Hearing level

Abstract: Objective: To estimate the prevalence of confirmed permanent childhood hearing impairment and its profile across age and degree of impairment in the United Kingdom. Design: Retrospective total ascertainment through sources in the health and education sectors by postal questionnaire. Setting: Hospital based otology and audiology departments, community health clinics, education services for hearing impaired children. Participants: Children born from 1980 to 1995, resident in United Kingdom in 1998, with permanent childhood hearing impairment (hearing level in the better ear >40 dB averaged over 0.5, 1, 2, and 4 kHz). Main outcome measures: Numbers of cases with date of birth and severity of impairment converted to prevalences for each annual birth cohort (cases/1000 live births) and adjusted for underascertainment. Results: 26 000 notifications ascertained 17 160 individual children. Prevalence rose from 0.91 (95% confidence interval 0.85 to 0.98) for 3 year olds to 1.65 (1.62 to 1.68) for children aged 9-16 years. Adjustment for underascertainment increased estimates to 1.07 (1.03 to 1.12) and 2.05 (2.02 to 2.08). Comparison with previous studies showed that prevalence increases with age, rather than declining with year of birth. Conclusions: Prevalence of confirmed permanent childhood hearing impairment increases until the age of 9 years to a level higher than previously estimated. Relative to current yields of universal neonatal hearing screening in the United Kingdom, which are close to 1/1000 live births, 50-90% more children are diagnosed with permanent childhood hearing impairment by the age of 9 years. Paediatric audiology services must have the capacity to achieve early identification and confirmation of these additional cases. What is already known on this topic The prevalence of confirmed permanent childhood hearing impairment (>40 dB HL) in the United Kingdom has been estimated to rise with age to 1.33/1000 live births among children aged 5 years and older It has been predicted that only an additional 16% of children will remain to be detected in the postnatal years, given current yields from universal neonatal hearing screening What this study adds The prevalence of confirmed permanent childhood hearing impairment (>40 dB HL) in the United Kingdom has risen with age to at least 1.65/1000 live births (and may be as high as 2.05/1000 live births) among children 9 years of age and older If the current yield from screening is sustained, then an additional 50-90% of children will remain to be detected in the postnatal years

Abstract: Purpose Large-scale epidemiological studies have often used self-report to estimate prevalence of age-related hearing loss. However, few large population-based studies have validated self-report against measured hearing loss. Our study aimed to assess the performance of a single question and a brief hearing handicap questionnaire in identifying individuals with hearing loss, against the gold standard of pure-tone audiometry. Methods We examined 2015 residents, aged 55-99 years, living in the west of Sydney, Australia, who participated in the Blue Mountains Hearing Study during 1997-1999. Audiologists administered a comprehensive questionnaire, including the question: 'Do you feel you have a hearing loss?' The Shortened Hearing Handicap Inventory for Elderly (HHIE-S) was also administered during the hearing examination, which included pure-tone audiometry. The single question and HHIE-S were compared with measured losses at levels >25, >40 and >60 decibels hearing level (dBHL) to indicate mild, moderate and marked hearing impairment, for pure-tone averages (PTA) of responses to 500, 1000, 2000 and 4000 Hz. Results The single question yielded reasonable sensitivity and specificity for hearing impairment, and was minimally affected by age and gender. HHIE-S scores >8 had lower sensitivity but higher specificity and positive predictive value. The HHIE-S performed slightly better in younger than older subjects and performed better for moderate hearing impairment. Conclusions In this older population with a high prevalence of hearing loss (39.4%), both a question about hearing and the HHIE-S appeared sufficiently sensitive and specific to provide reasonable estimates of hearing loss prevalence. Both could be recommended for use in epidemiological studies that aim to assess the magnitude of the burden caused by age-related sensory impairment but cannot measure hearing loss by audiometry.

