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One Test Your Doctor Probably Isn't Doing

Should hearing screenings be a part of your routine physical exam?

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A hearing loss screening should be a standard part of any annual physical, especially for those over 65.
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Think back to the last time you had a physical. Did the doctor ask you anything about your hearing?

The answer is probably no. A 2011 analysis of studies on the effectiveness of hearing screening found that almost two-thirds of primary care physicians, including geriatricians, do not include a hearing screening in an annual physical.

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Before you blame your doctor, you need to know that a 2012 report by the U.S. Preventive Services Task Force, a panel of federally appointed medical advisers, found insufficient evidence to recommend hearing loss screening for older adults.

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The task force found too few studies "to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults aged 50 year or older," even though the panel acknowledged that "hearing loss can affect social functioning and quality of life."

Wha'? This same report found that there was no risk in screening, that a simple, cost-free hearing test — like rubbing fingers together six inches behind the patient, or a whisper test at two feet -— was effective, and that the rate of hearing aid use went up in patients who were screened by their primary care physician.

The task force also noted that "given the noninvasive nature of both screening and associated diagnostic evaluation, these harms are probably small to none" and that there is adequate evidence showing that "the harms of treatment of hearing loss in older adults are small to none."

Despite this, the task force still could not recommend that older adults be regularly screened unless they complain of hearing problems.

The negative effects of untreated hearing loss have been well documented: a greater risk of falls in the elderly, depression and isolation, cognitive decline. In a statement she made in response to the task force report, Margaret Wallhagen, director of the John A. Hartford Center of Gerontological Nursing Excellence at the UC San Francisco School of Nursing, was outspoken in her frustration with the report: "Unfortunately, what that did was reconfirm what's already been going on — which is no screening. That's the last thing we needed."

Wallhagen has been researching the effects of hearing loss on seniors for years. "Screening should be standard practice," she said. In a report to the Institute of Medicine this year, Wallhagen pointed out some additional costs to society of untreated hearing loss: The loss in income for people with untreated hearing loss due to underemployment is estimated at $176 billion annually. Further, the use of hearing aids was shown to reduce the risk of income loss by 90 to 100 percent for those with milder hearing loss, and from 65 to 77 percent for those with severe to moderate hearing loss.

Other studies have found that the primary care physician can play an important role in the identification and treatment of hearing loss.

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A 2000 study found that 63 percent of people listed their primary care physician as the most important source of information about where to go for hearing health care services. The study also found that people with hearing loss are eight times more likely to be positively inclined to purchase a hearing aid if their physician recommends one.

This year, the Hearing Loss Association of America (HLAA) strongly recommended hearing screening in all adults during routine physicals, as well as during the "Welcome to Medicare" assessment and annual Medicare risk assessments.

For now, you may have to ask your doctor for a hearing screening. But patients shouldn't have to broach the subject. Many older people are unaware of the gradual encroachment of hearing loss and wouldn't think to ask for a screening.

A screening should be a standard part of any annual physical, especially for those over 65. If the screening shows a problem, the doctor should refer the patient to a hearing professional. It's simple: Hearing aids work.

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