By Daniel Fink, M.D.
The U.S. Preventive Services Task Force (USPSTF) is an expert panel within the Agency for Healthcare Research and Quality that makes recommendations about clinical preventive services.
Screening for disease is a time-honored medical and public health practice, in order to detect disease in its early stage when it is often most successfully treated, rather than allowing the disease to progress to a point where it can cause more serious problems or even death. Common screenings are mammograms and colonoscopies, and testing for high blood pressure (hypertension) and diabetes.
As screening programs for noninfectious diseases and conditions proliferated in the 1970s and 1980s, it became clear that too many tests were being done on too many patients to find too little disease. There are costs associated with the tests, and if doctors screen for rare diseases, the rate of false positives increases. This can lead to unnecessary treatment or to a “diagnostic cascade” of additional tests, some of them invasive. Also, psychological harm may occur as the patient worries about their diagnosis.
The USPSTF was created in 1984 to assess the evidence and recommend which screening tests are actually beneficial. Recommendations are based solely on published medical literature, not cost. Since 2013, federal and private insurance programs are required to pay for recommended screening procedures and tests meeting the highest USPSTF criteria.
The USPSTF recently considered whether the federal government should recommend screening for hearing loss in adults (which I wrote about here). In many ways, hearing loss is similar to hypertension. It doesn’t cause any pain and people often don’t know they have it, but neither condition is benign. In younger adults hearing loss is associated with lower educational and economic attainment. In older adults it is associated with social isolation, depression, dementia, and falls.
Hearing loss is common, affecting 20 percent of American adults ages 20 to 69, rising with age so that half of those over 65 and 80 percent of those over age 80 have hearing loss. Screening for hearing loss with pure-tone audiometry is relatively inexpensive and very accurate.
USPSTF posted its draft recommendation about screening for hearing loss in adults in late 2020, recommending against screening. I do not expect this to change when the final recommendation is issued. With the draft, the USPSTF let the public know that it didn't find sufficient evidence showing that screening for hearing loss in adults (and subsequently treating it with hearing aids) has any proven benefit. It's unlikely that anyone submitted enough scientific evidence during the public comment period to convince the USPSTF to change its recommendation.
The only treatment available for hearing loss is amplification. There is an unfortunate stigma associated with wearing hearing aids, they are costly and rarely covered by insurance, and many who have managed to get hearing aids don’t wear them. If ongoing research continues to show that using hearing aids reduces or prevents dementia, people may be more willing to wear them, insurance companies more willing to pay for them, and the USPSTF more likely to recommend adult hearing tests.
But until then, all we can do is recommend that people protect their hearing and wait for more definitive research results.
Daniel Fink, M.D., is the founding chair of the Quiet Coalition, the interim chair of Quiet Communities' Health Advisory Council, and a former board member of the American Tinnitus Association. He serves as an expert consultant to the World Health Organization on its Make Listening Safe Program, and as a subject matter expert on noise and the public to the National Center for Environmental Health at the U.S. Centers for Disease Control and Prevention.
