老年人听力损失的初级保健筛查和管理：系统综述

摘要(中文译文)

年龄相关性听力损失（老年性聋）影响相当比例的老年人，在家庭医学和初级保健环境中经常遇到，然而尽管其对沟通、认知功能和生活质量存在影响，其检出和管理仍显著不足。本系统综述综合了关于在家庭医学和初级保健背景下对55岁及以上成人听力损失进行早期发现和管理的证据，重点关注耳鼻咽喉（ENT）相关结局。对PubMed、Google Scholar和Cochrane Library进行了系统检索，检索时间范围为2000年至2026年，使用的检索词涉及听力损失、老年性聋、筛查、初级保健和家庭医学。符合条件的研究包括原始研究、随机对照试验（RCT）、队列研究、横断面研究和实用性试验，报告初级保健或社区健康环境中的ENT相关结局。研究采用与设计相适应的工具进行质量评价：RCT采用Cochrane偏倚风险2（RoB 2），队列研究采用纽卡斯尔-渥太华量表，诊断准确性研究采用诊断准确性研究质量评价2（QUADAS-2），横断面调查采用横断面研究评价工具（AXIS），非随机干预研究采用非随机干预研究偏倚风险工具（ROBINS-I）。在识别的888条记录中，去重和筛选后纳入11项研究，并以叙述性方式进行综合，共涵盖六个国家的25，964名参与者。筛查工具，包括老年听力障碍筛查量表（HHIE-S）、耳语声测试、单问题筛查和基于智能手机的测听，在以纯音测听为参照进行验证时显示出中至高的诊断准确性。基于初级保健的电子筛查提醒使听力学转诊率提高约五倍。传统助听器和个人声音放大设备均改善了自我感知的听力功能，且助听器使用与急诊就诊和住院减少相关。全科医生（GP）在年龄相关性听力损失筛查方面的知识和实践表现欠佳。总体而言，证据支持使用经过验证的简短工具和电子健康记录提醒将结构化听力筛查方案整合到家庭医学中，同时通过助听器和社区为基础的放大模式进行管理是有效的；然而，解决全科医生知识差距和系统性障碍对于将证据转化为常规初级保健实践至关重要。

Abstract

Age-related hearing loss (presbycusis) affects a substantial proportion of older adults and is frequently encountered in family medicine and primary care settings, yet it remains significantly under-detected and under-managed despite its impact on communication, cognitive function, and quality of life. This systematic review synthesised evidence on the early detection and management of hearing loss in adults aged 55 years and older within family medicine and primary care contexts, with a focus on ear, nose, and throat (ENT)-related outcomes. A systematic search of PubMed, Google Scholar, and the Cochrane Library was conducted from 2000 to 2026 using terms related to hearing loss, presbycusis, screening, primary care, and family medicine. Eligible studies included original research, randomised controlled trials (RCTs), cohort studies, cross-sectional studies, and pragmatic trials, reporting ENT-related outcomes in primary care or community health settings. Studies were quality-appraised using design-appropriate tools: Cochrane Risk of Bias 2 (RoB 2) for RCTs, Newcastle-Ottawa Scale for cohort studies, Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) for diagnostic accuracy studies, Appraisal Tool for Cross-Sectional Studies (AXIS) for cross-sectional surveys, and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) for non-randomised interventional studies. Of 888 records identified, 11 studies were included after deduplication and screening and were synthesised narratively, comprising a total of 25,964 participants across six countries. Screening tools, including the Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S), whispered voice test, single-question screening, and smartphone-based audiometry, demonstrated moderate-to-high diagnostic accuracy when validated against pure-tone audiometry. Primary care-based electronic screening alerts increased audiology referral rates by approximately fivefold. Both conventional hearing aids and personal sound amplification devices improved self-perceived hearing function, and hearing aid use was associated with reduced emergency department visits and hospitalisations. General practitioners (GPs) demonstrated suboptimal knowledge and practices regarding age-related hearing loss screening. Overall, the evidence supports integrating structured hearing screening protocols into family medicine using validated brief tools and electronic health record alerts, while management through hearing aids and community-based amplification models is effective; however, addressing GP knowledge gaps and systemic barriers is essential to translate evidence into routine primary care practice.

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