Abstract: • Hearing loss with age (presbycusis) is a substantial problem for the elderly. To investigate the possible relation of presbycusis to cardiovascular disease (CVD), the hearing status of a cohort of 1662 elderly men and women was determined and compared with their 30-year prevalence of cardiovascular disease. Age-adjusted multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) to describe the relation of hearing to cardiovascular disease events, cardiovascular disease risk factors, and both events and risk factors separately for the 676 men and for the 996 women. Cardiovascular disease events were the sum of coronary heart disease, stroke, and intermittent claudication. Five groups of risk factors were studied: hypertension and blood pressure; diabetes, glucose intolerance, and blood glucose level; smoking status and number of pack-years of cigarettes; relative weight; and serum lipid levels, including cholesterol, triglycerides, and lipoprotein fractions. Low-frequency hearing (low pure-tone average, 0.25 to 1.0 kHz) was related to cardiovascular disease events in both genders but more in the women. For women, the OR of having any cardiovascular disease event for a low pure-tone average of 40 dB hearing level was 3.06 (95% CI, 1.84 to 5.10); for a high pure-tone average (average of 4 to 8 kHz) of 40-dB hearing level, the OR for any cardiovascular disease event was 1.75 (95% CI, 1.28 to 2.40). In men with a low pure tone average of 40-dB hearing level, the OR for stroke was 3.46 (95% CI, 1.60 to 7.45) and for coronary heart disease the OR was 1.68 (95% CI, 1.10 to 2.57). In the women, a low pure-tone average of 40 dB hearing level was associated with an OR for coronary heart disease of 2.14 (95% CI, 1.21 to 3.79) and for intermittent claudication the OR was 4.39 (95% CI, 2.02 to 9.55). Adding cardiovascular disease risk factors to the logistic regression analyses did not affect the relationships. Of the suprathreshold tests, the synthetic sentence identification test showed a relation to heart attack or strokes in women. Of the risk factors, hypertension and systolic blood pressure were related to hearing thresholds in both men and women, and blood glucose level was related to low pure-tone average in the women. High-density lipoprotein levels were inversely related to low-frequency hearing thresholds only in the women. There is a small but statistically significant association of cardiovascular disease and hearing status in the elderly that is greater for women than men and more in the low than the high frequencies. Low-frequency presbycusis is classically associated with microvascular disease leading to atrophy of the stria vascularis. Further studies of the relation of vascular disease and hearing loss in the elderly are warranted to clarify the pathophysiologic mechanisms. (Arch Otolaryngol Head Neck Surg. 1993;119:156-161)

Abstract: Background Age-related peripheral hearing impairment (HI) is prevalent, treatable, and may be a risk factor for dementia in older adults. In prospective analysis, we quantified the association of HI with incident dementia and with domain-specific cognitive decline in memory, perceptual speed, and processing speed. Methods Data were from the Health, Aging and Body Composition (Health ABC) study, a biracial cohort of well-functioning adults aged 70-79 years. Dementia was defined using a prespecified algorithm incorporating medication use, hospital records, and neurocognitive test scores. A pure-tone average in decibels hearing level (dBHL) was calculated in the better hearing ear using thresholds from 0.5 to 4kHz, and HI was defined as normal hearing (≤25 dBHL), mild (26-40 dBHL), and moderate/severe (>40 dBHL). Associations between HI and incident dementia and between HI and cognitive change were modeled using Cox proportional hazards models and linear mixed models, respectively. Results Three-hundred eighty seven (20%) participants had moderate/severe HI, and 716 (38%) had mild HI. After adjustment for demographic and cardiovascular factors, moderate/severe audiometric HI (vs. normal hearing) was associated with increased risk of incident dementia over 9 years (hazard ratio: 1.55, 95% confidence interval [CI]: 1.10, 2.19). Other than poorer baseline memory performance (difference of -0.24 SDs, 95% CI: -0.44, -0.04), no associations were observed between HI and rates of domain-specific cognitive change during 7 years of follow-up. Conclusions HI is associated with increased risk of developing dementia in older adults. Randomized trials are needed to determine whether treatment of hearing loss could postpone dementia onset in older adults.