Primary Care Care Physicians and Hearing Aids: 

Should You Get Involved?

Helen Keller called hearing loss “A worse misfortune than being blind, because when you lose your vision you lose contact with things, when you lose your hearing, you lose contact with people.” Hearing loss is the third most common chronic health condition in the elderly population, and in the United States, only one out five people with hearing loss receives treatment. As hearing loss develops with age, many patients withdraw from previous enjoyable activities and may suffer from social isolation. This is particularly distressing in the elderly, who are often restricted from certain physical activities due to health problems. Social interaction through verbal communication becomes their only link with the world. A recent study by the National Council on Aging showed a definite link between hearing loss and depression in the elderly.

So why do so few hearing impaired elderly seek help? Past studies show that the main reasons are vanity, denial and lack of confidence that hearing aids will help. Vanity can often be overcome with the improvements in miniaturization of electronics. We now fit more than half of our patients with the completely in the canal size instruments. Denial can only be overcome by evidence. Performing a simple hearing screening test in your office, or referring for an objective hearing test by an Audiologist can demonstrate the extent of hearing loss. Family members can also support that hearing loss may be causing communication problems at home. Lack of confidence is a larger, more controversial issue.

Historically, hearing aids were sold over the counter at department stores, or by door to door salesmen. There were only two types of hearing aids available (powerful, and not as powerful). As technology and our understanding of ear physiology has improved, the educational requirements to evaluate and treat age related hearing loss have become more demanding. Unfortunately, the legal requirements to obtain a hearing aid dealers license are not substantially different than they were 40 years ago. It is still legal in West Virginia to obtain a license to test hearing and sell hearing aids with no university based academic training or degree. The field of Audiology has recognized the increased educational demands, and all Audiologists entering the field after 2007 must have a doctoral degree. Additionally, hearing aid dealers often attract customers by offering free hearing tests. They only get paid if they can sell the person hearing aids. This can present a conflict of interest. Since most primary care physicians will refer their hearing impaired patients to an ENT physician or Audiologist, the hearing aid dealer relies on marketing directly to the public, eliminating the primary care physician from the process.

Many hearing impaired patients wait years before committing to the effort and considerable expense of trying hearing aids. If they are not successful and satisfied, the hearing aids go into the nightstand drawer, and the patient is convinced hearings aid won’t help them. They are then doomed to a lifetime of untreated hearing loss.

A 2003 article in the Journal of the American Medical Association highly recommends routine hearing screening of adult patients. The incidence and consequences of hearing loss, and the availability of effective remediation justify that routine screening is worth the time and effort. More recently, Medicare has issued a recommendation that all new Medicare beneficiaries undergo a “Welcome to Medicare” wellness physical at the primary care level. Hearing screening is mandated as a part of that screening. The JAMA article, and the American Academy of Audiology both recommend the Hearing Handicap Inventory for the Elderly- Screening version (HHIE-S) as a simple effective screening tool. Please see the enclosed copy and feel free to photocopy and use it in your practice.

Should a primary care physician get involved in helping their patient seek effective hearing care? If you don’t, they are likely to do nothing, or make their choice of a hearing care provider based on the flashiest advertisement or free offer, rather than on your professional and trusted advice.

Hearing Handicap Inventory for the Elderly - Screening Version
Answer each question “yes,” “sometimes,” or “no.”

Does your hearing problem cause you to feel embarrassed when meeting new people?
Does a hearing problem cause you to feel frustrated when talking to members of your family?
Do you have difficulty hearing when someone speaks in a whisper?
Do you feel handicapped by a hearing problem?
Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?
Does a hearing problem cause you to attend religious services less often than you would like?
Does a hearing problem cause you to have arguments with family members?
Does a hearing problem cause you difficulty when listening to TV or radio?
Do you feel that any difficulty with your hearing limits or hampers you personal or social life?
Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

Scoring: 4 points for each yes, 2 points for each sometimes, 0 points for each no (possible total score = 40 points).

TOTAL SCORE_______points
REFER if score is 10 points or greater

SOURCE: FROM VENTRY IM, WEINSTEIN BE. IDENTIFICATION OF ELDERLY PEOPLE WITH HEARING PROBLEMS. ASHA 1983; 25:37-42. COPYRIGHT BY THE AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION. REPRINTED WITH PERMISSION.