FP Essentials™

Hearing Loss

Call for Authors

This edition of FP Essentials will cover recent updates on hearing loss. The content should include: evaluating the patient with hearing loss; hearing augmentation; communicating with patients who are deaf or hard of hearing; and issues in the deaf and hard of hearing communities. The content should emphasize recent, relevant literature, rather than provide a general review of the four topics.

This edition of FP Essentials should be approximately 10,000 words in length, divided into 4 sections of approximately 2,500 words each, plus an abstract of no more than 200 words for each section, key practice recommendations, a maximum of 15 tables and figures, recommended readings, and references. This edition should focus on what is new in each topic and should answer the key questions listed for each section. Each section should begin with an illustrative case, similar to the examples provided below, with modifications to emphasize key points; each case should have a conclusion that demonstrates resolution of the clinical situation. The references suggested here include information that should be considered in preparation of this FP Essentials. However, these references are only a useful starting point to point that should be used to identify additional information to review.

Section 1: Evaluating the Patient with Hearing Loss

Example case: When reviewing your patient schedule for tomorrow, you note that many of your patients have listed hearing loss as the reason for a visit. These patients include a woman in her 60s who has noticed hearing loss, a child who was referred after a school hearing screening, and a young man who cannot hear from his left ear. This reminds you how common hearing loss is, and how the etiologies of hearing loss differ across the lifespan. You plan to review educational materials on the evaluation of hearing loss before tomorrow.

Key questions to consider:

  • How prevalent is hearing loss? What are the different types of hearing loss? Which types of hearing loss are most common among different age groups? Do most individuals have some degree of hearing loss as they age?
  • Which hobbies and occupations place individuals at risk of hearing loss? What is the role of Occupational Safety and Health Administration in providing screening for populations and employees at such risk?
  • When and for which populations (ranging from infants to older adults) is hearing screening recommended? What are the different methods of hearing screening? How effective are those screening methods?
  • How do patients of different ages typically present with hearing loss? What other symptoms or signs are associated with hearing loss?
  • What are the common and critical causes of acute and chronic hearing loss in newborns, children, adolescents, young adults, and older adults?
  • Once hearing loss is suspected, how is it confirmed? What is a general approach to determining the type and degree of hearing loss? Should all patients with suspected hearing loss undergo audiometry? Why should they undergo audiometry?
  • Are laboratory tests or x-rays useful in the evaluation of hearing loss? When are they useful, and which patients are likely to benefit from their use?
  • What is the natural course of different types of hearing loss?
  • How does hearing loss affect daily functioning of patients of various ages? When is intervention recommended, and how does this differ among patients of different ages?

Initial references to consider:

  • National Institute on Deafness and Other Communication Disorders. Quick statistics. Updated June 16, 2010. Available at http://www.nidcd.nih.gov/health/statistics/Pages/quick.aspx(www.nidcd.nih.gov).
  • Chien W, Lin FR. Prevalence of hearing aid use among older adults in the United States. Arch Intern Med. 2012;172(3):292–293.
  • Desloovere C, Verhaert N, Van Kerschaver E, Debruyne F. Fifteen years of early hearing screening in Flanders: impact on language and education. B-ENT. 2013;(suppl 21):81-90.
  • Lin JW, Chowdhury N, Mody A, et al. Comprehensive diagnostic battery for evaluating sensorineural hearing loss in children. Otol Neurotol. 2011;32(2):259-264.
  • Kiely KM, Gopinath B, Mitchell P, Browning CJ, Anstey KJ. Evaluating a dichotomized measure of self-reported hearing loss against gold standard audiometry: prevalence estimates and age bias in a pooled national data set. J Aging Health. 2012;24(3):439-458.
  • Sharma A, Viets R, Parsons MS, Reis M, Chrisinger J, Wippold FJ 2nd. A two-tiered approach to MRI for hearing loss: incremental cost of a comprehensive MRI over high-resolution T2-weighted imaging. AJR Am J Roentgenol. 2014;202(1):136-144.
  • Choi YH, Miller JM, Tucker KL, Hu H, Park SK. Antioxidant vitamins and magnesium and the risk of hearing loss in the US general population. Am J Clin Nutr. 2014;99(1):148-155.
  • Alford RL, Arnos KS, Fox M, et al; ACMG Working Group on Update of Genetics Evaluation Guidelines for the Etiologic Diagnosis of Congenital Hearing Loss, Professional Practice and Guidelines Committee. American College of Medical Genetics and Genomics guideline for the clinical evaluation and etiologic diagnosis of hearing loss. Genet Med. 2014;16(4):347-355.
  • Swanepoel de W, Eikelboom RH, Hunter ML, Friedland PL, Atlas MD. Self-reported hearing loss in baby boomers from the Busselton Healthy Ageing Study: audiometric correspondence and predictive value. J Am Acad Audiol. 2013;24(6):514-521.

