[The Mini-Audio-Test (MAT). Screening inventory for hearing loss starting at the age of 50]

"I do not hear you!": hearing-impaired cancer patients report their communication experiences

PURPOSE

Hearing impairment has a high impact on communication between cancer patients and their oncologists. What is the patient's perspective on this problem and how can physicians draw lessons from it?

METHODS

Together with otorhinolaryngologists and hearing-impaired patients, we developed a questionnaire including the sections: WHO (Five) Well-Being Index (5 items), Abbreviated Profile of Hearing Aid Benefit (APHAB) as established self-estimation of hearing function (24 items), use of hearing aid (4 items) as well as patients' experiences (15 items), difficulties (9 items) and wishes (7 items) regarding the communication with physicians. The experiences, difficulties, wishes, and life satisfaction of cancer patients were analyzed between groups based on participants' APHAB scores, well-being and use of hearing aids. A total of 104 cancer survivors (median age 76.5 years, range 32-90 years) were included.

RESULTS

Between the groups of subjectively hearing-impaired and normal hearing participants, we registered a significant difference in difficulties in conversation, wishes for physician-patient communication and psychological well-being. Depending on participants' well-being, wishes and difficulties differed. Differences were also found between participants with and without hearing aids in terms of difficulties in conversation, but not in terms of their wishes and well-being. A large proportion of participants classified as subjectively hearing-impaired according to APHAB already had a hearing aid.

CONCLUSIONS

Cancer patients with hearing loss are very restricted in their understanding of given information and hearing aid use cannot completely compensate for this. Consequently, communication guidelines should be considered and specific educational tools need to be developed for these groups.

Impact of Hearing Loss on Geriatric Assessment

Background

Due to the aging society, the incidence of age-related hearing loss (ARHL) is strongly increasing. Hearing loss has a high impact on various aspects of life and may lead to social isolation, depression, loss of gain control, frailty and even mental decline. Comorbidity of cognitive and sensory impairment is not rare. This might have an impact on diagnostics and treatment in the geriatric setting.

Objective

The aim of the study was to evaluate the impact of hearing impairment on geriatric assessment and cognitive testing routinely done in geriatrics.

Material and Methods

This review is based on publications retrieved by a selective search in Medline, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews from 1960 until August 2020.

Results

Awareness of sensory impairment is low among patients and health professionals working with elderly people. The evaluation of the hearing status is not always part of the geriatric assessment and not yet routinely done in psychiatric settings. However, neurocognitive testing as an important part can be strongly influenced by auditory deprivation. Misunderstanding of verbal instructions, cognitive changes, and delayed central processes may lead to a false diagnosis in up to 16% of subjects with hearing loss. To minimize this bias, several neurocognitive assessments were transformed into non-auditory versions recently, eg the most commonly used Hearing-Impaired Montreal Cognitive Assessment (HI-MoCA). However, most of them still lack normative data for elderly people with hearing loss.

Conclusion

Hearing loss should be taken into consideration when performing geriatric assessment and cognitive testing in elderly subjects. Test batteries suitable for ARLH should be applied.

Pilotstudie zum Hörscreening mit dem Mini-Audio-Test (MAT)

Hintergrund Es gibt Hinweise, dass eine unbehandelte Schwerhörigkeit in der 2. Lebenshälfte das Risiko, an einer Demenz oder Depression zu erkranken, einen kognitiven Leistungsverlust zu erleiden, zu stürzen oder allgemein hilfsbedürftig zu werden, erhöht. Ein Großteil der Betroffenen ist nicht adäquat, z. B. mit Hörgeräten, behandelt. Der Mini-Audio-Test (MAT) ist ein evaluierter Fragebogen, der eine bisher nicht bekannte Schwerhörigkeit aufdecken kann. Mit dieser Studie sollte die Einsatzfähigkeit des MAT in einer repräsentativen Stichprobe der erwachsenen Bevölkerung getestet werden.

Methoden Im Frühjahr 2019 wurden insgesamt 123 Personen im Rahmen einer repräsentativen Befragung u. a. zu ihrem Hörvermögen mittels MAT befragt. Probanden mit auffälligem MAT wurde empfohlen, sich bei einem HNO-Arzt untersuchen zu lassen. Die zugehörigen Daten wurden anonymisiert zentral erfasst und deskriptiv statistisch ausgewertet.

Ergebnisse Insgesamt waren 79 der angesprochenen Probanden im Alter von 28 bis 93 Jahren bereit, an der Befragung teilzunehmen. Von diesen haben 63 den MAT ausgefüllt, 22 davon waren bereit, sich HNO-ärztlich untersuchen zu lassen; dieses ist nur in einem Fall tatsächlich geschehen.

Diskussion Ein unspezifischer Einsatz des MAT zum Screening auf Schwerhörigkeit erscheint zum jetzigen Zeitpunkt wenig Erfolg versprechend. Sinnvoller erscheint der strukturierte Einsatz, z. B. im Rahmen eines regulären Arztbesuchs ab dem 50. Lebensjahr. Ferner sollte die Bevölkerung grundsätzlich besser über die Risiken einer unbehandelten Schwerhörigkeit aufgeklärt werden.

