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Draft Research Plan

Draft Research Plan for Hearing Loss in Older Adults: Screening

This opportunity for public comment expires on December 12, 2018 at 8:00 PM EST

Note: This is a Draft Research Plan. This draft is distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF. The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Draft: Proposed Analytic Framework

This figure depicts the proposed key questions (KQs) within the context of the eligible populations, screenings/interventions, comparisons, outcomes, timing, and settings. On the left, the population of interest is specified as asymptomatic adults age 50 years or older. Moving from left to right, the figure illustrates the overarching question: Does screening for hearing loss improve health outcomes (i.e., improve quality of life and function or reduce depression and cognitive impairment) in asymptomatic older adults (KQ1)? The figure depicts the pathway from screening to detection of hearing loss to illustrate the second KQ: What is the accuracy of primary care–relevant screening tests, compared with diagnostic pure-tone audiometry testing, as a reference standard for identifying previously undiagnosed hearing loss in adults age 50 years or older (KQ2)? Screening for hearing loss may result in harms, which is addressed by KQ3. The figure also illustrates the fourth KQ: What are the benefits of interventions on health outcomes in asymptomatic, screen-detected older adults with hearing loss (KQ4)? Health outcomes of interest include quality of life, function, depression, and cognitive impairment. Finally, treatment may also result in harms, which is addressed by KQ5.

Draft: Proposed Key Questions to Be Systematically Reviewed

1. a. Does screening for hearing loss in asymptomatic adults age 50 years or older improve health outcomes?
    b. Does the effectiveness of screening for hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
2. What is the accuracy of primary care–relevant screening tests for hearing loss in adults age 50 years or older?
3. a. What are the harms of screening for hearing loss in adults age 50 years or older?
    b. Do the harms of screening for hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
4. a. How efficacious are interventions for screen-detected hearing loss in improving health outcomes in adults age 50 years or older?
    b. Does the efficacy of interventions for screen-detected hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?
5. a. What are the harms of interventions for screen-detected hearing loss in adults age 50 years or older?
    b. Do the harms of interventions for screen-detected hearing loss differ for subpopulations defined by age, sex, race/ethnicity, risk of past noise exposure, or comorbid condition?

Draft: Proposed Contextual Questions

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. Does adherence to hearing aid use improve health outcomes in adults with screen-detected hearing loss who are prescribed hearing aids?
  2. Do interventions to improve hearing aid adherence improve health outcomes?
  3. In adults who are prescribed hearing aids, what are the potential barriers to obtaining hearing aids and reasons for low uptake?

Draft: Proposed Research Approach

The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

Category Included Excluded
Population KQs 1–3: Adults age ≥50 years without diagnosed hearing loss, including those with comorbid depression, mild cognitive dysfunction, or diabetes

KQs 4, 5: Adults diagnosed with screen-detected (or recently detected) sensorineural hearing loss or presbycusis

KQs 1–3: Adults age <50 years with previously diagnosed hearing loss; adults who currently use a hearing aid (within the past 6 months)

KQs 4, 5: Adults with conductive hearing loss, congenital hearing loss, sudden hearing loss, or hearing loss caused by recent noise

Screening tests KQs 1–3: Screening tests that are used, available, or feasible for use in primary care settings, including the whispered voice test, finger rub test, watch tick test, single-question screening regarding perceived hearing loss, hearing loss questionnaire, and screening audiometry (e.g., via handheld device) KQs 1–3: Screening tests that are not used or available in primary care settings; Rinne and Weber tests (i.e., tests used to distinguish between sensorineural and conductive hearing loss)
Interventions KQs 4, 5: Amplification with hearing aids or assistive listening devices, with or without additional education or counseling KQs 4, 5: Nutritional pharmaceuticals, hearing rehabilitation, and cochlear implants
Outcomes KQs 1, 4: Hearing-related quality of life and/or function (e.g., as measured by the Hearing Handicap Inventory for the Elderly), general health-related quality of life and/or function (e.g., as measured by the 36-Item Short-Form Health Survey), cognitive impairment, and depression

KQ 2: Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and diagnostic odds ratio

KQs 3, 5: False-positive results, labeling, anxiety, and any other significant harms
KQs 1, 4: Outcomes related to hearing aid performance and efficacy (e.g., speech intelligibility and quality of the listening experience)
Comparators KQs 1, 3: Screened vs. nonscreened groups

KQ 2: Eligible screening tests vs. diagnostic pure-tone audiometry testing

KQs 4, 5: Amplification vs. no intervention, wait-list control, or placebo amplification device
All KQs: No comparison

KQs 4, 5: Studies comparing two different amplification devices

Settings All KQs: Studies performed in settings generalizable to primary care, including nursing home settings

KQs 2, 4, 5: Studies performed in specialty clinics

Studies performed in occupational health settings
Countries Studies conducted in countries categorized as “Very High” on the 2016 Human Development Index (as defined by the United Nations Development Programme) Studies conducted in countries not categorized as “Very High” on the 2016 Human Development Index
Study designs KQs 1, 4: Randomized, controlled trials and controlled cohort studies

KQ 2: Cross-sectional or cohort studies

KQs 3, 5: Randomized, controlled trials; controlled cohort studies; and case-control studies
All other study designs*
Language Full text published in English Languages other than English
Study quality Fair or good quality Poor quality (according to design-specific USPSTF criteria)

* Systematic reviews will be excluded from the evidence review. However, separate searches will be conducted to identify relevant systematic reviews, and the citations of all studies included in those systematic reviews will be reviewed to ensure that database searches capture all relevant primary studies.

Current as of: November 2018

Internet Citation: Draft Research Plan: Hearing Loss in Older Adults: Screening. U.S. Preventive Services Task Force. November 2018.
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-research-plan/hearing-loss-in-older-adults-screening1

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