Screening for handicapping hearing loss in the elderly

Of the 672 individuals who took the HHIE, the results from 126 were excluded because of known hearing loss for which hearing aids had been previously fitted. Of the remaining 546 participants, 502 completed all items, 29 had 1 to 4 missing items, and 15 individuals had 9 or more missing items. The number of responses per item of the HHIE ranged from to 527 to 546. The HHIE items probe the functional (social) and emotional difficulties experienced by people with hearing loss. The responses are scored 0 for a no response, 2 for a sometimes response, and 4 for a yes response. The score is the sum of all responses. Ten items from the HHIE are also used as the short or screening version (HHIES). We used these 10 items for this report.

The global history measure—the answer to the question, “Do you have a hearing problem now?”— was used as the subjective criterion of hearing loss.

The criterion handicapping hearing level used was recommended by Ventry and Weinstein,¹¹ namely an audiometric screening threshold level of 40 dB HL or greater at 1 and 2 kHz in one ear or at 1 or 2 kHz in both ears.

The HHIE-S scores were converted to a bivariate categorical variable by using the cutoff scores of 0 to 8 vs 10 and higher¹²; the sensitivity, specificity, and predictive values for a handicapping hearing loss were computed and compared with the same indicators for the global question. Exploratory models were developed to combine both screening measures. Statistical tests were performed with STATA 6.0 by using Spearman rank correlation for the categorical variables, the χ² test for proportions, and the t test for continuous variables.

Results

Table 1 displays the demographic aspects, hearing status, and HHIE-S scores of the 546 subjects. Forty percent indicated they had a hearing problem (global question) and 27% had the criterion level of hearing loss. As expected, more men than women had the criterion hearing loss (35% vs 22%, P=.010).

Table 2 shows the mean score for each item on the HHIE-S, in descending order, and the Spearman rank correlation coefficient of each item to the global question and to the hearing loss criterion. The mean responses to the social (functional) variables received significantly higher HHIE-S scores (3.9 ± 5.6) than the emotional variables (2.8 ± 6.4, P<.001).

The HHIE-S score was significantly related to hearing threshold level, the answer to the global question, and sex. The linear regression of average hearing level in the better ear on HHIE-S was highly significant (P<.0001), but only 15% of the variance in hearing level was accounted for by the HHIE-S score. The mean total HHIE-S score for those who said yes to the global question was significantly higher (8.65 ± 7.4) than for those who said they did not have a hearing problem (1.42 ± 2.49, P<.001). The mean total HHIE-S score was significantly higher for men (5.6 ± 7.04) than for women (3.5 ± 5.4, P<.001).

The sensitivity, specificity, likelihood ratios, predictive values, and percentage of patients referred for both screening measures to identify people with criterion hearing loss are shown in Table 3. Combining the measures was assessed in 2 ways. In the first instance, a positive screening test required that the individual who answered yes to the question and scored 10 or above on the HHIE-S (double positive) and all other cases be scored as negative. In the second instance, a negative screening test required a no answer to the question and a low HHIE-S score (double negative). Conceptually, the first combination as a positive screen required failure on both tests; in the second combination, a “pass” required passing both tests.

TABLE 1
Demographic, hearing, and HHIE characteristics of the subjects*

TABLE 2
Mean scores on HHIE ranked in decreasing order by 546 subjects and correlations of score to audiometric hearing loss and self-reports of hearing problems