0
The Rational Clinical Examination | Clinician's Corner

Does This Patient Have Hearing Impairment?

Akshay Bagai, MD; Paaladinesh Thavendiranathan, MD; Allan S. Detsky, MD, PhD
JAMA. 2006;295(4):416-428. doi:10.1001/jama.295.4.416.
Text Size: A A A
Published online

Context Hearing impairment is prevalent among the elderly population but commonly underdiagnosed.

Objective To review the accuracy and precision of bedside clinical maneuvers for diagnosing hearing impairment.

Data Sources MEDLINE and EMBASE databases (1966 to April 2005) were searched for English-language articles related to screening for hearing impairment.

Study Selection Original studies on the accuracy or precision of screening questions and tests were included. Articles that used unaccepted reference standards or contained insufficient data were excluded. Medical Subject Headings or keywords used in the search included hearing loss, hearing handicap, hearing tests, tuning fork, deafness, physical examination, sensitivity, specificity, audiometry, tuning fork tests, Rinne, Weber, audioscope, Hearing Handicap Inventory for the Elderly–Screening version, whispered voice test, sensorineural, and conductive.

Data Extraction One author screened all potential articles and 2 authors independently abstracted data. Differences were resolved by consensus. Each included study (n = 24) was assigned a methodological grade.

Data Synthesis A yes response when asking individuals whether they have hearing impairment has a summary likelihood ratio (LR) of 2.5 (95% confidence interval [CI], 1.7-3.6); a no response has an LR of 0.13 (95% CI, 0.09-0.19). A score of 8 or greater on the screening version of the Hearing Handicap Inventory for the Elderly (HHIE-S) has an LR of 3.8 (95% CI, 3.0-4.8); a score less than 8 has an LR of 0.38 (95% CI, 0.29-0.51). An abnormal Weber tuning fork test response has an LR of 1.6 (95% CI, 1.0-2.3); a normal response has an LR of 0.70 (95% CI, 0.48-1.0). An abnormal Rinne tuning fork test response has LRs ranging from 2.7 to 62; a normal response has LRs from 0.01 to 0.85. Inability to perceive a whispered voice has an LR of 6.1 (95% CI, 4.5-8.4); normal perception has an LR of 0.03 (95% CI, 0-0.24). Not passing the audioscope test has an LR of 2.4 (95% CI, 1.4-4.1); passing has an LR of 0.07 (95% CI, 0.03-0.17).

Conclusions Elderly individuals who acknowledge they have hearing impairment require audiometry, while those who reply no should be screened with the whispered-voice test. Individuals who perceive the whispered voice require no further testing, while those unable to perceive the voice require audiometry. The Weber and Rinne tests should not be used for general screening.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Figure 2. Algorithm for Determining Need for Formal Audiometric Testing
Graphic Jump Location

Tables

References

CME


You need to register in order to view this quiz.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 38

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Hearing Impairment

The Rational Clinical Examination
Original Article: Does This Patient Have Hearing Impairment?

brightcove.createExperiences();