Screening For Hearing Loss Research Articles

Universal Newborn Hearing Screening and Incidence of Hearing Loss in Ramathibodi Hospital: A 5 Years Experience (2014 to 2018)

Background: Congenital hearing loss is an important factor affecting a child’s speech and language development. The quality of universal newborn hearing screening and hearing intervention program plays an important role in assisting children with permanent hearing to achieve appropriate speech and language development. Objectives: To assess outcomes of the revised Ramathibodi Hospital universal newborn hearing screening (RUNHS) during 2014 to 2018, and to analyze the incidence of hearing loss in infants. Methods: This study was a retrospective analysis, all newborns delivered at Ramathibodi Hospital from January 1, 2014, to December 31, 2018 were included. Data were collected from medical records and evaluated the RUNHS outcomes compared with benchmarks. Descriptive statistics were used to analyze data. Results: Of 18 597 newborns, the screening coverage rate was 99. 8%, and the referral rate was 2.5%. The follow-up rate was 92.5%, and the diagnosis rate within 3 months of age was 20.1%. Among infants diagnosed with hearing loss, 42.9% received hearing aids by 6 months of age. The incidence of congenital permanent hearing loss was between 0.5 and 1.9 per 1000 live births. Conclusions: The outcomes met the benchmarks for coverage and referral rate, but the diagnosis and hearing aid fitting rate did not meet the criteria. As of the incidence, the amount of children with congenital hearing loss in this study was similar to those reported by others.

A study on the IOS application "uHear" as a screening tool for hearing loss in Bangkok.

This study was designed to compare the results of hearing tests performed using the uHear application with those of standard audiometry in Thai people in Bangkok. From December 2018 to November 2019, a prospective observational study was conducted involving Thai participants aged between 18 and 80 years. All participants were tested using standard audiometry and the uHear application in a soundproof booth and in a typical hearing environment. This study included 52 participants (12 males and 40 females). The Bland-Altman plot with the Minimal Clinical Meaningful Difference of 10dB between standard audiometry and the uHear in a soundproof booth found agreement at 2000 Hz. The uHear in a soundproof booth showed high sensitivity at all frequencies (82.5%-98.9%) and high specificity at 500 and 1000 Hz (85.7%-100%). uHear in a typical hearing environment showed high sensitivity at 4000 and 6000 Hz (97.6%) and high specificity at 500 and 1000 Hz (100%). When considering the pure-tone average, uHear in a soundproof booth showed high sensitivity (94.7%) and specificity (90.7%), whereas, in a typical hearing environment, uHear showed poor sensitivity (34%) and high specificity (100%). uHear was accurate for hearing loss screening at 2000 Hz in a soundproof booth. However, uHear in a typical hearing environment lacked accuracy. The uHear application in a soundproof booth can be used to screen hearing loss in some situations where standard audiometry is impossible. II.

Follow-up of children diagnosed with deafness in a neonatal hearing screening program in Manaus.

To evaluate the follow-up of children diagnosed with deafness in neonatal hearing screening and risk factors for hearing loss. Quantitative, cross-sectional, and retrospective study to evaluate factors associated with hearing loss and the follow-up of cases of children diagnosed with audiological dysfunction, by analyzing electronic medical records of 5,305 children referred to a Specialized Center in Type I Rehabilitation, from January/2016 to February/2020, in the city of Manaus, Amazonas. The statistical study used Pearson's chi-square test and binary logistic regression in which odds ratio scans were obtained with reliability intervals of 95%. Of the 5,305 children referred for the otoacoustic emission retest, 366 (6.9%) failed the retest. Children diagnosed with sensorineural hearing loss continued in the study, totaling 265 (72.4%). Only 58 (21.9%) children continued in the study to its end, of these 39 had received hearing aids at that point; and 16 (41%) had surgical indication for cochlear implants, of which only 3 (18.7%) had undergone surgery. Among the risk factors for hearing loss, we found 2.6 times more chance of failure in the otoacoustic emissions retest in those children who had a family history of hearing loss and ICU stay. Although the screening flow reaches a large part of live births, the dropout rates during the process are high, therefore, the socioeconomic and geographic characteristics of regions such as the Amazon should be considered as relevant factors to the evasion of rehabilitation programs of these children. Hospitalization in the neonatal ICU and family history of hearing loss in the investigations could be identified as the main and most important factors for alteration of the otoacoustic emissions retests.

