title: Long-term effectiveness of screening for hearing loss: the screening for auditory impairment--which hearing assessment test (SAI-WHAT) randomized trial.
abstract: OBJECTIVE
  To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans.
  
  
  METHODS
  Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care.
  
  
  METHODS
  Veterans Affairs Puget Sound Health Care System.
  
  
  METHODS
  The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools.
  
  
  METHODS
  Hearing aid use 1 year after screening.
  
  
  RESULTS
  Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability.
  
  
  CONCLUSIONS
  In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA. byueh@umn.edu
authors.forename: Bevan
authors.initials: B
authors.lastname: Yueh
authors.forename: Margaret P
authors.initials: MP
authors.lastname: Collins
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Souza
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Carl F
authors.initials: CF
authors.lastname: Loovis
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.forename: Susan C
authors.initials: SC
authors.lastname: Hedrick
mesh_terms: D005260:Female; D006310:Hearing Aids / Q000706:statistics & numerical data; D034381:Hearing Loss / Q000517:prevention & control*; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D038781:Otoscopy; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014728:Veterans; D014861:Washington