An outreach hearing program identified hearing loss in 44% of patients with intellectual disability, including previously undiagnosed hearing loss in 70% of those with confirmed hearing loss, but untreated or undertreated hearing loss declined only modestly over 1 year, from 41% to 38%.
Investigators evaluated 1,053 patients with intellectual disability who participated in the prospective, age-stratified HörGeist study in Germany. Patients ranged in age from 1 to 90 years, and screening was conducted in everyday settings, including nurseries, schools, workplaces, and residential facilities. When screening indicated possible hearing loss, patients received diagnostic testing and, when indicated, treatment or referrals. The screening, diagnostic, monitoring, and intervention protocol was repeated after 1 year.
The primary outcome was the change from baseline to 1 year in the number of patients with untreated or undertreated hearing loss, assessed overall and by age group. Secondary outcomes included hearing aid prescriptions, ear surgery, duration of hearing aid use, and the feasibility of delivering screening, diagnosis, treatment initiation, and monitoring in patients’ everyday environments.
At study entry, hearing loss was known in 14% of patients, and 9% had previously received hearing aids; fewer than half of those patients were using them. Across the study period, hearing loss was diagnosed in 463 of 1,053 patients, or 44%. Of patients with confirmed hearing loss, 323, or 70%, had previously undiagnosed hearing loss.
Treatment uptake remained limited following detection. Overall, 27% of patients received treatment prescriptions or referrals, but among the most readily traceable prescribed interventions, recommendations were followed in only 37% of cases. Among 165 patients who had been prescribed hearing aids prior to the 1-year assessment and were eligible for follow-up, 49, or 30%, obtained them, whereas 115 did not.
The primary outcome reflected the persistent treatment gap. Researchers classified 429 patients as having untreated or undertreated hearing loss at baseline and 399 at 1 year. High-quality hearing care—defined in part by whether hearing aids provided adequate speech audibility and were worn for a sufficient duration each day—was documented in 6 patients at baseline and 12 at follow-up.
Hearing aid use also varied among patients who received devices. Among 79 patients with hearing aid prescriptions and available daily-use data at follow-up, most either did not use their devices or wore them for less than the 8 to 10 hours per day specified by the researchers for adequate habituation. Among the 36 patients with sustained hearing aid use, mean daily use was approximately 11 hours.
Patterns of hearing aid use differed by age group. Younger patients tended to wear hearing aids longer at home, school-aged patients slightly longer at school, and adults longer in private settings than in institutional settings. The researchers also reported that greater hearing loss severity was associated with a higher likelihood of hearing aid use, particularly among adults.
Decisions by caregivers and patients were among the most frequently reported reasons for not obtaining prescribed hearing aids, accounting for 30% and 31% of cases, respectively. Failure to initiate appointment scheduling accounted for another 16%. Other reported barriers included doubts about the need for treatment, uncertainty or fear concerning hearing technology, and limitations in caregiver time and staffing.
The planned clinic-based comparison could not be completed. Researchers invited 141 patients with intellectual disability to undergo identical procedures in a clinical setting; 12 presented for screening, but none consented to study participation. Consequently, the study could not directly compare outcomes between the outreach and clinic-based approaches.
The investigators noted several limitations. Some conditions prompting treatment recommendations, including obstructive cerumen, reduced middle-ear pressure, and effusion, could have resolved spontaneously, meaning that nonimplementation of a recommendation did not necessarily indicate inadequate care. Hearing aid prescriptions based on a single diagnostic assessment could also subsequently prove unnecessary, and treatment information was unavailable for some patients. These factors may have slightly overestimated the number of interventions required and underestimated the number actually undertaken.
The coordinated outreach program was feasible for detecting hearing loss among patients with intellectual disability, while substantial gaps remained between detection and implementation of recommended care. The investigators emphasized education and structured auditory rehabilitation and communication training as components of sustainable implementation. “Sustainable implementation requires two core elements,” including “broad education of professionals, caregivers, families, and the wider community to raise awareness of hearing problems and the importance of ear and hearing care,” wrote lead study author Katrin Neumann, of the Department of Phoniatrics and Pediatric Audiology at University Hospital Münster, and colleagues.
Disclosures: The authors declared no competing interests.
Source: PLOS Global Public Health