Prevention and management of hearing loss in patients receiving ototoxic medications.

Following the efforts of patient advocates, the World Health Organization published updated guidelines for management of multidrug-resistant tuberculosis in 2018 that advised against the routine use of ototoxic second-line injectable drugs (amikacin, capreomycin and kanamycin). Although hearing loss is no longer considered an unavoidable harm for patients with multidrug-resistant tuberculosis, ototoxic medications continue to be used for several infectious and oncological disorders around the world. These drugs contribute to more than a half a million cases of hearing loss worldwide annually. Currently, there are no international standards for preventing and managing hearing loss associated with ototoxic medications. We present recent data on the prevention and management of hearing loss related to these drugs and highlight the variability in care across settings. More importantly, we aim to provide an evidence-based framework for evaluating, screening and preventing ototoxicity. Finally, we identify avenues for future research so that patients no longer have to choose between hearing loss and a disease cure. There remain significant gaps in our understanding about optimal screening and treatment of ototoxic hearing loss. Here we aim to inspire future international guidelines to address gaps in ototoxicity care and establish research agendas for eliminating ototoxic medications.

Ocular Manifestations in Patients with Sensorineural Hearing Loss.

Identification of ocular manifestations in patients with sensorineural hearing loss (SNHL) can have a large impact on the outcome and treatment of pediatric patients. Due to the common co-incidence of ocular manifestations and SNHL in children, both ophthalmologic and hearing loss screening and routine examinations must be conducted to minimize adverse outcomes and worsening of pathology. Early evaluation and diagnosis is imperative for intervention and further development of the patient. Co-incidence requires a thorough evaluation that includes a comprehensive history, examination, and diagnostic testing. In this article, a literature review was conducted to analyze the presentations of various diseases and syndromes, such as Alport Syndrome, Waardenburg Syndrome, Norrie Disease, Usher Disease, Stickler Syndrome, Marfan Syndrome, Congenital Rubella, and Hereditary Optic Neuropathies. We divided the various ocular pathologies into anterior and posterior segment presentations and associated systemic findings for better understanding. Additionally, this review aims to include an update on the management of patients with both ocular and hearing loss manifestations.

Usability, acceptabilityand clinical utility of a mobile app to screen for hearing loss in older adults in a geriatric rehabilitation hospital.

Hearing loss is a common problem for older adults entering rehabilitation hospitals. To pilot a hearing loss screening device to determine feasibility, usability, and impact on patient outcomes. We screened all patients newly admitted to a geriatric day hospital for hearing loss using the SHOEBOX® QuickTest (SHOEBOX Ltd.) app as part of a quality improvement programme. We measured the time it took for each patient to complete screening and recorded any issues they had using the app. We recorded the number of patients who screened positive who did not have a previous diagnosis and changes in physician behaviours after they received their patients' results. Seventy-four patients with a mean age of 83.4 years used the hearing screener. All patients were able to complete the screening with a mean time to completion of 10 min and 48 s. Ninety-nine percent of patients screened positive for hearing loss. Of these positives 56% were in participants not already known to have hearing loss. Physicians often changed their behaviour after receiving results by using assistive devices during visits and referring to audiology for formal testing. Screening for hearing loss is feasible in a geriatric day hospital. The SHOEBOX QuickTest app is acceptable, usable, resulting in the identification of undiagnosed hearing loss and in changes to physician behaviour.

SENSORINEURAL HEARING LOSS IN ISCHEMIC STROKE - A LONGITUDINAL OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL.

