Hearing Loss: Does Gender Play a Role?

, University of Washington Medical Center; , University of Washington Medical Center, Virginia Merrill Bloedel Hearing Research Center


Medscape General Medicine. 1997;1(2) 

In This Article

Screening for Hearing Loss

A reliable and valid screening program to detect hearing loss in the majority of elderly persons was developed by Ventry and Weinstein,[60] and validated in a group of primary care patients.[61]

The screening protocol involves the use of 2 tools. The first is the Welch-Allyn audioscope, which combines a hand-held otoscope with an integral screening audiometer that delivers a 40-dB tone at frequencies of 500, 1000, 2000, and 4000Hz. Hearing impairment was defined according to the criteria developed by Ventry and Weinstein.[60] When used alone, the sensitivity of the audioscope in detecting hearing loss is approximately 94%, while the specificity ranges from 72% to 90%, depending on the setting.[61]

The second tool is the Hearing Handicap Inventory for the Elderly: Screening Version (HHIE-S).[60] The HHIE-S is a self-administered, 10-item questionnaire designed to detect emotional and social problems associated with impaired hearing (Table II). Patients answer 5 questions, each concerning the emotional and social impact of their hearing loss on their lives, by responding yes (4 points), sometimes (2 points), or no (0 points); total HHIE-S scores range from 0 to 40. Above a score of 24, the specificity of the HHIE-S was 96% to 98%, while the sensitivity was 24% to 30%.[61] However, the highest test accuracy was achieved when the results of the audioscope and HHIE-S were combined (75% sensitivity, 86% specificity, and 83% accuracy).[61]

We recommend routine annual screening for hearing loss in all women aged 65 years and older, and screening earlier in women with any symptoms and/or signs of hearing loss. This agrees with the US Preventative Services Task Force of 1990 recommendation that a hearing exam be included in the routine physical exam for all persons over age 65. Patients are able to complete the HHIE-S in 5 minutes or less while waiting in the office, and the results are easily scored by office personnel in a matter of seconds. The audioscope can be used as an otoscope, and hearing can be tested any time the external auditory canal and tympanic membrane are examined.

Using data and formulas from the Acoustical Society of America, hearing thresholds were calculated for a highly screened population of women 65, 70, 75, and 80 years of age. These thresholds are calculated for women free of significant noise exposure and are presented as representative audiograms (Figs. 3A-3D). For each age, the 10th, 50th, and 90th percentiles are presented. These audiograms provide a visual reference for hearing loss in women as they age.

Figure 3. (3A) Normal hearing thresholds for population of 65-year-old women free of significant noise exposure. (3B) Normal hearing thresholds for population of 70-year-old women free of significant noise exposure. (3C) Normal hearing thresholds for population of 75-year-old women free of significant noise exposure. (3D) Normal hearing thresholds for population of 80-year-old women free of significant noise exposure.

The HHIE-S can be used alone as a screening tool. If patients score in excess of 10, and have no abnormal findings on their otoscopic examination, they should be referred to an otolaryngologist for further evaluation. Scores of 18 or greater on the HHIE-S suggest the need for amplification. If the audioscope is also used, patients should be referred to an otologist if unable to hear the 40-dB tone in either ear at either frequency (1000 or 2000Hz).[58] Finally, it should be emphasized that any patient with signs or symptoms suggestive of a unilateral hearing loss should be referred to an otolaryngologist for further evaluation, regardless of findings on the HHIE-S/audioscope screen. Weinstein[62] presents an excellent case discussion on the role of primary care screening, audiologic assessment, and rehabilitation of a representative elderly patient with hearing loss.