What are the current guidelines for managing hearing loss in adults?

Current Guidelines for Managing Hearing Loss in Adults

Adults aged 50 years and older should be screened for hearing loss at health care encounters, with comprehensive diagnostic evaluation for those who screen positive, followed by appropriate interventions including amplification, communication strategies, and regular follow-up. 1

Screening and Initial Evaluation

Screening Recommendations

• Screen all adults aged 50 years and older for hearing loss during health care encounters 1
• Screening methods include:
  • Single question screening: "Do you have difficulty with your hearing?"
  • Validated questionnaires such as the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S)
  • Smartphone-based hearing applications
  • Handheld audiometry devices 1

Initial Evaluation for Positive Screens

• Examine the ear canal and tympanic membrane with otoscopy to identify:
  • Cerumen impaction (common in older adults)
  • Infection
  • Other abnormalities of the external ear canal or tympanic membrane 1
• Refer for comprehensive audiometric evaluation including:
  • Pure tone audiometry (air and bone conduction)
  • Speech audiometry
  • Tympanometry
  • Acoustic reflex testing 1

Diagnostic Evaluation

Comprehensive Audiometric Testing

• Pure tone audiometry is the gold standard for detecting hearing loss 1
• Measures hearing sensitivity through bone and air conduction pathways
• Establishes pattern, degree, and configuration of hearing loss
• Can be repeated to monitor changes over time 1

Special Considerations

• Evaluate patients with the following for specialized care:
  • Significant asymmetric hearing loss
  • Conductive or mixed hearing loss
  • Poor word recognition on diagnostic testing 1
• Sudden sensorineural hearing loss (loss of 30 dB or more within 72 hours) requires prompt otolaryngology referral and treatment within 14 days of symptom onset 1, 2

Treatment Approaches

Amplification

• Hearing aids are strongly recommended as first-line treatment for age-related hearing loss 2
• Offer or refer patients for appropriately fit hearing aids 1
• For single-sided deafness, options include:
  • Contralateral routing of signals (CROS) hearing aids
  • Bilateral contralateral routing of signals (BICROS) hearing aids
  • Osseointegrated bone conductive devices
  • Deep intracanal devices 1, 2

Communication Strategies and Assistive Devices

• Counsel all patients with hearing loss on communication strategies:
  • Face-to-face communication with good lighting
  • Minimizing background noise
  • Rephrasing rather than repeating when not understood
  • Using visual aids for important information 2
• Recommend assistive listening technologies:
  • Infrared and frequency modulated (FM) systems
  • Auditory, visual, and tactile alerting systems 1, 2

Advanced Interventions

• Refer patients with persistent hearing difficulty despite appropriate hearing aid use for cochlear implant evaluation 2
• Cochlear implantation is beneficial for patients with severe to profound sensorineural hearing loss 2

Follow-up and Monitoring

Regular Assessment

• Assess if communication goals have been met and if there has been improvement in hearing-related quality of life at subsequent healthcare encounters or within 1 year 1
• Reassess hearing at least every 3 years in patients with known hearing loss 1
• More frequent monitoring may be warranted for individuals with fluctuating hearing loss 1

Audiometric Follow-up

• Conduct audiometric evaluation at the end of treatment and within 6 months post-treatment 2
• Monitor for changes in hearing status that may require adjustment of interventions 1

Patient Education and Support

Education Components

• Educate patients and family/care partners about the impact of hearing loss on:
  • Communication
  • Safety
  • Function
  • Cognition
  • Quality of life 1, 2
• Inform patients about the importance of follow-up evaluations and potential need for rehabilitation 2

Support Resources

• Connect patients with consumer-based organizations such as the Hearing Loss Association of America (HLAA) 1
• Address psychological aspects of hearing loss including anxiety, depression, and social isolation 2

Common Pitfalls to Avoid

• Delaying treatment for sudden hearing loss, which requires prompt intervention 2
• Failing to consider cochlear implantation for patients with persistent hearing difficulty despite appropriate hearing aid use 2
• Not addressing sociodemographic factors that influence access to hearing healthcare 1
• Relying solely on patient self-report of hearing improvement without objective audiometric testing 1
• Overlooking the psychological impact of hearing loss 2

By following these guidelines, clinicians can provide comprehensive care for adults with hearing loss, improving their communication abilities, quality of life, and potentially reducing associated risks such as cognitive decline, depression, and social isolation.