Hearing aids may improve quality of life for those with hearing loss, but a recent study analyzing the 2010 National Health and Nutritional Examination Survey (NHANES) demonstrated a low prevalence of hearing aid use among U.S. adults, especially for those in their 50s. (Arch Intern Med 2012;172:292).
“Overall, the results are pretty much consistent with older studies that have been done on the topic,” said Frank R. Lin, PhD, the lead author and an assistant professor of otology and epidemiology at Johns Hopkins University School of Medicine in Baltimore. “The biggest shock to me is not so much the adults who are [older] than 60 years, but the 50-year-olds where the prevalence of hearing aid use is shockingly low [in comparison].”
A questionnaire assessed hearing aid use by whether an individual reported wearing a hearing aid at least once a day (1999-2004) or for at least five hours a week (2005-2006). The questions used in NHANES about hearing aid use changed during this period. Hearing loss was defined as a speech frequency pure-tone average of 25 dB or higher in both ears.
The authors estimated that 3.8 million (14.2%) Americans 50 and older with hearing loss wore hearing aids in the period from 1999 to 2006 while 22.9 million did not. The prevalence of hearing aid use in those with hearing loss increased with each age group: 4.3 percent (50-59), 7.3 percent (60-69), 17.0 percent (70-79), and 22.1 percent (80 and older).
“For individuals 50 years and older in the United States with hearing loss (4.5 million), one in seven individuals uses a hearing aid, and for working-aged adults (50-59 years), the rate of hearing aid use declines to less than one in 20,” the authors wrote.
Why are hearing aids not worn by those who need them? The answer is multifaceted, according to Dr. Lin, but one major reason may be the lack of studies that prove the efficacy of hearing aids on quality of life.
“Hearing aids definitely have an impact on hearing-related quality of life, but outcomes like dementia and cognitive decline [also play a role],” Dr. Lin said. “Also, there is a general perception among medical professionals that hearing loss is an inconsequential part of the aging process. When you combine these two things, I don't think it's that surprising.”
Dr. Lin also recognized that vanity may affect the decision to wear hearing aids, especially for those 50 to 59. “I think it is likely to play a role,” he said, and also noted that some people are in denial about aging, another reason for low hearing aid usage.
Lack of reimbursement from insurance companies in some states for hearing rehabilitative services also has an impact, said Dr. Lin. He suggested conducting more epidemiologic and randomized controlled studies on the association of hearing loss with outcomes like cognitive and physical function decline and dementia.
“Hearing loss may be associated with cognitive decline, but the big question is if our current treatments have any impact on these outcomes,” Dr. Lin said. “We're going to set up a large randomized controlled study powered by hearing loss and its effect on cognitive decline and the risk for dementia.”
Dr. Lin also suggested adopting a more community-centered approach toward hearing intervention, such as “community-based hearing screening, home-based rehabilitation in proper use of devices, broad public health campaigns to educate the public about hearing loss, and hearing loop induction systems installed widely to augment audibility for those with hearing loss.”
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