Listen Up: Hearing Tests Going Mobile in Geriatric Clinics

Introduction: Although the US Preventive Service Task Force has not reported strong evidence for routine hearing screening in the elderly population, screening is without much risk and has the potential for positive outcomes. Moreover, hearing loss has been identified to be the largest modifiable risk factor for dementia. In 2019, The World Health Organization developed a hearWHO application, a mobile, number-based hearing test designed for screening.

Methods: The aim of this pilot study was to examine the accuracy and feasibility of using the hearWHO app in an elderly population and validate its use in a community clinic. Patients were offered to participate in a hearing screening as part of their annual physical in a community geriatric clinic.

Results: In total, 123 patients completed a hearWHO test. Of these patients, 79.0% had hearing loss detected by the application and were recommended referral to audiology. Of these, 27.8% obtained a formal audiogram and 16 patients were recommended hearing aids for amplification. The Positive Predictive Value of the hearWHO test was 59.3% (16/28). In the study period, only 3.2% of patients declined the screening as part of their geriatric physical. Using a chi-square test, there was a statistically significant relationship (p=0.006) between the hearing loss and lower mini-cognitive scores. Of the patients who did not seek further audiologic workup (70/97), only one patient reported seeking over the counter hearing aids as an alternative.

Conclusions: This study indicates patients seen in geriatric clinic are interested in a hearing evaluation as part of their annual visit. HearWho and similar applications may be a user-friendly tool to identify hearing impairment in the primary care setting with a positive predictive value of approximately 60%. This study also identified that despite wanting the hearing test, the majority of patients did not seek further workup or intervention such as over the counter hearing aids despite the awareness of potentially meaningful hearing loss. Access to hearing aids will likely require more mobile solutions to address barriers to care for hearing improvement.