RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, North Carolina.
Department of Medicine, University of North Carolina at Chapel Hill.
JAMA. 2021 Mar 23;325(12):1202-1215. doi: 10.1001/jama.2020.24855.
Hearing loss is common in older adults and associated with adverse health and social outcomes.
To update the evidence review on screening for hearing loss in adults 50 years or older to inform the US Preventive Services Task Force.
MEDLINE, Cochrane Library, EMBASE, and trial registries through January 17, 2020; references; and experts; literature surveillance through October 8, 2020.
English-language studies of accuracy, screening, and interventions for screen-detected or newly detected hearing loss.
Dual review of abstracts, full-text articles, and study quality. Meta-analysis of screening test accuracy studies.
Quality of life and function, other health and social outcomes, test accuracy, and harms.
Forty-one studies (N = 26 386) were included, 18 of which were new since the previous review. One trial enrolling US veterans (n = 2305) assessed the benefits of screening; there was no significant difference in the proportion of participants experiencing a minimum clinically important difference in hearing-related function at 1 year (36%-40% in the screened groups vs 36% in the nonscreened group). Thirty-four studies (n = 23 228) evaluated test accuracy. For detecting mild hearing loss (>20-25 dB), single-question screening had a pooled sensitivity of 66% (95% CI, 58%-73%) and a pooled specificity of 76% (95% CI, 68%-83%) (10 studies, n = 12 637); for detecting moderate hearing loss (>35-40 dB), pooled sensitivity was 80% (95% CI, 68%-88%) and pooled specificity was 74% (95% CI, 59%-85%) (6 studies, n = 8774). In 5 studies (n = 2820) on the Hearing Handicap Inventory for the Elderly-Screening to detect moderate hearing loss (>40 dB), pooled sensitivity was 68% (95% CI, 52%-81%) and pooled specificity was 78% (95% CI, 67%-86%). Six trials (n = 853) evaluated amplification vs control in populations with screen-detected or recently detected hearing loss over 6 weeks to 4 months. Five measured hearing-related function via the Hearing Handicap Inventory for the Elderly; only 3 that enrolled veterans (n = 684) found a significant difference considered to represent a minimal important difference (>18.7 points). Few trials reported on other eligible outcomes, and no studies reported on harms of screening or interventions.
Several screening tests can adequately detect hearing loss in older adults; no studies reported on the harms of screening or treatment. Evidence showing benefit from hearing aids on hearing-related function among adults with screen-detected or newly detected hearing loss is limited to studies enrolling veterans.
听力损失在老年人中很常见，与不良的健康和社会后果有关。
更新关于 50 岁及以上成年人听力损失筛查的证据综述，为美国预防服务工作组提供信息。
通过 2020 年 1 月 17 日，对 MEDLINE、Cochrane 图书馆、EMBASE 和试验登记处进行了检索；参考文献；以及专家意见；通过 2020 年 10 月 8 日进行文献监测。
关于准确性、筛查和干预措施的英语语言研究，用于筛查发现或新发现的听力损失。
对摘要、全文文章和研究质量进行双重审查。对筛查试验准确性研究进行荟萃分析。
生活质量和功能、其他健康和社会结果、测试准确性和危害。
共纳入 41 项研究（N=26386 人），其中 18 项是自上次综述以来的新研究。一项在美国退伍军人中进行的试验（n=2305）评估了筛查的益处；在 1 年时，在听力相关功能方面经历最小临床重要差异的参与者比例在筛查组（36%-40%）和非筛查组（36%）之间没有显著差异。34 项研究（n=23228 人）评估了测试的准确性。对于检测轻度听力损失（>20-25dB），单一问题筛查的敏感性为 66%（95%置信区间，58%-73%），特异性为 76%（95%置信区间，68%-83%）（10 项研究，n=12637 人）；对于检测中度听力损失（>35-40dB），汇总敏感性为 80%（95%置信区间，68%-88%），汇总特异性为 74%（95%置信区间，59%-85%）（6 项研究，n=8774 人）。在 5 项关于使用老年听力障碍筛查量表（Hearing Handicap Inventory for the Elderly-Screening ）检测中度听力损失（>40dB）的研究中（n=2820），汇总敏感性为 68%（95%置信区间，52%-81%），汇总特异性为 78%（95%置信区间，67%-86%）。6 项试验（n=853）评估了在 6 周至 4 个月期间有屏幕检测或最近发现听力损失的人群中，放大与对照的效果。5 项研究通过老年听力障碍筛查量表（Hearing Handicap Inventory for the Elderly ）来衡量听力相关功能；只有 3 项纳入退伍军人（n=684）的研究发现了有意义的差异，被认为代表了最小的重要差异（>18.7 分）。很少有试验报告其他合格的结果，也没有研究报告筛查或干预的危害。
几种筛查测试可以充分检测老年人的听力损失；没有研究报告筛查或治疗的危害。在有屏幕检测或新发现听力损失的成年人中，助听器对听力相关功能的益处证据仅限于纳入退伍军人的研究。
