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Audiometry Interpretation for Hearing Loss in Adults

Mandi Sehgal, MD
Alexandra Sellers, AuD, CCC-A
Wendy S. Biggs, MD

American Family Physician. 2024;109(4):316-323.

Author disclosure: No relevant financial relationships.

Hearing loss is a prevalent, chronic condition in the United States; it is often gradual and progressive and is underreported by patients and undertreated by physicians. The impaired ability to effectively hear and communicate may result in negative emotional, cognitive, economic, and social consequences for individuals and may pose a safety risk. Questionnaires and smartphone apps are available to help identify and evaluate self-perceived hearing loss. Physicians should assess for objective hearing impairment when the patient or family member raises a concern or if cognitive or mood symptoms are present that could be influenced by hearing loss. Three types of hearing loss exist: conductive, sensorineural, and mixed. Pure-tone audiometry uses an audiometer and is reported on an audiogram; it is the most accurate method for hearing loss detection. It can be used for screening or comprehensive testing when combined with tympanometry, speech-reception thresholds, and word-recognition testing. Audiograms that show a unilateral or asymmetrical sensorineural hearing loss can be signs of retrocochlear pathology and warrant additional evaluation by an audiologist and otolaryngologist as well as imaging studies. Medicare Parts A and B do not pay for hearing aids, although some Medicare Advantage (Part C) or supplemental plans may provide insurance coverage for hearing aids. Less expensive, over-the-counter hearing aids may help mild to moderate hearing loss. Family physicians should counsel patients on the importance of protecting their hearing.

Hearing loss is one of the most prevalent chronic conditions in the United States, and it affects approximately 16% of the U.S. adult population.1 Consistent use of face masks during the COVID-19 pandemic sometimes revealed undiagnosed hearing loss, and patients with known hearing loss, especially those who are lip readers, experienced daily difficulties in understanding speech.2 Hearing loss is often gradual and progressive and is underreported by patients and undertreated by physicians.1,3 Untreated hearing loss has been associated with poorer objective physical functioning in older adults, increased risk for disability, and poorer quality of life.3 Hearing loss may result in negative emotional, cognitive, economic, and social consequences for individuals and may pose a safety risk.3–5

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating Comments
The U.S. Preventive Services Task Force found insufficient evidence to assess the balance of benefits and harms of screening for hearing loss in adults 50 years or older.6 C Systematic review
Physicians should assess for objective hearing impairment when the patient or a family member raises a concern or if cognitive or mood symptoms are present that could be influenced by hearing loss.12,17 C Expert opinion
Patients with hearing loss refractory to hearing aids can be referred to an otolaryngologist to be evaluated for a cochlear implant.12,48 C Expert opinion

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

MANDI SEHGAL, MD, is the program director of the Geriatric Medicine Fellowship at the Cleveland Clinic Florida, Weston, and a clinical affiliate professor at Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton.

ALEXANDRA SELLERS, AuD, CCC-A, is a clinical audiologist in the Department of Otolaryngology at the Cleveland Clinic Florida.

WENDY S. BIGGS, MD, is a professor of family medicine at Central Michigan University College of Medicine, Saginaw.

Address correspondence to Mandi Sehgal, MD (sehgalm@ccf.org). Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.

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