Section 2: Hearing Augmentation

Example case: Mrs. Kravitz, a 70-year-old otherwise healthy woman is having increasing difficulty with hearing that is adversely affecting her quality of life. She is interested in learning about the different options to augment her hearing. Her youngest grandson was born with deafness and has had success with a cochlear implant. Mrs. Kravitz read online that cochlear implants are now being used in elderly patients to restore their hearing, and asks if she might be a candidate.

Key questions to consider:

  • Which patients are likely to benefit from hearing augmentation? Are there certain levels of hearing loss at which hearing augmentation is warranted? Do patients need some level of residual hearing to benefit from the available methods of hearing augmentation?
  • What are the different methods available for hearing augmentation? Outline an approach to discussing general options with patients. Does that approach differ for different age patients or for different causes of hearing loss?
  • What are assistive listening devices and how do they work? How much do they cost and are they a covered expense by health insurance plans? What are the advantages and disadvantages of this type of hearing augmentation? Which patients are most likely to benefit from assistive listening devices?
  • How do hearing aids work? Which patients are most likely to benefit from hearing aids? What are the different types of hearing aids? How much do they typically cost, and are they a covered expense by health insurance plans? What are the advantages and disadvantages of the various types of hearing aids compared to other methods of hearing augmentation? What is the likelihood that patients who obtain hearing aids will continue to use them long term?
  • What are cochlear implants? How do they work? Which patients are most likely to benefit from cochlear implants? How much do cochlear implants typically cost, and are they a covered expense by health insurance plans? What are the advantages and disadvantages of cochlear implants compared to other methods of hearing augmentation? What do patients who have been deaf since birth experience when they undergo cochlear implantation later in life?
  • What are bone-anchored hearing aids (BAHAs)? How do they work? Which patients are most likely to benefit from BAHAs? How much do BAHAs typically cost, and are they a covered expense by health insurance plans? What are the advantages and disadvantages of BAHAs compared to other methods of hearing augmentation?
  • What are middle ear implants? What is their current use in hearing augmentation? What other information is available about this relatively new approach?
  • Are there other important types of hearing augmentation devices currently available? Are there new methods of hearing augmentation likely to become available over the next several years?
  • What are the current ethical deliberations surrounding augmenting hearing augmentation for patients with normal hearing?

Initial references to consider:

