Referring patients for treatment of hearing loss

Ask your patients one simple question and you may change their lives forever:
“How is your hearing?”

• Studies show that 10 percent of Americans suffer hearing loss – with a new majority being Baby Boomers. It is the most prevalent and undiagnosed disorder in the 50+ age group.
• Only 25 percent of people seek treatment on their own, and only 13 percent of physicians routinely screen for hearing loss.
• While it takes just minutes to determine if your patient needs a hearing test, treatment can mean the difference between depression and vitality.
• By advocating for diagnosis and treatment of hearing loss, you enhance your patient’s trust in you as a total health care provider.
• Our Doctors of Audiology can assist you in treating hearing loss through a variety of means, including hearing aids, other assistive listening devices and education, including information about the ototoxic effects of cancer-fighting drugs. A quality audiology practice is the difference between just supplying a hearing aid and providing the best hearing possible.

Identifying hearing loss and referring patients for a hearing test

• Because one out of three older adults has hearing loss, a full audiological evaluation should be included as part of a testing panel at age 50. However, a hearing evaluation is recommended any time a patient or family member describes communication difficulty.
• Family members may complain that the patient “doesn’t pay attention” or “has selective hearing.” Patients may complain that “others mumble,” or say “I can hear fine if I’m looking at someone,” or “I can’t hear in crowded or noisy situations.”
• If your patient needs to be evaluated for hearing loss, our Doctors of Audiology provide:
  • Complete hearing evaluations accompanied by extensive patient and family guidance. We treat hearing loss as a family issue.
  • Rehabilitation strategies such as hearing aids, assistive listening devices, and or home appliance warning systems.
  • Understanding of auditory medical issues and the prescriptive aspect of fitting hearing aids properly.
  • A 95 percent success rate with hearing instruments for patients.

What tests to ask for

1. Full audiological or hearing evaluation: This will include hearing tests that define the degree of loss, determine the clarity remaining in the auditory system, and rule out medical issues. This kind of referral allows the audiologist to choose additional tests as warranted by the results (for example, tympanometry).

2. Baseline audiogram: A test similar to a full hearing evaluation that defines a starting hearing level. Generally used for industrial purposes, or for patients who may be going on a regimen of ototoxic drugs.

3. Full audiological (or hearing evaluation) with tympanometry: This is requested when you suspect there may be a medical (or conductive) issue in the ear that might be treatable.

How does hearing loss affect people?

• They can feel embarrassed, fatigued, irritable, tense, stressed, angry, or lonely;
• They feel isolated; they avoid social activities and/or withdraw from social situations altogether;
• They can be depressed or negative; they may endanger their safety; they may reject or become rejected by others;
• They are in general poor health; they are at risk for multiple ear infections, have tinnitus (ringing in the ears), and show a decline in overall psychological health.
• They lack understanding and communication skills; they show signs of a learning disability or decreased job performance.

What is your role as a physician in treating hearing loss?
Most seniors rely on their primary care doctor for hearing health care decisions. If their doctor doesn’t recommend a hearing test, many seniors simply won’t act on a hearing problem.

Can cancer drugs affect hearing?
An unwanted side effect of platinum-based chemotherapy agents (cisplatin, carboplatin) is ototoxicity and/or vestibulotoxicity. Patients should receive a full hearing evaluation before starting chemotherapy, and should be monitored throughout the treatment and then again after a few months, as effects may be delayed.

What other drugs can affect your patient’s hearing?
Loop diuretics can be ototoxic. Drugs like gentamycin or tobramycin can cause permanent damage to your patient’s hearing. This type of ototoxicity is often reversible when the patient no longer takes the drug.

Does treatment for hearing loss improve other aspects of health?
The National Institutes of Health report that patients treated for hearing impairment suffer less anxiety, depression and loneliness. Encouraging an evaluation or treatment for hearing loss can be a way to get your withdrawn patients involved with life again.
Relationships are also improved with better hearing! One of the most common early complaints of sensorineural hearing loss is “I hear, but I can’t understand,” or (from a spouse), “He hears what he wants to hear.”

What if someone reports unwanted sounds in their ears?
Tinnitus, or unwanted sound in the ears, often accompanies early sensorineural hearing loss. A patient with tinnitus should be evaluated audiologically. While generally benign, tinnitus can be a symptom of acoustic neuroma.

How common is hearing loss in Alzheimer’s patients?
A study showed that 50 percent of Alzheimer’s patients had untreated hearing loss. When treated, their level of functioning increased. Hearing loss is frequently misdiagnosed as “confusion.” A hearing test will sort this out.

Is it important to hear well in both ears?
Hearing well in both ears can mean the difference between just hearing vs. hearing and understanding. Balanced hearing helps a patient function more normally, localize sound, understand more in noisy situations, hear better with less volume, and hear equally well from both sides.

We need two ears performing equally well to determine the direction of sound. Patients with hearing loss in one ear can find it difficult to determine where sounds are coming from, which compromises their safety in traffic or other situations.

Call (207) 883-6466 or e-mail info@martylayneassociates.com.
We’re always happy to answer questions.