Hearing impairment commonly involves dysfunction of the inner ear or auditory nerve, a condition known as sensorineural Hearing loss (SNHL). A longitudinal observational study of 38 stroke patients was conducted at a tertiary care hospital for a period of 6 months to know the proportion of sensorineural hearing loss in stroke patients and also the progression of hearing loss during the recovery period of stroke. Clinical & audiological evaluation was done for all patients and they underwent pure tone audiometry at serial intervals of 1st, 2nd and 3rd month from the date of diagnosis of stroke. The proportion of sensorineural hearing loss in stroke patients was found to be 60%. On comparison of serial pure tone audiometry readings, it was observed that hearing loss improved signicantly during the recovery period of stroke. This study concluded that high proportion of sensorineural hearing loss in stroke patients indicates the importance of screening for hearing loss to improve the rehabilitation as well as quality of life post stroke.

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule

Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults. To project the monetary value of future research clarifying uncertainties around the optimal adult hearing screening schedule. In this economic evaluation, a validated decision model of HL (DeciBHAL-US: Decision model of the Burden of Hearing loss Across the Lifespan) was used to simulate current detection and treatment of HL vs hearing screening schedules. Key model inputs included HL incidence (0.06%-10.42%/y), hearing aid uptake (0.54%-8.14%/y), screening effectiveness (1.62 × hearing aid uptake), utility benefits of hearing aids (+0.11), and hearing aid device costs ($3690). Distributions to model parameters for probabilistic uncertainty analysis were assigned. The expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) using a willingness to pay of $100 000 per quality-adjusted life-year (QALY) was estimated. The EVPI and EVPPI estimate the upper bound of the dollar value of future research. This study was based on 40-year-old persons over their remaining lifetimes in a US primary care setting. Screening schedules beginning at ages 45, 55, 65, and 75 years, and frequencies of every 1 or 5 years. The main outcomes were QALYs and costs (2020 US dollars) from a health system perspective. The average incremental cost-effectiveness ratio for yearly screening beginning at ages 55 to 75 years ranged from $39 200 to $80 200/QALY. Yearly screening beginning at age 55 years was the optimal screening schedule in 38% of probabilistic uncertainty analysis simulations. The population EVPI, or value of reducing all uncertainty, was $8.2 to $12.6 billion varying with willingness to pay and the EVPPI, or value of reducing all screening effectiveness uncertainty, was $2.4 billion. In this economic evaluation of US adult hearing screening, large uncertainty around the optimal adult hearing screening schedule was identified. Future research on hearing screening has a high potential value so is likely justified.

Results of Neonatal Genetic Screening for Hearing Loss in Peking Union Medical College Hospital in the Past 10 Years

Results of Neonatal Genetic Screening for Hearing Loss in Peking Union Medical College Hospital in the Past 10 Years

Neonatal management and outcome in complicated monochorionic twins: What have we learned in the past decade and what should you know?

Monochorionic (MC) twin pregnancies are at increased risk of neonatal morbidity and mortality due to the shared placenta with vascular connections that can give rise to various complications, including twin-twin transfusion syndrome, twin anemia polycythemia sequence (TAPS), selective fetal growth restriction, and other hematological imbalances at birth. Each complication presents its own challenges and considerations in the neonatal period. Measurement of hemoglobin levels and reticulocyte count is required to establish a correct diagnosis. Placenta dye injection is needed to properly distinguish between the various conditions. Risk factors for adverse outcome in MC twins include prematurity, severe cerebral injury, and the type of MC pregnancy complication. We, therefore, recommend cerebral ultrasound examinations in all complicated MC twins at birth to rule out a severe brain injury. Lastly, we strongly encourage screening for hearing loss using automated auditory brainstem response in all spontaneous TAPS donors to prevent permanent speech development delay.

Hearing Loss Screening, Diagnosis, and Treatment for Refugees and Asylees in an Urban Clinic, 2014-2017.