  • Teschner M, Polite C, Lenarz T, Lustig L. Cochlear implantation in different health-care systems: disparities between Germany and the United States. Otol Neurotol. 2013;34(1):66-74.
  • Semenov YR, Martinez-Monedero R, Niparko JK. Cochlear implants: clinical and societal outcomes. Otolaryngol Clin North Am. 2012;45(5):959-981.
  • Boons T, Brokx J, Frijns J, et al. Newborn hearing screening and cochlear implantation: impact on spoken language development. B-ENT. 2013;(suppl 21):91-98.
  • Banga R, Doshi J, Child A, Pendleton E, Reid A, McDermott AL. Bone-anchored hearing devices in children with unilateral conductive hearing loss: a patient-career perspective. Ann Otol Rhinol Laryngol. 2013;122(9):582-587.
  • Zawawi F, Kabbach G, Lallemand M, Daniel SJ. Bone-anchored hearing aid: why do some patients refuse it? Int J Pediatr Otorhinolaryngol. 2014;78(2):232-234.
  • Achar P. Hearing rehabilitation with middle ear implants: an overview. Surgeon. 2013;11(3):165-168.
  • Lachowska M, Pastuszka A, Glinka P, Niemczyk K. Is cochlear implantation a good treatment method for profoundly deafened elderly? Clin Interv Aging. 2013;8:1339-1346.
  • Forzley B, Chen J, Nedzelski J, et al. Bilateral sequential adult cochlear implantation: who should receive priority in the context of a constrained health care system? Laryngoscope. 2013;123(12):3137-1340.
  • Chen DS, Clarrett DM, Li L, Bowditch SP, Niparko JK, Lin FR. Cochlear implantation in older adults: long-term analysis of complications and device survival in a consecutive series. Otol Neurotol. 2013;34(7):1272-1277.
  • Verhaert N, Desloovere C, Wouters J. Acoustic hearing implants for mixed hearing loss: a systematic review. Otol Neurotol. 2013;34(7):1201-1209.
  • Wolbring G. Hearing beyond the normal enabled by therapeutic devices: the role of the recipient and the hearing profession. Neuroethics. 2013;6:607-616.

Section 3: Communicating with the Patient Who Is Deaf or Hard of Hearing

Example case: Mr. Mitchell, a 75-year-old man presents for a routine follow-up appointment for hypertension and high cholesterol. His wife called your office the day before to tell you that her husband is having increasing difficulty hearing and probably will not tell you about it. During the appointment, you note that you have to ask many questions more than once. When you ask Mr. Mitchell if he is having trouble hearing, he replies, “No.”

Key questions to consider:

  • How common is deafness in patients seen in the primary care practice setting? How common is deafness in older adults?
  • Are most patients who are hard of hearing aware of the hearing loss? Do most patients who are aware that they are hard of hearing disclose this to their physicians? How can hearing loss be detected in the patient who does not report it?
  • What strategies can be used to improve interpersonal communication with the patient who is deaf or hard of hearing during office visits? What strategies can family members use?
  • What are common challenges, other than communication barriers, of working with patients who are deaf? Do common examinations such as cognitive testing maintain their validity in the patient who is deaf? How does social isolation affect the physician-patient relationship and communication?
  • What is the physician’s responsibility to ensure effective communication with a patient who is deaf? Is the physician’s practice responsible for providing devices to assist hearing? Is the physician’s practice responsible for providing a sign language interpreter when a patient who is deaf communicates using sign language?
  • What are useful strategies for ensuring effective communication between office visits to accomplish tasks such as providing test results and answering questions?  Should the physician's practice have capabilities to communicate with patients via a telecommunications device for the deaf, also known as a text telephone to typewriter?
  • How can a family physician be an effective advocate for their deaf patients as they navigate the health care system? How can physicians make their practices welcoming to patients who are deaf?

Initial references to consider:

  • Hines J. Communication problems of hearing-impaired patients. Nurs Stand. 2000;14(19):33-37.
  • McKee MM. Caring for older patients who have significant hearing loss. Am Fam Physician. 2013;87(5):360-366.
  • Dean PM, Feldman DM, Morere D, Morton D. Clinical evaluation of the mini-mental state exam with culturally deaf senior citizens. Arch Clin Neuropsychol. 2009;24(8):753–760.
  • Deuster D, Matulat P, Schmidt CM, Knief A. Communication skills for interviewing hearing-impaired patients. Med Educ. 2010;44(11):1130-1131.
  • Iezzoni LI, O’Day BL, Killeen M, Harker H. Communicating about health care: observations from persons who are deaf or hard of hearing. Ann Intern Med. 2004;140(5):356-362.
  • De Silva M, McLaughlin MT, Rodrigues EJ, Broadbent JC, Gray AR, Hammond-Tooke GD. A mini-mental status examination for the hearing impaired. Age Ageing. 2008;37(5):593-595.
  • Jahncke H, Halin N. Performance, fatigue and stress in open-plan offices: the effects of noise and restoration on hearing impaired and normal hearing individuals. Noise Health. 2012;14(60):260-272.
  • Poost-Foroosh L, Jennings MB, Shaw L, Meston CN, Cheesman MF. Factors in client-clinician interaction that influence hearing aid adoption. Trends Amplif. 2011;15(3):127-139.

