Adult Hearing Loss Poised to Nearly Double by 2060

Diana Swift

March 09, 2017

The number of US adults aged 20 years or older with hearing loss (pure tone average >25 decibels) is projected to increase from 44.11 million in 2020 to 73.50 million in 2060, with a rise in prevalence from 15% to 22.6%.

Outpacing the overall population growth rate, this increase will be most evident in older adults, according to a study published online March 2 in JAMA Otolaryngology-Head & Neck Surgery.

By 2060, 67.4% of all adults with hearing impairment will be aged 70 years or older, up from 55.4% in 2020, report Adele M. Goman, PhD, a postdoctoral research fellow at the Center on Aging & Health at Johns Hopkins University in Baltimore, Maryland, and colleagues.

The researchers used previous prevalence estimates from the National Health and Nutrition Examination Survey and, assuming that current rates of hearing loss prevalence would stay relatively constant by age decade, applied them to 10-year US Census population estimates for 2020 - 2060.

The researchers made estimates both by age decade and by decibel (dB)-measured severity of hearing loss, which was defined as mild (>25 dB - 40 dB) or moderate or more (>40 dB). Severity was based on the hearing sensitivity measure of the 4-frequency pure-tone average in the better ear: 0.5, 1.0, 2.0, and 4.0.

Dr Goman and coauthors think their projections will help policy makers and public health researchers plan for the coming wave of demands in hearing healthcare. "Given the projected increase in the number of people with hearing loss that may strain future resources, greater attention to primary (reducing incidence of hearing loss), secondary (reducing progression of hearing loss), and tertiary (treating hearing loss to reduce functional sequelae) prevention strategies is needed to address this major public health issue," they write.

They note that currently more than 66% of adults aged 70 years or older have clinically significant hearing loss, a condition associated with faster cognitive decline, worse physical functioning,and increased healthcare costs.

Their concerns parallel 2016 recommendations from the National Academies of Sciences, Engineering, and Medicine ‎for improving access to hearing health interventions and services. "The increased need for affordable interventions and accessibility to trained hearing specialists will require novel and cost-effective approaches to audiologic health care," Dr Goman and colleagues write.

Hearing Aids Do Help

Part of that healthcare will involve greater access to hearing devices. In the first randomized, double-blinded, placebo-controlled trial of outcomes using different hearing aid delivery models, researchers demonstrated that hearing devices definitely benefit older adults.

Perhaps more unexpected, the researchers also found that patient-selected over-the-counter (OTC) hearing aids benefit older adults about as much as audiologist-fitted ones.

Larry E. Humes, PhD, a hearing sciences professor at Indiana University in Bloomington, Indiana, and colleagues compared patient outcomes when hearing aids were delivered via a "best audiology practices" model vs a "customer-decides" OTC model. The investigators reported their results in an article published online March 2 in the American Journal of Audiology.

"The research findings provide firm evidence that hearing aids do, in fact, provide significant benefit to older adults," said Dr Humes, in a related press release. "This is important because, even though millions of Americans have hearing loss, there has been an absence of rigorous clinical research that has demonstrated clear benefits provided by hearing aids to older adults."

The study evaluated 154 men and women aged 55 - 79 years with mild-to-moderate hearing loss. Recruited from the community, participants were divided into three groups. The best-practices group received audiologist care that included professional fitting and counseling — the gold standard. Those in the OTC group selected their hearing aids themselves, and those in the placebo group were fitted by audiologists but received dummy hearing aids programmed to provide no acoustical enhancement. All participants received the same high-end bilateral, digital, mini hearing aids (ReSound Alera 9).

The primary outcome measure was score on the Profile of Hearing Aid Benefit questionnaire, a 66-item, self-assessment inventory of the outcome of hearing aid fitting across seven subscales, including hearing familiar talkers, ease of communication, reverberation, reduced cues, background noise, and sound distortion.

A secondary outcome measure was the Connected Speech Test benefit. In addition, hearing-aid benefit, satisfaction, and usage were also analyzed.

After 6 weeks, the researchers found that both the best-practices and OTC approaches provided comparable benefit, with moderate or large effect sizes (Cohen's d). But the latter participants expressed significantly (P<.05) less satisfaction with their hearing devices, and fewer participants in that group were planning to purchase them after the trial, compared with those in the best-practices group: 55% versus 81%. Only 36% in the placebo group were planning to buy their devices.

The researchers also evaluated the effect of device purchase prices. The first half of the trial's participants were offered their devices at $3,600 a pair, a typical retail purchase price, whereas the second half were offered a reduced price of $600. Purchase price had no effect on outcomes.

After the initial trial, OTC and placebo participants were permitted to continue for an extra 4 weeks under the best-practices model, and satisfaction significantly increased for patients from both groups who chose ongoing audiologist care. In addition, more participants opted to purchase their devices after this continued period of care.

The authors point out that while nearly 29 million US adults could benefit from hearing aids, among those aged 70 years or older with hearing loss, only about 30% have actually used them. Moreover, among those aged 20 to 69 years, only about 16% of those who could benefit have ever used them.

The authors also note that because hearing aids have a typical life expectancy of 5 years, older adults can anticipate paying tens of thousands of dollars in their later years for devices, batteries, and audiology services.

"More studies are needed to assess the generalization of the results obtained here to other patient populations, other devices, and other models of OTC service delivery," said Dr Humes in the press release.

He concedes that the higher quality and cost of the devices used, as well as the complete audiological exams conducted on all study participants, could have optimized patient outcomes. "However, the results of this study should serve as a yardstick for comparing outcomes of future hearing aid studies," he said.

The study by Goman et al was supported by the National Institutes of Health and the Eleanor Schwartz Charitable Foundation. Dr Goman and Dr Lin reported consulting and research support from Cochlear Ltd. Dr Lin reported consulting for the Gerson Lehrman Group, serving on the scientific advisory boards of Pfizer and Autifony, and serving as a speaker for Amplifon.

The trial by Humes et al was supported by a research grant from the National Institute on Deafness and Other Communication Disorders. Hearing aids were purchased from GN ReSound, which provided no funding.

JAMA Otolaryngology–Head & Neck Surgery. Published online March 2, 2017. Abstract

Am J Audiol. Published online March 2, 2017. Full text

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