Sensitivity and Specificity of Pure-Tone and Subjective Hearing Screenings Using Spanish-Language Questions

Hearing Difficulties Among Farmworkers in the México-US Southwest Border Region

Migrant and seasonal farmworkers are a vulnerable population with a potentially high risk for hearing loss due to farm-related noise exposures. Occupational noise-induced hearing loss (NIHL) is permanent, and it is associated with an increased risk for injuries on the job, as well as communication difficulties, isolation, and depression. The México/US border region is one of the most productive agricultural regions in the country, however, no known studies have explored hearing loss among farmworkers in this area. This pilot study was a first step toward measuring and addressing hearing loss and noise exposure among this region's farmworkers. We conducted a cross-sectional survey to estimate the prevalence of subjective hearing difficulties among Yuma County, Arizona farmworkers. Survey interviews took place during a late-night farmworker health fair from 2 am to 6 am to accommodate local farms' labor schedules. Multivariable regression adjusted for demographic and work covariates estimated subjective hearing loss prevalence ratios. Among 132 farmworker participants, 36% reported they have or might have hearing loss, and 62% reported no hearing loss. Subjective hearing loss prevalence was lower in farmworkers who report not working in noise compared to prevalence in farmworkers who work in noise [prevalence ratio, 0.44 (95% CI 0.23-0.82)]. This report contributes to understanding the perception of hearing-related health and occupational exposures among farmworkers in the México-US Southwest border region. The information from this line of research will inform appropriate safety measures known to lower the risk of experiencing occupational NIHL.

Applied Research in Clinical Audiology with Spanish Speakers in the United States: A Scoping Review

BACKGROUND

 The Hispanic population is growing, and Spanish is the second most spoken language in the United States. When individuals experience a hearing problem, culturally and linguistically responsive services represent an important part of person-centered care, contributing to wellbeing and intervention outcomes.

PURPOSE

 The purpose was to identify research in clinical audiology conducted with Spanish speakers to illuminate gaps and inform future research.

RESEARCH DESIGN

 A scoping literature review.

DATA COLLECTION AND ANALYSIS

 A database search was completed in January 2022. Included research was conducted in clinical audiology, had Spanish-speaking deaf or hard-of-hearing (DHH) adults/parents of a DHH child in the United States, Spanish language data collection, and published in English in a peer-reviewed journal. Studies were categorized by the area of audiology and a narrative description provided.

RESULTS

 The search identified 655 articles. Following screening, 11 studies met the inclusion criteria and 1 article was identified from the reference lists of included articles for a total 12 articles. The articles were published between 1997 and 2021. Most studies were conducted with adults and a few were with parents of DHH children. Research was conducted in four areas: hearing loss experiences, hearing aid experiences, hearing screening, and communication.

CONCLUSIONS

 There is limited research with Spanish-speaking DHH individuals and parents of DHH children. There is an urgent need for future research to inform culturally and linguistically responsive clinical practice, and to provide evidence-based interventions for effective hearing health care management.

Mixed Evidence of an Association between Self-Rated Hearing Difficulties and Falls: Prospective Analysis of Two Longitudinal Studies

INTRODUCTION

This study aimed to assess the extent to which a single item of self-reported hearing difficulties is associated with future risk of falling among community-dwelling older adults.

METHODS

We used data from two Australian population-based cohorts: three waves from the PATH Through Life study (PATH; n = 2,048, 51% men, age 66.5 ± 1.5 SD years) and three waves from the Concord Health and Ageing in Men Project (CHAMP; n = 1,448, 100% men with mean age 77.3 ± 5.3 SD years). Hearing difficulties were recorded on a four-point ordinal scale in PATH and on a dichotomous scale in CHAMP. The number of falls in the past 12 months was reported at each wave in both studies. In CHAMP, incident falls were also ascertained by triannual telephone call cycles for up to four years. Multivariable-adjusted random intercept negative binomial regression models were used to estimate the association between self-reported hearing difficulties and number of falls reported at the following wave or 4-monthly follow-ups.

RESULTS

In PATH, self-reported hearing difficulties were associated with a higher rate of falls at follow-up (incidence rate ratio = 1.15, 95% CI = 1.03-1.27 per a one-level increase in self-reported hearing difficulties), after adjusting for sociodemographic characteristics, health behaviours, physical functioning, balance, mental health, medical conditions, and medications. There were no significant associations between hearing difficulties and the rate of falls based on either repeated survey or 4-monthly follow-ups in CHAMP.

CONCLUSION

Though we find mixed results, findings from PATH data indicate an ordinal measure of self-reported hearing loss may be predictive of falls incidence in young-old adults. However, the null findings in the male-only CHAMP preclude firm conclusions of a link between hearing loss and falls risk.