Section 4: Issues in the Deaf and Hard of Hearing Communities

Example case: Paul and Dana, a young couple, who both have normal hearing, have learned that their infant is deaf. They have been referred to and seen several subspecialists over the past few months and have begun to recognize and consider the important decisions that they will need to make for their child. They have asked for your guidance in better understanding the various choices they have and help in making those choices.

Key questions to consider:

  • What communication decisions need to be made early on when parents have a child who is deaf or hard of hearing?
  • What educational choices are available to the child and adult who is deaf or hard of hearing?
  • What are the elements of a comprehensive approach to early intervention in the child who is deaf or hard of hearing?
  • Are there any mental health disorders that are more prevalent in the patient who is deaf or hard of hearing? What are these issues, and how can they be managed?
  • What disparities in areas such as health care, education, and employment are experienced by the individual in the deaf or hard of hearing communities?
  • What stereotypes and biases surround the deaf and hard of hearing communities? How do these biases affect the patient who belongs to one of these communities?
  • Where can the patient or the patient’s parents get information about these issues? Are support groups available? How can they be located?
  • What should the physician know about deaf culture?
  • What are the implications of being prelingually deaf, postlingually deaf, or late deafened?
  • Why do terms such as hearing impaired, deaf and dumb, and deaf mute have negative connotations to individuals who are deaf? How can the physician be sensitive to different views on deafness?

Initial references to consider:

  • Jung D, Bhattacharyya N. Association of hearing loss with decreased employment and income among adults in the United States. Ann Otol Rhinol Laryngol. 2012;121(12):771-775.
  • O'Hearn A. Deaf women's experiences and satisfaction with prenatal care: a comparative study. Fam Med. 2006;38(10):712-716.
  • Cawthon S, Leppo R. Assessment accommodations on tests of academic achievement for students who are deaf or hard of hearing: a qualitative meta-analysis of the research literature. Am Ann Deaf. 2013:158(3):363-376.
  • Theunissen SC, Rieffe C, Netten AP, et al. Self-esteem in hearing-impaired children: the influence of communication, education, and audiological characteristics. PLoS One. 2014;9(4):e94521
  • Theunissen SC, Rieffe C, Netten AP, et al. Psychopathology and its risk and protective factors in hearing-impaired children and adolescents: a systematic review. JAMA Pediatr. 2014;168(2):170-177.
  • Walter GG, Dirmyer R. The effect of education on the occupational status of deaf and hard of hearing 26-to-64-year-olds. Am Ann Deaf. 2013;158(1):41-49.
  • Rich S, Levinger M, Werner S, Adelman C. Being an adolescent with a cochlear implant in the world of hearing people: coping in school, in society and with self identity. Int J Pediatr Otorhinolaryngol. 2013;77(8):1337-1344.
  • Li CM, Zhang X, Hoffman HJ, Cotch MF, Themann CL, Wilson MR. Hearing impairment associated with depression in US adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngol Head Neck Surg. 2014;140(4):293-302.
  • Shaver DM, Marschark M, Newman L, Marder C. Who is where? Characteristics of deaf and hard-of-hearing students in regular and special schools. J Deaf Stud Deaf Educ. 2014;19(2):203-219.
  • Foss KA. (De)stigmatizing the silent epidemic: representations of hearing loss in entertainment television. Health Commun. 2014;29(9):888-900.
  • World Health Organization. Deafness and hearing loss. Updated February 2014. Available at http://www.who.int/mediacentre/factsheets/fs300/en/(www.who.int).
  • Smeijers AS, Ens-Dokkum MH, van den Bogaerde B, Oudesluys-Murphy AM. Clinical practice: the approach to the deaf or hard-of-hearing paediatric patient. Eur J Pediatr. 2011;170(11):1359-1363.