The prevalence of hearing loss and use of hearing aids among adults in Germany: a systematic review

BACKGROUND

Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a systematic review.

METHODS

A systematic literature search was carried out in electronic databases as well as by means of hand-searching. Studies published after 1975 and indicating the prevalence or incidence of hearing impairment among German adults were included. Study selection, data extraction and additional quality assessments were made by two independent reviewers.

RESULTS

By means of a systematic literature search it was possible to identify 6 sources, which provided solely cross-sectional data, whereby the reported data are based on a study population of between some hundred and 10 million people living in Germany. The prevalences ascertained showed a broad range of between 16% and 25% and varied according to age, study setting, definition of hearing loss and method of data capture. At present there are no utilizable data on the extent of the use of hearing aids.

DISCUSSION

The present review demonstrates clearly that evidence-based information relating to Germany can only be made on the basis of a clear definition of hearing loss within the framework of an up-to-date and representative epidemiological study carried out with appropriate methodology. In view of the high prevalence of illnesses causing hearing impairment and of the risks to health associated with untreated hearing impairment as well as of socio-economic costs, such an epidemiological study is of great social significance.

Sensitivity and specificity of the abbreviated profile of hearing aid benefit (APHAB)

Subjective hearing loss in hearing-impaired patients can be assessed by inventory questionnaires. The abbreviated profile of hearing aid benefit (APHAB) measures subjective hearing loss in four typical hearing situations (subscales). It is used to fit hearing aids in patients with statutory insurance in Germany. In addition, the unaided APHAB (APHAB_u) can be used as a primary diagnostic instrument in audiology. There are no published data regarding the sensitivity and specificity of the unaided APHAB_u. Therefore, we investigated these parameters for detecting hearing loss of at least 25 dB at any frequency between 0.5 and 8.0 kHz. We used the APHAB_u to determine hearing loss in 245 subjects aged 50 years and older without any reported disease of the ears. Due to incomplete answering of the APHAB form, 55 subjects have been excluded. We also measured the pure-tone thresholds by air conduction for all octave frequencies between 0.5 and 8 kHz. Receiver operating characteristic (ROC) curves and the Youden Index were used to determine the diagnostic value of the APHAB_u, particularly sensitivity and specificity, in three different ways: (1) separately for ease of communication (EC_u), background noise (BN_u), and hearing with reverberation (RV_u) subscales; (2) with the mean value of EC_u, BN_u, and RV_u; and (3) with a logistic regression model. The area under the ROC curve was lower for BN only (0.83) and nearly equal for all other methods (0.87–0.89). Depending on how we performed the analyses, the sensitivity of the APHAB_u was 0.70–0.84 (single subscales), 0.76 (mean value of EC_u, BN_u, and RV_u), or 0.85 (logistic regression model). The specificity was 0.79–0.95. The use of single APHAB_u subscales for determining the sensitivity and specificity of the APHAB_u due to confusing results. In comparison, the use of the mean value of EC_u, BN_u, and RV_u and the use of the logistic regression model due to equal values in the ROC curves but a higher sensitivity in the logistic regression model. Therefore, we would recommend the last method for determining the sensitivity and specificity of the APHAB_u.

Associations between the probabilities of frequency-specific hearing loss and unaided APHAB scores

The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire reports subjective hearing impairments in four typical conditions. We investigated the association between the frequency-specific probability of hearing loss and scores from the unaided APHAB (APHAB_u) to determine whether the APHAB_u could be useful in primary diagnoses of hearing loss, in addition to pure tone and speech audiometry. This retrospective study included database records from 6558 patients (average age 69.0 years). We employed a multivariate generalised linear mixed model to analyse the probabilities of hearing losses (severity range 20–75 dB, evaluated in 5-dB steps), measured at different frequencies (0.5, 1.0, 2.0, 4.0, and 8.0 kHz), for nearly all combinations of APHAB_u subscale scores (subscale scores from 20 to 80%, evaluated in steps of 5%). We calculated the probability of hearing loss for 28,561 different combinations of APHAB_u subscale scores (results available online). In general, the probability of hearing loss was positively associated with the combined APHAB_u score (i.e. increasing probability with increasing scores). However, this association was negative at one frequency (8 kHz). The highest probabilities were for a hearing loss of 45 dB at test frequency 2.0 kHz, but with a wide spreading. We showed that the APHAB_u subscale scores were associated with the probability of hearing loss measured with audiometry. This information could enrich the expert’s evaluation of the subject’s hearing loss, and it might help resolve suspicious cases of aggravation. The 0.5 and 8.0 kHz frequencies influenced hearing loss less than the frequencies in-between, and 2.0 kHz was most influential on intermediate degree hearing loss (around 45 dB), which corresponded to the frequency-dependence of speech intelligibility measured with speech audiometry.