More Work Necessary to Improve Hearing Literacy Among Patients

Although most patients recognize the importance of eye exams, blood pressure tests and cancer screenings, awareness about hearing loss and hearing improvement lags behind many other health disorders. This is despite hearing loss ranking among the most prevalent and undertreated disorders worldwide. A recent study, which appeared in Otology & Neurotology, used a national cross-sectional survey to better characterize adult patients’ awareness and perceptions of hearing loss and rehabilitation.

Study design

In the study, 1,250 patients between the ages of 50 and 80 years responded to the survey. Of these, 500 indicated at least moderate hearing loss (40% moderate, 48% moderately severe, 10% severe and 3% profound) and were currently using hearing aids, and 750 indicated that they had not been diagnosed with hearing loss and were not using hearing aids. The survey asked respondents about their knowledge of “normal” or average health metrics (i.e., vision, blood pressure, cholesterol and hearing), their likelihood of prioritizing health conditions and life activities in the next 12 months and to rank the most important health conditions to manage. They were also asked about the timing of their last hearing test and their reasons for not having their hearing tested more frequently.

“Beyond just impaired communication and safety concerns, we know that untreated hearing loss is also linked to depression, social isolation, lower quality of life, heightened fall risk and premature mortality, among others,” says Sarah Sydlowski, AuD, PhD, MBA, a co-author on the study and Audiology Director of the Hearing Implant Program at Cleveland Clinic. “But even though we know how prevalent hearing loss is and that these links exist, hearing loss remains greatly underdiagnosed and undertreated. This study quantifies patients’ literacy surrounding hearing loss and hearing treatment and identifies specific knowledge gaps.”

Findings

Based on survey answers, the authors found that the respondents had a disproportionately limited understanding of hearing loss compared to other common medical conditions. Only 9% of respondents were able to correctly identify the normal or average range of hearing, and the 500 respondents with hearing loss were only slightly more likely than their counterparts without hearing loss to select the correct answer (11% versus 8%). However, the normal range of values for vision, blood pressure and total cholesterol were identified by 93%, 85% and 52% of respondents, respectively.

Both cohorts of respondents also ranked the importance of hearing loss as the third least important to address compared to 10 other common health conditions. For example, 72% said they were very likely to have an annual physical exam, 70% were very likely to have a cholesterol test, very likely to have an eye exam (66%), and very likely to bring their pet to the veterinarian (54 %) – in contrast, only 27% reported they were very likely to have their hearing tested. When respondents were asked when their last hearing test was, the most frequent response (22%) was longer than 10 years. Among respondents with hearing loss, the most frequent response was in the past six months (36%), but 64% of respondents with hearing loss had their hearing checked within the past 12 months. The most common response for why a respondent had not had a hearing test was “I do not think I am experiencing hearing loss” (47%) and “my healthcare provider has never mentioned getting my hearing tested” (30%).

“Because most patients mainly rely on their primary care physician for information regarding their medical conditions, a significant burden is placed on these front-line caregivers,” says Dr. Sydlowski. “However, we know that only a small percentage of primary care physicians regularly screen for hearing loss among their patients and roughly half believe there is nothing to be done about hearing loss, which couldn’t be further from the truth.”

In regard to their knowledge about links between hearing loss and other health and social issues, less than a quarter of respondents indicated strong awareness. Although most respondents recognize the potential impacts of hearing loss on safety, quality of life, and health, only 38% believe that hearing loss is treatable and only 17% believe that hearing loss is preventable. There was also much more hesitancy towards taking corrective measures towards hearing loss than other conditions — 67% were open to corrective lenses for vision problems. Still, just 40% would consider using hearing aids. Respondents with hearing loss were more likely to consider hearing aids, but only a quarter of respondents were open to undergoing surgery for a cochlear implant (CI).

Importance of improving hearing loss literacy

“Despite widely available technology to treat hearing loss with CI, utilization among eligible patients in the United States is unbelievably low – about 2% of patients who could benefit from a CI has one,” says Dr. Sydlowski. “Improved technology and surgical techniques have expanded candidacy to include individuals with residual hearing, asymmetric hearing loss and single-sided deafness. But, just like with the hearing aid population, even though the numbers for new CI users continues to rise, the number of CI candidates far outpaces the number of actual users.”

Dr. Sydlowski notes that one of the primary reasons for this trend is likely poor general knowledge about long-term negative sequelae of hearing loss. “There is a significant onus placed on the front-line care providers because most patients don’t voluntarily bring up their hearing health during routine visits,” explains Dr. Sydlowski. “We don’t usually think of hearing loss as a vital part of our health – but it is. With the recent ruling from the FDA that will make some hearing aids available without a prescription, patients can now take on some of the responsibility for managing their hearing loss. However, we must also take steps to help patients improve their hearing literacy. Hearing loss must first be recognized as important to health so patients prioritize managing it – then we can address the best devices to do that. Hopefully, the results from this study will close the knowledge gap patients have in regard to their hearing health and will prompt primary care physicians and other front-line caregivers to prioritize hearing health by recommending a hearing test with an audiologist.”