The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has issued new clinical practice guidelines aimed at improving identification, education, and management of age-related hearing loss (ARHL) – a prevalent yet often underdiagnosed and undertreated condition in adults 50 and over.
ARHL, defined as gradually progressive bilateral sensorineural hearing loss associated with aging, affects communication abilities and has been linked to increased risks of dementia, depression, cardiovascular disease, falls, social isolation, and lower income and employment status.
the well-documented downstream health effects of untreated ARHL, the condition frequently goes unaddressed by clinicians.
Evidence Based Recommendations for Clinicians
The overarching purpose of the new guidelines is to provide clinicians with trustworthy, evidence-based recommendations and identify key quality improvement opportunities regarding ARHL identification and management. An expert panel developed a series of 11 clear, actionable statements communicating these opportunities.
The statements detail the supporting evidence, evaluate its quality, and provide implementation guidance.
**KAS= Key Action Statement
| Statement | Action | Strength |
|---|---|---|
| KAS 1: Screening for Hearing Loss | Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. | Recommendation |
| KAS 2: Ear Exam and Other Ear Conditions | If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. | Recommendation |
| KAS 3: Sociodemographic Factors and Patient Preferences | If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. | Recommendation |
| KAS 4: Hearing Test | If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. | Strong recommendation |
| KAS 5: Identifying Conditions Other than ARHL | Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. | Recommendation |
| KAS 6: Patient Education and Counseling | Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. | Recommendation |
| KAS 7: Communication Strategies and Assistive Technologies | Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. | Recommendation |
| KAS 8: Amplification | Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. | Strong recommendation |
| KAS 9: Candidacy for Cochlear Implants | Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. | Strong recommendation |
| KAS 10: Assessing Goals and Improvement | For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. | Recommendation |
| KAS 11: Retesting | Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing. | Option |
Improving Access to Hearing Healthcare
The primary goals are to prompt clinicians to make hearing screening and treatment a routine part of caring for older adults, improve access to hearing health services, and ensure patients receive appropriate counseling and intervention to mitigate the negative impacts of ARHL on communication, safety, cognition and quality of life.
The guidelines focus specifically on age-related sensorineural hearing loss in patients aged 50 and up, as opposed to other types of hearing loss like conductive or medication-induced. They are not intended as a comprehensive management guide, but rather to highlight evidence-based practices judged most important for quality improvement by the multidisciplinary panel.
Flowchart Showing Key Action Statements (KAS) and Process of Care. Credit: AAO-HNS
Key strong recommendations advise clinicians to obtain audiology referrals if screening suggests possible hearing loss, offer properly fitted hearing aids for diagnosed ARHL cases, and refer for cochlear implant evaluation if hearing aids fail to provide sufficient benefit.
Other recommendations cover implementing routine hearing screenings for adults 50+ during healthcare encounters, examining the ear if screening is positive, identifying sociodemographic barriers to hearing care access, and managing conductive or asymmetric losses. The guidelines emphasize patient education on communication strategies, impacts of untreated hearing loss, and reassessing treatment outcomes.
The statements are classified as strong recommendations, recommendations, or options based on an analysis of potential benefits and harms balanced against the quality of the supporting evidence.
Collaborative Effort to Develop Standard of Care
Guideline authors stressed the guidance allows for clinical judgement but establishes clear standards aimed at improving hearing health and associated outcomes in the rapidly growing population of older adults with ARHL.
Dr. Kevin Zhan, Assistant Professor of Otology & Neurotology and Medical Director of the Northwestern Medicine Cochlear Implant program, expressed his appreciation for the new guidelines, emphasizing their timeliness and significance. In response to a comment request from HHTM, he highlighted the lack of guidance on screening for hearing loss from a public health perspective and commended the multidisciplinary effort behind the document’s development. Dr. Zhan stressed that the guidelines exclusively focus on age-related hearing loss, assuming that other forms of hearing loss have been excluded.
“This was truly a wonderful effort by many experts in the field in numerous disciplines, all invested in figuring out how to best take care of hearing loss patients and addressing the significant underutilization of hearing care in our country.”
–Kevin Zhan, MD
The new guidelines were published as a supplement in the May 2024 issue of Otolaryngology-Head and Neck Surgery on April 30 and can be accessed here.
Source: AAO-HNS
