Quality Indicators for the Care of Hearing Loss in Vulnerable Elders

Abstract

on quality of life. 3 Use of hearing aids or surgical intervention improves hearing and has a positive effect on quality of life. 4‐6 A number of screening tests have been developed for hearing loss and are the focus of two of the quality indicators (QIs) listed below. These tests will be described in more detail below. To confirm the presence of hearing loss, formal testing (audiogram) is necessary. Formal audiological testing is performed in a sound-protected setting and takes 30 to 60 minutes to complete. The patient’s auditory threshold (pure-tone threshold) is assessed for frequencies from 500 to 8,000Hz. The patient indicates the minimum decibel level at which a sound is perceived. Speech recognition is examined by having the patient listen to monosyllabic words at a comfortable listening level (usually 40dB above speech threshold) and recording the percentage of correctly repeated words using a 50-word list. The two major forms of hearing loss are sensorineural and conductive hearing loss. Sensorineural hearing loss is more common and is associated with aging. Sensorineural hearing loss due to aging is termed presbycusis. This type of hearing loss typically occurs gradually over decades. Damage is at the neural level, including the hair cells in the inner ear. Because no treatment is available to reverse this damage, sensorineural hearing loss is usually treated with amplification. Alternatively, conductive loss results from mechanical abnormalities of the middle and external ear and may result from the presence of foreign bodies, fluid (otitis media), or ossicular discontinuities. In general, these losses respond best to surgical intervention. In summary, hearing impairment is not only prevalent but also burdensome in the older population. Early diagnosis and treatment of hearing impairment can improve quality of life and functional status in the aging population.