When she was in her late 40s, Carolyn Meyer of Elkins Park, Pa., found that she often couldn't understand the person on the other end of a phone call.
"I kept calling the telephone company," she said, thinking that something must be wrong with her phone line.
As a last resort, she got rid of all the phones in her house and replaced them with new ones -- but it still didn't fix the problem. For more than a year, she lived with the frustration of not being able to hear her callers.
Meyer didn't know the problem was her ears, not her phone.
"I didn't know it was my fault," she said.
Meyer's experience may not be an uncommon one. Twenty to 40 percent of adults older than 50 -- and more than 80 percent of adults older than 80 -- show some evidence of hearing loss. It can negatively affect a person's quality of life and the ability to live independently.
Even so, on Monday the U.S. Preventive Services Task Force posted a final guideline for hearing-loss screening in older adults. In contrast to its 1996 guidelines, which recommended asking all older patients about hearing, the Task Force now says it can't recommend for or against it in patients not complaining of hearing loss.
"The Task Force recognizes this is important and common," Dr. Albert Siu, vice co-chairman of the Task Force, said. "We also know for people who complain of problems with their hearing, hearing aids can be beneficial. However, we don't believe there is sufficient evidence that older adults who don't have complaints should be screened."
The recommendations from the USPSTF are often used by doctors to determine what screening tests they should be conducting on certain patients. Time, costs, the balance between risks and benefits, and study findings determine whether or not screening tests are recommended.
"Guidelines are important for the purpose of deciding what is the best way to practice," said Dr. Hamid Djalilian, director of neurotology at the University of California, Irvine. "This guideline doesn't provide a recommendation one way or the other."
When it comes to screening for hearing loss, the tests are simple and can be performed in the office in just seconds. So on the surface, it may seem like a slam dunk for a recommended test.
That being said, the costs of additional testing and hearing aids, which generally aren't covered by Medicare, can be very expensive. Moreover, many hearing loss experts agree that there simply is not enough research in the area to make a solid recommendation on the tests.
Still, the impact of hearing loss on day-to-day living can be profound.
"Hearing loss may mimic dementia or depression and can lead to social isolation," said Dr. Jennifer Smullen at the Massachusetts Eye and Ear Institute.
And Dr. Frank Lin, a hearing-loss expert at Johns Hopkins Center on Aging and Health, said hearing loss could not only mimic dementia but even mild hearing loss could double the risk of dementia.
"We are increasingly recognizing that hearing loss in older adults is associated with real, detrimental consequences on poorer cognitive functioning and the risk of dementia," Lin said. "We don't know yet if treating hearing loss could have an effect on these outcomes, but hearing loss screening and treatment are interventions that carry essentially no risk."
Screening can sometimes catch these problems before they start -- but as Lise Hamlin, director of Public Policy of the Hearing Loss Association of America said, many like Meyer may not even know they have a problem with their ears.
"You don't know, can't know what you're missing," Hamlin, who is hearing impaired, said during an interview conducted over a special voice recognition phone with captioning.
As for whether the new guidelines will change anything, Smullen points out that with everything that needs to get squeezed into a primary care visit, hearing loss was often already getting overlooked even under the old guidelines.
"If the screening requirement is dropped, then even more hearing loss may be missed," Smullen said.
Because of this, some doctors said it was important for patients and their families to be particularly vigilant when it came to the signs of hearing loss.
"Family members should pay attention to their older relatives," Smullen said. If a relative is withdrawing from social situations, avoiding group outings, turning up the television or answering a different question than what was asked, there may be some hearing loss."
Djalilian agreed, adding that people often shy away from this topic, perhaps because of the stigma associated with hearing aids.
"Somehow, people who wear glasses are considered more intelligent, while those who wear hearing aids are considered less," Djalilian said. "It's ridiculous."
As for Meyer, a severe dizzy spell eventually sent her to a specialist. She received a diagnosis of Meniere's disease, an inner ear disorder that affects both balance and hearing. She eventually got hearing aids and later a cochlear implant.
"I feel like my quality of life has been restored," she said. "I don't believe in miracles, but this is a miracle."
Since her experience, Meyer, now 70, has become an advocate for people who have hearing loss.
"It is so helpful for someone to be diagnosed early," she said. "Hearing loss affects everybody, not just you, [but] everybody with whom you interact."