by Brian Taylor, AuD, Editor-at-Large
By now every clinician ought to be familiar with the public health concerns related to untreated hearing loss. A driving force behind over-the-counter (OTC) device availability, after all, is the stubbornly low hearing aid uptake rate despite solid evidence of poor health-related outcomes and a lower quality of life being linked to untreated hearing loss in older adults.
A cornerstone of OTC hearing aid use is the ability of individuals to self-direct their care without the involvement of a licensed professional. This includes the availability of automated or self-guided hearing screening that enable individuals to test their own hearing, using a so-called do-it-yourself (DIY) approach, perhaps before fitting their own hearing aids.
Recent studies and review articles suggest these DIY hearing screening approaches are effective and certainly have the potential to close the gap on the time between when hearing loss becomes burdensome and when hearing aids are acquired. A timeframe that takes an average of more than 8 years.
Two recently published articles, however, indicate that a professional’s direct involvement in hearing screening could speed the journey toward hearing aid acceptance and use, which has the cascading effect of improving health related outcomes, including quality of life.
Value of Hearing Screenings in Primary Care
In the first study, researchers at the Medical University of South Carolina examined the cost effectiveness of hearing screening in primary care clinics. Their target population was adults 65 to 75 years of age without documented hearing loss who were routinely visiting their primary care physician (PCP).
A total of 660 adults were enrolled in the study. This pool of 660 adults was evenly divided into three groups with a different hearing screening protocol used for each respective group.
The hearing screening protocols consisted of
- At-home hearing screening without PCP encouragement to complete the hearing screening
- At-home hearing screening with PCP encouragement to complete the hearing screening; and
- Completing the hearing screening in the clinic during their appointment with the PCP
The researchers followed the number of participants who completed the hearing screening within 120 days of the request, the number of individuals who failed the hearing screening, as well the number who received a follow-up appointment, a recommendation for hearing aids, and finally, the number of individuals who obtained hearing aids.
The researchers also determined the cost-effectiveness of each of the three hearing screening protocols and examined the impact screening and subsequent follow-up and treatment had on quality of life, using the quality-adjusted life years (QALY) metric.
Although the overall costs to implement the in-person hearing screening program were higher than the two at-home protocols, the in-person screening protocol yielded both a significantly lower cost per patient who completed the hearing screening and significantly lower cost per patient who failed the hearing screening.
One of the most revealing findings in the study was the difference in the number of individuals enrolled in each program that completed the hearing screening. For adults who were enrolled in the at-home screening just 22.7% of the “no PCP encouragement” group and 26.8% of the “PCP encouragement” completed the hearing screening, compared to 100% of the group who completed the hearing screening in the clinic. Perhaps unsurprisingly, more than 80% of the individuals in the two at-home groups failed the hearing screening, while 54.5% of the “in clinic” group failed the screening. The latter percentage is more reflective of hearing loss prevalence for the age range of the participants.
Given the documented prevalence of hearing loss in people aged 65 to 75, these results suggest that completing an at-home hearing screening, albeit it an accurate and reliable method of identifying hearing loss, leads to about one-third of patients in this age range with suspected hearing loss remaining unidentified. Consequently, relying on a DIY-like, at-home approach to hearing screening, even with PDP encouragement, misses a substantial percentage of adults with hearing loss who could benefit from follow-up and treatment.
QALY Analysis
Another illuminating facet of this study was the QALY analysis. Although the ultimate goal of any hearing screening program would be the acquisition of hearing aids for those who fail the screening, the authors’ QALY analysis suggests there are plenty of quality-of-life benefits obtained from the mere presence of a hearing screening program.
As the authors astutely lay out in the Discussion section of their paper, even patients that obtain a hearing screening and pass, or those who obtain a hearing screening and do not show up for a more detailed assessment, accrue the benefit of valuable information. Knowledge and information conveyed by a professional, about the status of the individuals’ hearing, how hearing loss affects their day-to-day communication and how it can be corrected with hearing aids.
Further, the authors applied a monetary value to their QALY analysis using a figure of $100,000 per QALY.
This yielded the following net total QALY monetary values for each program:
- At-home hearing screening without PCP encouragement to complete the hearing screening: $330,000
- At-home hearing screening with PCP encouragement to complete the hearing screening: $352,000
- Completing the hearing screening in the clinic during their appointment with the PCP: $1,107,500
Their QALY estimates show that all three hearing screening programs are beneficial and cost-effective, by far however, the greatest QALY benefit comes from the in-clinic hearing screening program.
Now you might be wondering, how many of the 660 study participants acquired hearing aids at the end of this meticulously tracked process? The short answer is five (all except one were acquired by individuals in the group who were screened in the clinic). That low number brings us to the next important bit of recent research that sheds light on the role of the professional in moving individuals with hearing loss more efficiently through the patient journey.
Underreported Hearing Loss & Underused Hearing Aids
A group of researchers at the University of Minnesota looked at underreported hearing loss and underused hearing aids.
More precisely, this second recent study, published online by JAMA, examined rates of underreported hearing loss and hearing aid use by history of a recent hearing test. Their dataset included more than 3000 individuals with an average age of 70.5 years. Like the previously cited study, this one also shows the value of professional involvement in speeding the journey toward follow-up and treatment.
Results indicated that a history of having a more recent hearing test was linked to a lower risk of underreporting hearing loss and a higher likelihood of acquiring hearing aids.
The authors suggest that the process of participating in a hearing assessment plays an important role in older adults’ awareness of hearing loss and use of hearing aids. That is, individuals who undergo more consistent testing or interact with a professional immediately following a hearing test are more likely to acquire hearing aids.
Together, both articles show the value of a well-planned hearing screening program and systematic follow-up by a professional. One who can provide fact-based information, positive reinforcement and support to the individual, regardless of their stage in the patient journey.
DIY care might be coming to Audiology, but the professional is needed to speed the journey toward a favorable outcome.