First, to determine whether using a single-question subjective hearing screen vs gold standard audiometric evaluation is effective for hearing loss screening in refugees and asylees. Second, to understand the clinical pathways for hearing loss diagnosis and treatment. This is a case series with chart review from January 2014 to December 2017. A large urban safety net primary care clinic in San Francisco, California. Patients were included who had a medical record and completed single-question subjective hearing screening and audiometric evaluation during refugee health examinations. An overall 349 patients met all inclusion criteria. Out of 349 patients, 48% were male; the median age was 29.3 years (SD, 15.1). The majority came from Central or South America (n = 148, 42%) and China (n = 79, 23%). Among all patients, 10 (3%) failed the subjective hearing screen, and 18 (5%) failed audiometric evaluation. Of those who failed the subjective hearing screen, 4 (40%) passed audiometric evaluation. Of those who failed the audiometric evaluation, 12 (66%) passed subjective screening, and only 5 (28%) received a diagnostic audiogram, with 4 diagnosed with hearing loss and 1 receiving hearing aids. The sensitivity of the subjective screening question was 33% and the specificity 99% as compared with audiometric evaluation. Audiometric evaluation is relatively inexpensive and easily administered, while a single subjective question is a poor screening tool. Hearing loss is undertreated in this population. Ensuring appropriate hearing loss screening, diagnosis, and treatment in this population is paramount to improving quality of life.

Predictive factors of acute sensorineural hearing loss in adult Japanese patients for clinical application by primary care doctors: a cross-sectional study

BackgroundSeveral methods are used for hearing loss screening; however, their benefits are uncertain. In this study, we aimed to determine the predictive factors of acute sensorineural hearing loss for clinical application by primary care doctors.MethodsThis retrospective, cross-sectional study included 365 patients with acute sensorineural hearing loss without prior therapy. The patients’ clinical data, demographic information, and medical histories were obtained, and they were asked about comorbidities. In addition, we assessed lifestyle factors such as stress level, alcohol consumption, marital status, and socioeconomic level. Logistic regression analysis was performed to investigate the diagnostic predictive ability of the selected factors associated with acute sensorineural hearing loss. The hearing levels of all patients were evaluated using pure tone audiometry.ResultsWe identified significant predictive factors for acute sensorineural hearing loss. The absence of hyperacusis was a predictive factor for sudden sensorineural hearing loss. Younger age, female sex, and marital status were predictive factors for acute low-tone hearing loss. High body mass index, high socioeconomic level, low alcohol consumption, high stress level, hyperacusis, and vertigo/dizziness were predictive factors for Ménière’s disease. High body mass index and ear fullness were predictive factors for perilymph fistula. Low stress level was a predictive factor for acoustic tumours.ConclusionsOur findings can be used to distinguish between the types of acute sensorineural hearing loss. Symptoms, physical status, and lifestyle factors identified during this study are useful markers for predicting acute sensorineural hearing loss occurrence.

Reframing Our Health Care System for Patients With Hearing Loss.

Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.

Loss to Follow-up After Newborn Hearing Screening and Its Related Factors

Background: Hearing loss is one of the most common birth defects and early detection of this disorder at birth is not possible without hearing screening. The aim of this study was to determine the frequency of loss to follow-up after neonatal hearing screening and its related factors in Khorramabad, Iran. Methods: This retrospective correlational study was conducted from March 2018 to February 2021. The medical records of 13,710 infants born in this period were assessed. All the infants suspected of hearing loss in the first screening of one or both ears (n=310) were followed up for the second screening. The demographic and medical information of the infants and their parents was collected by a valid researcher-made checklist. The initial and follow-up data were extracted from the infants’ electronic records available at Assalian Hospital and the information available at the Dabbagh Clinic, respectively. To analyze the data, frequency distribution was determined and the relationships between the variables were assessed by the Chi-square test using SPSS software v. 16. The significance level was set at α=0.05. Results: Out of 13,710 neonates, 310 cases (2.26%) did not pass the first hearing screening. Of this group, 60 infants (20%) missed the second screening follow-up. Among the studied variables, a number of socio-economic variables and neonatal factors were associated with not following hearing loss screening (P<0.05). Among the mothers’ personal causes of loss to follow-up, the feeling of no need to follow up with 36.7% and fear of COVID-19 with 26.7% were the most common causes. Conclusion: About one-fifth of infant hearing screening follow-ups were not performed, which makes education about hearing screening follow-ups necessary for families. Providing a suitable context to facilitate preventing developmental problems in children and save future medical expenses is necessary and this program is needed to be on the agenda of the Ministry of Health and clinics providing mother and child health services.

