The Results Are Not a Basis for Screening

Letters to the Editor The Prevalence of Hearing Loss and Provision With Hearing Aids in the Gutenberg Health Study by Dr. med. Julia Döge, Dr. med. Berit Hackenberg, Dr. med. Karoline O Brien, Andrea Bohnert, Prof. Dr.-Ing. Tobias Rader, Prof. Dr. med. Dipl.-Psych. Manfred E. Beutel, Prof. Dr. med. Thomas Münzel, Prof. Dr. med. Norbert Pfeiffer, Markus Nagler, Dr. rer. physiol. Irene Schmidtmann, Prof. Dr. med. Philipp S. Wild, Prof. Dr. med. Christoph Matthias, and Dr. med. Katharina Bahr in issue 7/2023

With a reported overall mean prevalence of hearing loss of 34% and a prevalence of 60% in people older than 60, general practitioners are puzzled: had most of these been overlooked by the GPs? Perhaps this discrepancy between reported data and lived experience has a different explanation: of the 8731 persons who might qualify, no otorhinolaryngologic data were collected in 40% (3614) because of a lack of staff. As someone with experience of studies I can assume that the examining staff—with the best intentions for the patients—probably tended to examine those in whom hearing loss was actually suspected. The result would be an overestimate of the prevalence.

Calling for screening would be justifiable on the basis of confirmed benefit as a result of “early provision of hearing aids” and subsequent confirmation of “clinical improvement” in patients; but for proving this randomized controlled trials are needed. Screenings without subsequent proof of benefit are ethically unacceptable (1).

Furthermore, rates of adverse effects need to be investigated. One thing is certain: the ethical mandate of “the right not to know” is breached. Communicating a “defect” to a person corresponds with a partial dismantling of the person’s integrity. At the very least it needs to be investigated in which proportion of informed patients this would be regarded as a harm.

A further point deserves a mention: 30 million German residents are 60 years or older. If of those—as the study implies—60% have hearing loss, this would equate to 18 million persons. Assuming half of those would be willing to have a hearing aid prescribed, this would translate to 8 million residents—once those already in possession of a hearing aid have been subtracted in this calculation. In view of the cost of €1500 per device, this corresponds to €12 billion, excluding the costs of the screening. And general practitioners know that most of the devices are kept on people’s bedside tables anyway.

DOI: 10.3238/arztebl.m2023.0108

Prof. em. Dr. med. Heinz-Harald Abholz

Institut für Allgemeinmedizin, IfAM, Universität Düsseldorf

References

1. Döge J, Hackenberg B, O‘Brien K, et al.: The prevalence of hearing loss and provision with hearing aids in the Gutenberg Health Study. Dtsch Arztebl Int 2023; 120: 99–106

2. Health Council of the Netherlands: Screening between hope and hype. The Hague 2008. www.healthcouncil.nl/documents/advisory-reports/2008/04/01/screening-between-hope-and-hype (last accessed on 10 May 2023).