Hearing Screening Protocol for Stroke Patients

Hearing loss alone can be life-altering to many but combine it with a stroke and it can be utterly debilitating. Strokes can result in paralysis, memory issues or problems with reasoning, as well as trouble speaking, swallowing and more. It’s less commonly known that a stroke can result in hearing loss.
As the leading cause of neurological conditions as well as one of the most likely causes of disability, nearly two-thirds of those hospitalized due to a stroke will leave the facility with some sort of disability. They often have a less than optimal recovery after discharge, and their hearing loss may actually double the chances of getting dementia after resolving the vascular issues.
Strokes can be responsible for damage to all areas of the hearing passage. This includes the inner ear through to the central hearing tracts. It’s attributed to many types of hearing impairment such as cortical deafness, disordered auditory processing, and peripheral hearing loss.
There are three main categories of stroke which include:

  • Hemorrhagic stroke- this occurs when an artery in the brain or on its surface ruptures and bleeds, which kills brain cells in the surrounding area
  • Ischemic stroke- this occurs when part of the brain is starved for oxygen due to a blood clot or other matter blocking a blood vessel
  • Transient ischemic attacks (TIAs)- these are also known as mini-strokes which occur when an artery in the brain is temporarily blocked

Because strokes can affect different parts of the body, everyone has different results based on the area of the brain the stroke occurs in. When it impacts either one of the temporal lobes, located just below the temples, mild hearing loss can occur. If it affects both of the temporal lobes, complete deafness can follow, though this is a rare occurrence.
Stroke survivors can also experience other disorders that are related to hearing such as:

  • Auditory agnosia- this is an inability to identify or distinguish sounds that can occur in intense conversations, music notes, and songs
  • Auditory verbal agnosia- this ailment is characterized by an inability to comprehend speech, also known as pure word deafness
  • Auditory illusions- is the illusion of hearing sounds, an unusual or garbled sound
  • Auditory hallucinations- hearing phantom sounds that don’t actually exist

After a stroke, it’s important for doctors to perform a preliminary hearing screening, though it’s not exactly practical to launch a detailed audiological assessment on every stroke patient. If someone fails the initial screening, they can then receive the full assessment.
In a professional evaluation of three popular screening tools, researchers tested a group of stroke patients for hearing impairment. The trial included a handheld hearing screening tool that is used to determine peripheral hearing loss, a questionnaire revolving around specific auditory claims known as the Amsterdam Inventory for Auditory Disability (AIAD), and the Hearing Handicap Inventory for Elderly (HHIE) which is a sensitive tool known to specifically identify loss of hearing.
The study comprised of 42 patients who were tested between three and twelve months after their stroke, as hearing impairment is considered to be stabilized at that time. The testing began with a complete audiological assessment that identified the individuals hearing and categorized it into a profile of one of four options:

  • Normal hearing
  • Peripheral hearing loss
  • Central auditory processing disorder
  • A combination o peripheral and central hearing impairment

After completing the testing, the team calculated both the sensitivity of and the specificity of each method to evaluate the accuracy of the individual tools as to their ability to diagnose hearing impairment. The sensitivity of these screening tools is listed at 93 percent for the handheld screener, 44 percent for the HHIE questionnaire, 36 percent for the AIAD questionnaire, and 50 percent for the combined handheld and AIAD.
As many professionals do, the researchers chose a pure-tone audiogram as the gold standard in regard to the handheld hearing screener as well as information from the different hearing questionnaires. The results had 100 percent specificity for all three methods, though it dropped to 89 percent for the handheld and AIAD tests combined.
The purpose of the handheld screening tools is to determine if the possibility exists for an individual to be suffering from hearing loss, not to determine hearing limits. Covering the area of self-reporting options, the standardized questionnaires are an appealing alternative to expensive equipment as well as taking care of the problem of storage space.
An additional plus is that using these screening tools to determine someone’s hearing profile does not necessitate an audiologist to administer them. They are quick yet reliable methods of identifying which stroke patients need a more in-depth assessment. By following these protocols, patients with stroke-related hearing loss can get the additional help they may need to have optimal recovery throughout their rehabilitation.
To learn more, contact your hearing health professional.


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