Final Research Plan
Screening for Hearing Loss in Older Adults
February 14, 2019
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
The final Research Plan is used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.
The draft Research Plan was available for comment from November 8 to December 12, 2018.
1. a. Does screening for hearing loss in asymptomatic adults age 50 years or older improve health outcomes?
b. Does the effectiveness of screening for hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
2. What is the accuracy of primary care–relevant screening tests for hearing loss in adults age 50 years or older?
3. a. What are the harms of screening for hearing loss in adults age 50 years or older?
b. Do the harms of screening for hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
4. a. What is the efficacy of interventions for screen-detected hearing loss in improving health outcomes in adults age 50 years or older?
b. Does the efficacy of interventions for screen-detected hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
5. a. What are the harms of interventions for screen-detected hearing loss in adults age 50 years or older?
b. Do the harms of interventions for screen-detected hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- Does adherence to hearing aid use improve health outcomes in adults with screen-detected hearing loss who are prescribed hearing aids?
- Do interventions to improve hearing aid adherence improve health outcomes?
- In adults who are prescribed hearing aids, what are the potential barriers to obtaining hearing aids and reasons for low uptake?
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).
|Population||KQs 1–3: Adults age ≥50 years without diagnosed hearing loss, including those with comorbid depression, mild cognitive dysfunction, or diabetes
KQs 4, 5: Adults diagnosed with screen-detected (or recently detected) sensorineural hearing loss or presbycusis
|KQs 1–3: Adults age <50 years; adults with previously diagnosed hearing loss, adults who currently use a hearing aid (within the past 6 months), or adults with comorbid dementia
KQs 4, 5: Adults with conductive hearing loss, congenital hearing loss, sudden hearing loss, or hearing loss caused by recent noise exposure
|Screening tests||KQs 1–3: Screening tests that are used, available, or feasible for use in primary care settings, including the whispered voice test, finger rub test, watch tick test, single-question screening regarding perceived hearing loss, hearing loss questionnaire, and screening audiometry (e.g., via handheld device or smartphone)||KQs 1–3: Screening tests that are not used or available in primary care settings; Rinne and Weber tests (i.e., tests used to distinguish between sensorineural and conductive hearing loss)|
|Interventions for hearing loss||KQs 4, 5: Amplification with hearing aids (any type), personal assistive listening devices, and personal sound amplification devices, with or without additional education or counseling||KQs 4, 5: Nutritional pharmaceuticals, hearing rehabilitation alone (without amplification), and cochlear implants|
|Outcomes||KQs 1, 4: Hearing-related quality of life and/or function (e.g., as measured on the Hearing Handicap Inventory for the Elderly), general health-related quality of life and/or function (e.g., as measured on the 36-Item Short-Form Health Survey), cognitive impairment, depression, social isolation, and falls (including injuries attributed to falls)
KQ 2: Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and diagnostic odds ratioKQs 3, 5: False-positive results, overdiagnosis, labeling, anxiety, and any other significant harms
|KQs 1, 4: Outcomes related to hearing aid performance and efficacy (e.g., speech intelligibility, quality of the listening experience)|
|All KQs: No comparison
KQs 4, 5: Studies comparing two different amplification devices
|Settings||All KQs: Studies performed in settings generalizable to primary care, including nursing home settings
KQs 2, 4, 5: Studies performed in specialty clinics
|Studies performed in occupational health settings|
|Countries||Studies conducted in countries categorized as “Very High” on the 2016 Human Development Index (as defined by the United Nations Development Programme)||Studies conducted in countries not categorized as “Very High” on the 2016 Human Development Index|
|Study designs||KQs 1, 4: Randomized, controlled trials and controlled cohort studies
KQ 2: Cross-sectional or cohort studiesKQs 3, 5: Randomized, controlled trials; controlled cohort studies; and case-control studies
|All other study designs*|
|Language||Full text published in English||Languages other than English|
|Study quality||Fair or good quality||Poor quality (according to design-specific USPSTF criteria)|
* Systematic reviews will be excluded from the evidence review. However, separate searches will be conducted to identify relevant systematic reviews, and the citations of all studies included in those systematic reviews will be reviewed to ensure that database searches capture all relevant primary studies.
The draft Research Plan was posted for public comment on the USPSTF Web site from November 8, 2018 to December 12, 2018. In response to public comments, the USPSTF added social isolation and falls (including injuries attributed to falls) to the list of eligible health outcomes and added overdiagnosis to the list of eligible harms. For KQ2, the USPSTF clarified that primary care screening tests for hearing loss that rely on smartphone or other computerized technology are eligible for inclusion. Several comments requested clarification on whether newer amplification technology (including over-the-counter devices) is eligible for inclusion, and whether eligible interventions could have multiple components (e.g., include amplification and brief counseling or education related to hearing loss). The USPSTF made minor edits to clarify that amplification with hearing aids (any type), personal assistive listening devices, or personal sound amplification devices, with or without additional education or counseling, are eligible interventions for KQs 4 and 5. Other comments requested that the USPSTF expand the population to include children, adolescents, and younger adults, and also include other prevention strategies (e.g., interventions to reduce hazardous noise exposure, or screening in occupational health settings); these populations and interventions are considered to be outside the scope of this topic.