Age-related sensorineural hearing loss (presbycusis) is one of the most common chronic sensory conditions affecting older adults and is associated with communication difficulties, social isolation, reduced quality of life and adverse health outcomes including cognitive decline and depressive symptoms. Screening studies and population surveys consistently show that the prevalence of hearing impairment rises steeply with age, making the geriatric population a high-priority group for case-finding and early intervention [1].

Pure-tone audiometry (PTA) performed in a sound-treated environment by trained personnel remains the reference standard for quantifying hearing thresholds and grading the degree of hearing loss, and established grading systems (including those evaluated by the World Health Organization and hearing researchers) are commonly used to classify mild, moderate and more severe losses for both clinical and public-health purposes. However, conventional PTA requires specialised equipment, personnel and facilities that limit its scalability for routine screening in many clinical and community settings [2].

Because of these practical constraints, portable and application-based screening methods (handheld audiometers, calibrated mobile apps and smartphone-based audiometry) have been investigated as pragmatic alternatives to identify older adults with clinically relevant hearing loss. Systematic reviews and meta-analyses report generally high pooled sensitivity and specificity for modern smartphone and mobile-health audiometry compared with standard PTA, while also highlighting important sources of variation in accuracy — notably participant age, calibration and headphone type, and testing environment (soundproof booth versus non-soundproof settings). These findings suggest that appropriately validated screening audiometry can be a reliable tool for early detection when used with suitable devices and protocols [3-6].

Given the growing evidence for portable screening approaches and the high burden of undetected hearing loss among older adults, there is a need for hospital-based evaluations that: (1) document the prevalence and degree of hearing loss measured by PTA in geriatric outpatients, (2) assess the diagnostic accuracy of screening audiometry in the same population, and (3) examine age-related trends in hearing thresholds. The present study aimed to address these objectives by comparing screening audiometry with standard PTA in a cohort of geriatric patients and by describing the distribution of hearing loss across age strata

This cross-sectional, observational study was conducted at an Indian tertiary care hospital. Written informed consent was taken from all participants.

Study Population: A total of 156 geriatric participants aged 60 years and above, attending the outpatient department for various non-otologic complaints, were enrolled. Individuals with a history of prolonged exposure to occupational noise, ototoxic drug use, ear surgery, chronic suppurative otitis media, or systemic conditions affecting hearing (such as uncontrolled diabetes or hypothyroidism) were excluded.

Data Collection: Detailed demographic and clinical data were recorded, including age, sex, occupational background, and history of hearing difficulties. Each participant underwent a comprehensive otologic examination to rule out external and middle ear pathology.

Audiometric Evaluation: Pure tone audiometry (PTA) was performed in a sound-treated room using a calibrated clinical audiometer adhering to ANSI standards. Air conduction thresholds were measured at frequencies of 250, 500, 1000, 2000, 4000, and 8000 Hz, and bone conduction thresholds were assessed at 500, 1000, 2000, and 4000 Hz. The average hearing threshold across 500, 1000, 2000, and 4000 Hz frequencies was used to classify hearing loss according to the World Health Organization (WHO) criteria.

Screening Audiometry: Screening audiometry was performed using a portable, handheld screening audiometer at fixed frequencies of 1000, 2000, and 4000 Hz. Participants failing to respond to tones above 25 dB HL at any frequency in either ear were considered to have failed the screening test.

Statistical Analysis: 2Data were analyzed using SPSS version 24. Descriptive statistics were applied to summarize demographic and audiometric data. The diagnostic performance of screening audiometry was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) against standard pure tone audiometry. A p-value of <0.05 was considered statistically significant.

A total of 156 geriatric participants were enrolled in the study, with the majority belonging to the 60–69-year age group, followed by those aged 70–79 years. Males constituted a higher proportion of the study population compared to females. Nearly half of the participants were retired or non-working, and hypertension was the most common comorbidity, followed by diabetes mellitus and combined hypertension with diabetes (Table 1).

Evaluation with pure tone audiometry (PTA) revealed that a considerable proportion of ears demonstrated varying degrees of sensorineural hearing loss, ranging from mild to severe categories according to the WHO classification. Normal hearing thresholds were observed in less than half of the tested ears (Table 2).

When screening audiometry findings were compared with PTA results, a high level of diagnostic agreement was observed. Screening audiometry demonstrated a sensitivity of 91.6%, specificity of 88.5%, positive predictive value of 92.6%, and negative predictive value of 87.1%, indicating its reliability in detecting early hearing impairment among the elderly (Table 3).

