Long-Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment—Which Hearing Assessment Test (SAI-WHAT) Randomized Trial

Authors

  • Bevan Yueh MD, MPH,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Margaret P. Collins PhD, CCC-A,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Pamela E. Souza PhD, CCC-A,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Edward J. Boyko MD, MPH,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Carl F. Loovis PhD, CCC-A,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Patrick J. Heagerty PhD,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Chuan-Fen Liu PhD,

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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  • Susan C. Hedrick PhD

    1. From the *Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota; Health Services Research and Development Service, Rehabilitation Care Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and §Departments of Speech and Hearing Sciences, #Internal Medicine, **Biostatistics, and ††Health Services, University of Washington, Seattle, Washington.
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Address correspondence to Bevan Yueh, Department of Otolaryngology/Head & Neck Surgery, University of Minnesota, MMC396, 420 Delaware Street SE, Minneapolis, MN 55455. E-mail: byueh@umn.edu

Abstract

OBJECTIVES: To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans.

DESIGN: Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care.

SETTING: Veterans Affairs Puget Sound Health Care System.

INTERVENTIONS: The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools.

MEASUREMENTS: Hearing aid use 1 year after screening.

RESULTS: Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability.

CONCLUSION: In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids.

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