Hearing aid utilization in Ontario – a population based study

Background Hearing loss is one of the most common sensory impairments and hearing aids are the most common unmet assistive device need among individuals with a disability. The benefits of hearing interventions are well-documented as they are known to deter the sequalae of hearing loss including social isolation, poor mental health, falls and cognitive decline. Identifying trends in hearing aid users can provide valuable information for improving access to hearing loss interventions. Methods Data were retrieved from ICES databases that were used to generate a cohort of 372,448 individuals in Ontario, Canada, who first claimed hearing aids between April 2007 and March 2018 through the Assistive Devices Program. Results The data indicated that the frequency distribution of hearing aids has steadily inclined since 2007. The mean age of hearing aid users was 70.25 ± 14.70 years and higher neighbourhood income quintile was associated with greater hearing aid use (p < 0.001). Most first claims occurred after visiting primary care physicians (70.60%) compared with otolaryngology (13.39%). An examination of clinical comorbidities revealed hypertension (63.41%), and diabetes (24.93%) to be the most common. Regression analysis demonstrated a positive associated between age and most comorbidities. Furthermore, higher neighbourhood income quintiles were associated with a reduced risk of having the examined comorbidities. Conclusions This study examines patient demographics and clinical comorbidities in a cohort of hearing aid users in Ontario. The results identify associations between demographics and comorbidities that provide information relevant for improving access to hearing interventions and clinical decision-making in primary care. Implications for Rehabilitation Screening for hearing loss (using an audiogram) in elderly individuals that manage multiple comorbidities, and any patient with significant risk factors for hearing loss (e.g., noise exposure history, prior ototoxic medications, prior head injury, history of ear surgery, family history of hearing loss) will identify deficits and direct appropriate hearing interventions. Improving access to care in low-income communities should include community-based education around expectation management and communication strategies to reinforce proper use and care of hearing devices. Geographic proximity to hearing testing facilities and hearing aid dispensaries is a significant barrier to hearing rehabilitation strategies.

Association Between Expanded Genomic Sequencing Combined With Hearing Screening and Detection of Hearing Loss Among Newborns in a Neonatal Intensive Care Unit

Hearing loss is a global social burden. Early identification of hearing loss missed by newborn hearing screening tests in the neonatal intensive care unit is crucial. To assess the association between expanded genomic sequencing combined with hearing screening and detection of hearing loss as well as improvement in the neonatal intensive care unit. This cohort study was performed between August 8, 2016, and December 31, 2020, among 8078 newborns admitted to the neonatal intensive care unit of the Children's Hospital of Fudan University in Shanghai, China. Follow-up for hearing status was performed via telephone interviews between September 1 and November 30, 2021. A hearing screening test and the expanded genomic sequencing targeting 2742 genes were administered to each patient. Those who failed the hearing screening test or had positive genetic findings were referred for diagnostic audiometry at a median of 3 months of age. The primary outcome was hearing loss missed by hearing screening test. Secondary outcomes were genetic findings and benefits associated with the expanded genomic sequencing for clinical management of patients in the neonatal intensive care unit. Of 8078 patients (4666 boys [57.8%]; median age, 6.3 days [IQR, 3.0-12.0 days]), 52 of 240 (21.7%) received a diagnosis of hearing loss. Expanded genomic sequencing combined with hearing screening was associated with a 15.6% increase (7 of 45 patients) in cases of diagnosed hearing loss that were missed by hearing screening. Of the 52 patients with hearing loss, genetic factors were identified for 39 patients (75.0%); GJB2 and SLC26A4 were the most common genes identified. Patients with genetic findings experienced a more severe degree of hearing loss than those without genetic findings (21 profound, 4 severe, 7 moderate, and 7 mild vs 2 severe, 4 moderate, and 7 mild; P = .005), with more bilateral hearing loss (39 of 39 [100%] vs 9 of 13 [69.2%]; P = .003). Clinical management strategies were changed for patients who underwent genomic sequencing combined with hearing screening. This study suggests that expanded genomic sequencing combined with hearing screening may be effective at detecting hearing loss among patients in the neonatal intensive care unit.