Analysis of age-related trends showed a progressive increase in mean hearing threshold levels with advancing age. Participants aged 80 years and above exhibited the highest mean hearing thresholds, and this correlation between age and hearing loss was statistically significant (p < 0.01) (Table 4)..

Table 1. Baseline Characteristics of the Study Participants (n = 156)

Table 2. Distribution of Hearing Thresholds on Pure Tone Audiometry (PTA)

Table 3. Screening Audiometry Results in Comparison with Pure Tone Audiometry (PTA)

Sensitivity = 91.6%; Specificity = 88.5%; PPV = 92.6%; NPV = 87.1%

Table 4. Correlation between Age and Degree of Hearing Loss

This hospital-based study demonstrates a high burden of age-related sensorineural hearing loss among geriatric outpatients and shows that screening audiometry has strong diagnostic performance when compared with conventional pure tone audiometry (PTA). In our cohort, a majority of ears exhibited some degree of hearing impairment and mean thresholds rose significantly with advancing age, findings that are consistent with contemporary descriptions of presbycusis as a progressive, age-dependent decline in auditory sensitivity that preferentially affects higher frequencies [7].

The diagnostic accuracy of screening audiometry observed here — sensitivity 91.6% and specificity 88.5% — aligns with pooled estimates and individual validation studies of portable and application-based screening tools. Recent systematic and comparative evaluations report high pooled sensitivity (commonly ~80–95%) and variable specificity depending on device, testing protocol and ambient noise control, supporting the role of validated portable methods for case-finding in older adults where full audiometry is not immediately available [8,9].

Several recent primary studies corroborate these findings. Comparative investigations of smartphone- and tablet-based audiometry against clinical PTA have documented strong correlations and high detection rates for clinically meaningful hearing loss when devices are calibrated and testing conditions controlled; some series have reported sensitivities approaching or exceeding 90% and specificities in the 80–95% range, comparable to the performance we observed. These results reinforce that appropriately implemented screening audiometry can reliably identify individuals who require formal diagnostic evaluation and possible intervention [10,11].

From a public-health and clinical workflow perspective, routine incorporation of screening audiometry in geriatric clinics or primary care can expedite referral of affected individuals to audiology services and auditory rehabilitation pathways. Qualitative and implementation studies describe improved case detection and increased referral rates after integration of simple hearing-screen protocols into routine practice, although they also emphasize that staff training, device calibration, and pathways for confirmatory testing are critical to realize benefits [12].

Nevertheless, accuracy and utility of screening depend on important contextual factors. Device type (handheld versus app-based), headphone quality, calibration, operator training and the testing environment (sound-treated booth versus quiet clinic room) all influence sensitivity and specificity; several reports highlight that variability in these factors accounts for much of the heterogeneity in published performance estimates. Thus, local validation and quality-control procedures are recommended before widespread deployment [13].

Our age-stratified analysis showed a clear stepwise increase in mean thresholds across older age groups, mirroring epidemiologic studies that document steep increases in prevalence and severity of hearing loss with advancing age. This pattern supports targeted screening of older strata (for example, ≥70 years) where yield is highest, while not excluding younger elderly who may benefit from earlier detection. Early identification is clinically important because hearing rehabilitation (hearing aids, communication strategies) mitigates adverse outcomes associated with untreated hearing loss, including social isolation and cognitive decline [14].

Strengths of our study include a reasonably large sample of geriatric outpatients and direct comparison of screening results to gold-standard PTA in the same individuals. Limitations include the single-centre design and the use of a clinic-based sample that may over-represent symptomatic or comorbid individuals relative to community populations; ambient testing conditions in non-soundproof settings could also affect measured specificity, and we did not assess long-term outcomes after referral or intervention. Future research should evaluate implementation strategies (task-shifting, community screening, tele-audiology) and cost-effectiveness of screening programs in low- and middle-income settings.

The present study demonstrates that age-related sensorineural hearing loss is a common and progressive condition among geriatric individuals, with increasing prevalence and severity observed with advancing age. Screening audiometry showed high sensitivity and specificity in identifying early hearing deficits when compared to standard pure tone audiometry, making it a reliable and convenient tool for large-scale community and outpatient screening. Routine use of portable screening audiometry in elderly populations can facilitate early diagnosis, timely intervention, and improved quality of life through prompt rehabilitative measures such as hearing aids and auditory counseling.

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