What are the recommendations for hearing screening in older adults with Presbycusis (age-related hearing loss)?

From the Guidelines

Older adults with Presbycusis should undergo hearing screening every 1-3 years, starting at age 50, as the benefits of early detection and intervention can improve quality of life and reduce associated risks. Here are the key recommendations:

• Annual screening for adults 65 and older
• Screening every 2-3 years for adults aged 50-64
• Use pure-tone audiometry as the primary screening method, as it is a relatively accurate and reliable screening tool for identifying adults with objective hearing loss 1 The screening process typically involves:

• A brief questionnaire about hearing difficulties, such as the HHIE-S, to identify adults with perceived hearing difficulty
• Otoscopic examination to check for ear canal obstructions
• Pure-tone audiometry testing at frequencies of 500,1000,2000, and 4000 Hz to confirm diagnosis of objective hearing loss If hearing loss is detected, referral to an audiologist or otolaryngologist is recommended for further evaluation and potential treatment options, such as hearing aids, which can improve self-reported hearing, communication, and social functioning for some adults with age-related hearing loss 1 Regular screening is important because age-related hearing loss (presbycusis) is common and often develops gradually, and early detection can lead to earlier intervention, potentially improving quality of life and reducing associated risks like cognitive decline and social isolation 1 Hearing loss in older adults can be caused by various factors, including natural aging processes, noise exposure, and certain medical conditions, and regular screening helps identify these issues early, allowing for timely management and prevention of further deterioration 1

From the Research

Recommendations for Hearing Screening in Older Adults with Presbycusis

• Screening for hearing loss is recommended in adults older than 50 to 60 years 2
• The most cost-effective option identified is a one-stage audiometric screen for bilateral hearing loss ≥30 dB hearing level (HL) at age 60, repeated at ages 65 and 70 3
• It is recommended that hearing screening be offered every 5 years to adults aged 50-64 years, and every 1-3 years to adults aged 65 years or older 4

Screening Tests

• Office screening tests include the whispered voice test and audioscopy 2
• The Audioscope is preferred by patients and outperforms the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) using a variety of reference standard definitions 5
• Hearing screening can be conducted without specialised equipment by using pure tones set to a fixed level, an automated mobile- or web-based digits-in-noise test, or the whispered voice test 4
• Hearing screening can also be conducted in audiology clinics using pure-tone air conduction threshold testing 4

Identification and Management of Hearing Loss

• Adults presenting with idiopathic sudden sensorineural hearing loss should be referred for urgent assessment 2
• Management of hearing loss is based on addressing underlying causes, especially obstructions (including cerumen) and ototoxic medications 2
• Residual hearing should be optimized by use of hearing aids, assistive listening devices, and rehabilitation programs 2
• Surgical implants are indicated for selected patients 2