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Make the Diagnosis: Hearing Impairment

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Prior Probability of Hearing Impairment

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Presbycusis, sensorineural hearing loss related to aging, is the most common cause of hearing loss in the United States, affecting 25%-40% of adults aged 65 years or older.1, 2, 3, 4, and 5 The prevalence is 40%-66% for adults older than 75 years and more than 80% for patients older than 85 years.6, 7, and 8

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Population in Whom Hearing Impairment Should Be Considered

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Hearing loss is categorized as conductive, sensorineural, or mixed (ie, patients have features of both types). Conductive hearing loss is caused by sound waves that fail to reach the inner ear. Common causes include cerumen impaction, perforated tympanic membrane, and otitis media. Sensorineural hearing loss follows from damage to the inner ear structures that can be genetic or acquired. Prolonged noise exposure or ototoxic substances (eg, aminoglycosides), inner ear infections, or systemic diseases that affect the inner ear can create sensorineural hearing loss. Because of presbycusis, sensorineural hearing loss should be considered in all older adults.

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Assessing the Likelihood of Hearing Impairment

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When patients report hearing loss, the self-administered Hearing Handicap Inventory for the Elderly (Screening Version, HHIE-S) can be used before a visit (see Box 73-1). A patient's “yes” response to the simple question of whether they have hearing loss is an efficient screening question.

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Box 73-1Hearing Handicap Inventory for the Elderly (Screening Version)9

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