Comprehensive Genomic Sequencing–Based Screening for Hearing Loss in the Neonatal Intensive Care Setting—Is It Time?

Comprehensive Genomic Sequencing–Based Screening for Hearing Loss in the Neonatal Intensive Care Setting—Is It Time?

Main outcomes from the first 2 years of France's screening programme for neonatal permanent hearing loss through a descriptive study.

This study aimed to evaluate the implementation of France's neonatal hearing loss screening programme years after its launch, and to estimate permanent bilateral neonatal hearing loss (PBNHL) prevalence and distribution by severity. This descriptive study used aggregated regional data on all births in France in 2015-2016. Screening coverage, refusal rate, positive predictive value (PPV), proportion of children with suspected PBNHL, PBNHL prevalence and distribution by severity were calculated. Eight hundred thousand neonates were eligible for the screening programme per year. Between 2015 and 2016, screening coverage increased (83.3% vs. 93.8%; p < 0.001), and the refusal rate remained stable (0.1%). In 2016, when considering the additional tests performed several weeks after birth, the proportion of suspected PBNHL neonates decreased (1.4% vs. 0.9%) while the PPV increased (4.7% vs. 7.6%). In 2015, the estimated prevalence of PBNHL (moderate to profound) was 0.09% (95% CI 0.08-0.10). Among neonates with >= 41 decibels deficit, 56.8%, 16.6%, and 26.6% had moderate, severe and profound hearing loss, respectively. The national target of 90% screening coverage was exceeded. The additional test could be useful to avoid overcrowding in diagnostic structures. Diagnostic data quality must be improved to confirm PBNHL prevalence and distribution by severity.

Grey areas in community-based research with rural Alaska Native partners

In The Lancet Global Health, Susan Emmett and colleagues present compelling evidence in favour of mobile health screening for hearing loss in rural children and the effectiveness and economic value of telemedicine referral to improve access to specialty follow-up care.1 The cluster-randomised trial was conducted in 15 rural communities populated almost entirely by Alaska Native people. Telemedicine referral more than doubled the percentage of children who received medical follow-up within 9 months compared with standard primary care referral (68·5% vs 32·1%); mobile health screening outperformed standard school screening for detecting possible hearing impairment; and both mobile health screening and telemedicine referral were extraordinarily cost-effective.

A hearing bolt-on item increased the measurement properties of the EQ-5D-5L in a community-based hearing loss screening program.

To investigate the measurement properties of a hearing item ('bolt-on') added to the EQ-5D-5L descriptive system. Cross-sectional data on the EQ-5D-5L descriptive system with the addition of a hearing bolt-on item, namely, 'I have no/slight/moderate/severe/extreme problems hearing', was collected through face-to-face interviews with 418 participants of a community-based hearing loss screening program in Singapore. The distribution of responses to the EQ-5D and the hearing items were compared in terms of the proportion of 'no problems' and the Shannon index (H'). The measurement properties of the hearing item were assessed by testing its correlation with the hearing thresholds in dBHL; and with the standard EQ-5D items. The properties were also evaluated by comparing the proportion of 'full health' in participants with different hearing severities between standard and hearing bolt-on EQ-5D-5L; and the ability in identifying the participants between the standard EQ-5D-5L index score and the level sum score (LSS) of the hearing bolt-on system. Compared to the standard EQ-5D items, the hearing item has a lower proportion of 'no problems' (80.1% vs. 80.9-97.9%); more evenly-distributed responses (H' value: 0.92 vs. 0.18-0.87); and much stronger correlation with the hearing thresholds (|r|: 0.322 and 0.325 vs. 0.008-0.139). It generally has a weak correlation with EQ-5D items (|r|: 0.055-0.160); and reduces the proportion of 'full health' for the participants with different hearing functions with the percentage reduction varying from 6.6 to 22.7%. The LSS is more discriminative than the standard EQ-5D-5L index score as well (F-statistic: 12.71 and 13.93 vs.4.06 and 4.70). A hearing bolt-on to EQ-5D-5L can validly measure hearing severities and is likely to increase the sensitivity of the resultant preference-based EQ-5D index to hearing loss.