Abstract：
OBJECTIVE: Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition.
OBJECTIVE: The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.
UNASSIGNED: The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.
OBJECTIVE: The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.
UNASSIGNED: The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.
摘要：
目的：年龄相关性听力损失（ARHL）在50岁及以上的人群中是一种普遍但往往未得到充分诊断和治疗的疾病。它与各种社会人口统计学因素和健康风险有关，包括痴呆症，抑郁症,心血管疾病,和瀑布。虽然ARHL的原因及其下游影响是明确的，缺乏临床医生的优先考虑以及有关识别的指导，教育,和管理这种情况。
目的：本临床实践指南的目的是确定质量改进的机会，并为临床医生提供值得信赖的服务。关于ARHL识别和管理的循证建议。这些机会是通过明确的可操作的陈述传达的，并在文献中解释了支持，对证据质量的评估，和执行建议。该指南的目标患者是50岁及以上的任何个体。目标受众是所有护理环境中的所有临床医生。本指南旨在关注指南开发小组（GDG）认为最重要的基于证据的质量改进机会。它不是一个全面的，关于ARHL管理的一般指南。本指南中的陈述并不旨在限制或限制临床医生根据他们的经验和对个别患者的评估提供的护理。
■GDG对以下关键行动声明（KAS）提出了强有力的建议：（KAS4）如果筛查表明听力损失，临床医生应获取或转介能够获取听力图的临床医生.(KAS8)临床医生应该提供，或者是指可以提供的临床医生，对ARHL患者进行适当的扩增。（KAS9）当患者具有适当的适应性放大和持续的听力困难且言语理解不良时，临床医生应推荐患者进行人工耳蜗植入候选资格的评估。GDG对以下KAS提出了建议：（KAS1）临床医生应在医疗保健时对50岁及以上的患者进行听力损失筛查。（KAS2）如果筛查提示听力损失，临床医生应通过耳镜检查耳道和鼓膜，或咨询可以检查耳部是否有耳垢嵌塞的临床医生，感染,或其他异常。（KAS3）如果筛查提示听力损失，临床医师应明确影响听力保健获取和利用的社会人口统计学因素和患者偏好.（KAS5）临床医生应评估和治疗或参考能够评估和治疗严重不对称听力损失患者的临床医生，传导性或混合性听力损失，或者在诊断测试中单词识别不佳。(KAS6)临床医生应就听力损失对沟通的影响对听力损失患者及其家人/护理伙伴进行教育和咨询。安全,函数,认知，和生活质量。临床医生应就沟通策略和辅助听力设备向听力损失患者提供咨询。（KAS10）对于听力损失的患者，临床医师应评估沟通目标是否得到满足,以及在随后的医疗护理中或1年内听力相关生活质量是否得到改善.GDG提供了以下KAS作为一种选择：（KAS11）临床医生应至少每3年评估已知听力损失或报告关注听力变化的患者的听力。
目的：本临床实践指南的目的是确定质量改进的机会，并为临床医生提供值得信赖的服务。关于ARHL识别和管理的循证建议。这些机会是通过明确的可操作的陈述传达的，并在文献中解释了支持，对证据质量的评估，和执行建议。该指南的目标患者是50岁及以上的任何个体。目标受众是所有护理环境中的所有临床医生。本指南旨在关注指南开发小组（GDG）认为最重要的基于证据的质量改进机会。它不是一个全面的，关于ARHL管理的一般指南。本指南中的陈述并不旨在限制或限制临床医生根据他们的经验和对个别患者的评估提供的护理。
■GDG对以下关键行动声明（KAS）提出了强有力的建议：（KAS4）如果筛查表明听力损失，临床医生应获取或转介能够获取听力图的临床医生.(KAS8)临床医生应该提供，或者是指可以提供的临床医生，对ARHL患者进行适当的扩增。（KAS9）当患者具有适当的适应性放大和持续的听力困难且言语理解不良时，临床医生应推荐患者进行人工耳蜗植入候选资格的评估。GDG对以下KAS提出了建议：（KAS1）临床医生应在医疗保健时对50岁及以上的患者进行听力损失筛查。（KAS2）如果筛查提示听力损失，临床医生应通过耳镜检查耳道和鼓膜，或咨询可以检查耳部是否有耳垢嵌塞的临床医生，感染,或其他异常。（KAS3）如果筛查提示听力损失，临床医师应明确影响听力保健获取和利用的社会人口统计学因素和患者偏好.（KAS5）临床医生应评估和治疗或参考能够评估和治疗严重不对称听力损失患者的临床医生，传导性或混合性听力损失，或者在诊断测试中单词识别不佳。(KAS6)临床医生应就听力损失对沟通的影响对听力损失患者及其家人/护理伙伴进行教育和咨询。安全,函数,认知，和生活质量。临床医生应就沟通策略和辅助听力设备向听力损失患者提供咨询。（KAS10）对于听力损失的患者，临床医师应评估沟通目标是否得到满足,以及在随后的医疗护理中或1年内听力相关生活质量是否得到改善.GDG提供了以下KAS作为一种选择：（KAS11）临床医生应至少每3年评估已知听力损失或报告关注听力变化的患者的听力。