Sensitivity and specificity of hearing tests for screening hearing loss in older adults

Objectives

The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older.

Methods

This study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening (HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated.

Results

Among all tests, only the single self-perception question (0.7064 for sensitivity; 0.7225 for specificity) and whisper test (0.7833 for sensitivity; 0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years.

Conclusion

Overall, we suggest using the whisper test to identify disabling hearing loss (>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single self-perception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.

Online Assessment of Speech Perception and Auditory Spectrotemporal Processing in Spanish-English Bilinguals

PURPOSE

There is limited access to audiology services for the growing population of Spanish-English bilinguals in the United States. Online auditory testing can potentially provide a cost-effective alternative to in-person visits. However, even for bilinguals with high English proficiency, age of English acquisition may affect speech perception accuracy. This study used a comprehensive test battery to assess speech perception and spectrotemporal processing abilities in Spanish-English bilinguals and to evaluate susceptibility of different tests to effects of native language.

METHOD

The online battery comprised three tests of speech in quiet (vowel and consonant identification and words in sentences), four tests of speech perception in noise (two for intelligibility and two for comprehension), and three tests of spectrotemporal processing (two tests of stochastically modulated pattern discrimination and one test of spectral resolution). Participants were 28 adult Spanish-English bilinguals whose English acquisition began either early (≤ 6 years old) or late (≥ 7 years old) and 18 English monolingual speakers.

RESULTS

Significant differences were found in six of the 10 tests. The differences were most pronounced for vowel perception in quiet, speech-in-noise test, and two tests of speech comprehension in noise. Late bilinguals consistently scored lower than native English speakers or early bilinguals. In contrast, no differences between groups were observed for digits-in-noise or three tests of spectrotemporal processing abilities.

CONCLUSION

The findings suggest initial feasibility of online assessment in this population and can inform selection of tests for auditory assessment of Spanish-English bilinguals.

Screening for Hearing Loss in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Hearing loss is common in older adults and associated with adverse health and social outcomes.

OBJECTIVE

To update the evidence review on screening for hearing loss in adults 50 years or older to inform the US Preventive Services Task Force.

DATA SOURCES

MEDLINE, Cochrane Library, EMBASE, and trial registries through January 17, 2020; references; and experts; literature surveillance through October 8, 2020.

STUDY SELECTION

English-language studies of accuracy, screening, and interventions for screen-detected or newly detected hearing loss.

DATA EXTRACTION AND SYNTHESIS

Dual review of abstracts, full-text articles, and study quality. Meta-analysis of screening test accuracy studies.

MAIN OUTCOMES AND MEASURES

Quality of life and function, other health and social outcomes, test accuracy, and harms.

RESULTS

Forty-one studies (N = 26 386) were included, 18 of which were new since the previous review. One trial enrolling US veterans (n = 2305) assessed the benefits of screening; there was no significant difference in the proportion of participants experiencing a minimum clinically important difference in hearing-related function at 1 year (36%-40% in the screened groups vs 36% in the nonscreened group). Thirty-four studies (n = 23 228) evaluated test accuracy. For detecting mild hearing loss (>20-25 dB), single-question screening had a pooled sensitivity of 66% (95% CI, 58%-73%) and a pooled specificity of 76% (95% CI, 68%-83%) (10 studies, n = 12 637); for detecting moderate hearing loss (>35-40 dB), pooled sensitivity was 80% (95% CI, 68%-88%) and pooled specificity was 74% (95% CI, 59%-85%) (6 studies, n = 8774). In 5 studies (n = 2820) on the Hearing Handicap Inventory for the Elderly-Screening to detect moderate hearing loss (>40 dB), pooled sensitivity was 68% (95% CI, 52%-81%) and pooled specificity was 78% (95% CI, 67%-86%). Six trials (n = 853) evaluated amplification vs control in populations with screen-detected or recently detected hearing loss over 6 weeks to 4 months. Five measured hearing-related function via the Hearing Handicap Inventory for the Elderly; only 3 that enrolled veterans (n = 684) found a significant difference considered to represent a minimal important difference (>18.7 points). Few trials reported on other eligible outcomes, and no studies reported on harms of screening or interventions.

CONCLUSIONS AND RELEVANCE

Several screening tests can adequately detect hearing loss in older adults; no studies reported on the harms of screening or treatment. Evidence showing benefit from hearing aids on hearing-related function among adults with screen-detected or newly detected hearing loss is limited to studies enrolling veterans.

Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review

BACKGROUND

Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed.

OBJECTIVE

To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs.

METHODS

Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed.

RESULTS

There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs.

CONCLUSION

Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.