueh B, Shapiro N, MacLean CH, Shekelle PG (2003). "Screening and management of adult hearing loss in primary care: scientific review". JAMA. 289 (15): 1976–85. doi:10.1001/jama.289.15.1976. PMID 12697801.CS1 maint: Multiple names: authors list (link)
8. ↑ Goman AM, Reed NS, Lin FR, Willink A (2020). "Variations in Prevalence and Number of Older Adults With Self-reported Hearing Trouble by Audiometric Hearing Loss and Sociodemographic Characteristics". JAMA Otolaryngol Head Neck Surg. 146 (2): 201–203. doi:10.1001/jamaoto.2019.3584. PMC 6902177 Check `|pmc=` value (help). PMID 31750866.CS1 maint: Multiple names: authors list (link)
9. ↑ Bagai A, Thavendiranathan P, Detsky AS (2006). "Does this patient have hearing impairment?". JAMA. 295 (4): 416–28. doi:10.1001/jama.295.4.416. PMID 16434632.CS1 maint: Multiple names: authors list (link)  Review in: Evid Based Nurs. 2006 Oct;9(4):120 Review in: Evid Based Med. 2006 Aug;11(4):116
10. ↑ Goman AM, Reed NS, Lin FR, Willink A (2020). "Variations in Prevalence and Number of Older Adults With Self-reported Hearing Trouble by Audiometric Hearing Loss and Sociodemographic Characteristics". JAMA Otolaryngol Head Neck Surg. 146 (2): 201–203. doi:10.1001/jamaoto.2019.3584. PMC 6902177 Check `|pmc=` value (help). PMID 31750866.CS1 maint: Multiple names: authors list (link)
11. ↑ Sandström J, Swanepoel de W, Carel Myburgh H, Laurent C (2016). "Smartphone threshold audiometry in underserved primary health-care contexts". Int J Audiol. 55 (4): 232–8. doi:10.3109/14992027.2015.1124294. PMID 26795898.CS1 maint: Multiple names: authors list (link)