Detection of hearing impairment and handicap in Pagetʹs disease of bone using a simple scoring system: A case control study

Pagetʹs disease of bone is known to be associated with hearing loss but there are limited data on the prevalence of hearing impairment and handicap in people with Pagetʹs disease. Previous published population studies have used patient-completed questionnaires or review of GP records, none have included audiometry. 80 Pagetʹs subjects were selected at random from a hospital database, 75 (94%) entered the study and were matched by age and gender with 76 controls. All participants completed a screening questionnaire for hearing handicap, the HHIE-S; a questionnaire on perception of hearing-related handicap, noise exposure, hearing aids and GP consultations regarding hearing; and audiometry. The results show significant problems from hearing loss in people with Pagetʹs disease of bone. Pagetʹs patients were significantly more likely to perceive hearing handicap (P = 0.0001), 41% Pagetʹs patients rated themselves moderate–severe compared to none of the controls. Pagetʹs patients were significantly more likely to report difficulties such as hearing normal speech, watching TV or hearing over background noise (all P = 0.0001). They were more likely to consult their GP due to hearing problems (P = 0.004) or tinnitus (P = 0.0001), or use a hearing aid (P = 0.0001). Audiometry confirmed higher rates of deafness in Pagetʹs patients. 41/75 Pagetʹs patients compared to 19/76 controls had at least 40 decibels hearing loss (dBHL) (P = 0.0001). The HHIE-S proved to be an effective screening tool. A score of greater than 8 increased the odds ratio of detecting moderate hearing impairment (> 40 dBHL) in people with Pagetʹs disease by 5.1. The specificity of HHIE-S > 8 as a screening tool to select for audiometry appears good, 1/46 (2%) of Pagetʹs patients would have proved to have normal hearing thresholds. The sensitivity is better with worse hearing loss, 7/16 Pagetʹs patients with moderate loss (> 40 dBHL) and 2/25 with severe-profound loss (> 60 dBHL) would have been missed. In conclusion, 55% unselected Pagetʹs patients have at least moderate levels of hearing loss, compared to 25% of age and gender matched controls. Pagetʹs patients and controls under-reported hearing problems, many of which can be ameliorated. Screening for hearing problems in Pagetʹs disease of bone can be done using the HHIE-S.