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Objectives: The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no)., Design: We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider., Results: All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups., Conclusions: The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening., Competing Interests: Dr. Francis reports serving on the Surgical Advisory Boards for Advanced Bionics and Med-El. No other author reports a conflict of interest outside of funding for the study., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Acoustic reflex (AR) threshold and growth were measured in one ear for each of 20 normal-hearing individuals as pressure in the ear canal was varied between +/- 120 mm of H2O. These same parameters were studied in 10 of the subjects after disruption of the probe seal. Activating stimuli for AR threshold measures were 500, 1000, 2000, and 4000 Hz tones and broadband noise. The AR growth function was generated by a 500 Hz tone. As ear canal pressure was increased or decreased relative to the point of maximal compliance, systematic increases in AR threshold were observed for all activating stimuli. These mean pressure effects were relatively small (4 to 8 dB) and were essentially independent of stimulus composition. The ear canal pressure variations had no effect on the relative difference between tone and broadband noise AR thresholds. Absence of an airtight seal had a negligible effect on AR threshold. Growth of the AR was significantly altered by application of a relatively mild positive or negative canal pressure. Absence of a probe seal which had no effect on AR threshold was found to significantly reduce magnitude of the AR. These findings indicate that caution should be exercised during the measurement of AR growth to ensure both proper maintenance of desired canal pressure and canal-probe coupling.