1
|
Ishak EM, Denham MW, Grewal MR, Golub JS. Age-based disparities in hearing loss diagnosis and treatment in the United States population. Am J Otolaryngol 2024; 45:104403. [PMID: 39047624 PMCID: PMC11343661 DOI: 10.1016/j.amjoto.2024.104403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To investigate age-related disparities in the diagnosis and treatment of borderline/mild hearing loss (HL) in the United States. STUDY DESIGN A cross-sectional epidemiologic study. SETTING The National Health and Nutrition Examination Survey (NHANES). METHODS Multivariable logistic regressions controlling for hearing level were performed to investigate the association between: (1) age and recent hearing test; (2) age and hearing aid use. Age was grouped into quartiles (<25, 25-49, 50-74, ≥75 years). The first quartile of life was used as a reference group in all odds ratios, controlling for hearing level. RESULTS Of 2115 participants with borderline/mild HL, 3 % (n = 53) were in age quartile Q1; 7 % (n = 147) were in Q2, 56 % (n = 1190) were in Q3, and 34 % (n = 725) were in Q4. Compared to Q1, those in Q2, Q3, and Q4 had 4.06 times (95 % CI = 2.11-8.02, p < 0.001), 4.51 times (2.56-8.19, p < 0.001), and 4.56 times (2.55-8.39, p < 0.001) lower odds of a hearing test within the past 4 years. Similar, although slightly larger, odds ratios were obtained when the outcome was hearing test within 1 year. Compared to Q1, those in Q2, Q3, and Q4 respectively had 4.38 times (1.47-13.5, p < 0.05), 5.41 times (2.27-11.8, p < 0.001), and 3.95 times (1.65-8.72, p < 0.05) lower odds of using a hearing aid. CONCLUSION We have characterized a large, unaddressed, and modifiable disparity in the treatment of borderline/mild HL as individuals age out of the first quartile of life. Future studies are needed to explore factors, such as ageism, that may underlie these findings.
Collapse
Affiliation(s)
- Emily M Ishak
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States of America.
| | - Michael W Denham
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States of America. https://twitter.com/michaelwdenham
| | - Maeher R Grewal
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Justin S Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States of America. https://twitter.com/jsgolub
| |
Collapse
|
2
|
Dillard LK, Matthews LJ, Maldonado L, Simpson AN, Dubno JR. Demographic factors impact the rate of hearing decline across the adult lifespan. COMMUNICATIONS MEDICINE 2024; 4:171. [PMID: 39215139 PMCID: PMC11364848 DOI: 10.1038/s43856-024-00593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Little is known about the natural history of hearing loss in adults, despite it being an important public health problem. The purpose of this study is to describe the rate of hearing change per year over the adult lifespan. METHODS The 1436 participants are from the MUSC Longitudinal Cohort Study of Age-related Hearing Loss (1988-present). Outcomes are audiometric thresholds at 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz, averaged across right and left ears, and pure-tone average (PTA). Demographic factors are sex (female/male), race, which is categorized as white or racial Minority, and baseline age group (18-39, 40-59, 60-69, 70+ years). Linear mixed regression models are used to estimate the effect of age (per year) on the rate of threshold and PTA change. RESULTS Participants' mean age is 63.1 (SD 14.9) years, 57.7% are female, and 17.8% are racial Minority (17.1% were Black or African American). In sex-race-adjusted models, rates of threshold change are 0.42 to 1.44 dB across thresholds. Rates of change differ by sex at most individual thresholds, but not PTA. Females (versus males) showed higher rates of threshold change in higher frequencies but less decline per year in lower frequencies. Black/African American (versus white) participants have lower rates of threshold and PTA change per year. Hearing thresholds decline across the adult lifespan, with older (versus younger) baseline age groups showing higher rates of decline per year. CONCLUSIONS Declines to hearing occur across the adult lifespan, and the rate of decline varies by sex, race, and baseline age.
Collapse
Affiliation(s)
- Lauren K Dillard
- Department of Otolaryngology- Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Lois J Matthews
- Department of Otolaryngology- Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Lizmarie Maldonado
- Department of Healthcare Leadership & Management, Medical University of South Carolina, Charleston, SC, USA
| | - Annie N Simpson
- Department of Otolaryngology- Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Healthcare Leadership & Management, Medical University of South Carolina, Charleston, SC, USA
| | - Judy R Dubno
- Department of Otolaryngology- Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
3
|
Denham MW, Arnold ML, Sanchez VA, Lin FR, Tucker LH, Gomez MC, Fernandez K, Arpi P, Neil H, Boyle S, Selevan S, Sussman TJ, Fine I, Glynn NW, Teresi J, Noble JM, Goldberg T, Luchsinger JA, Golub JS. Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial. Otol Neurotol 2024; 45:594-601. [PMID: 38728564 PMCID: PMC11093050 DOI: 10.1097/mao.0000000000004093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment. STUDY DESIGN Randomized, controlled, single-site, early phase II, superiority trial. SETTING Tertiary academic medical center. PARTICIPANTS One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included. INTERVENTIONS Participants will be randomized 1:1 to a best practice hearing intervention or a health education control. MAIN OUTCOME MEASURES The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity. RESULTS Trial enrollment will begin in early 2024. CONCLUSIONS After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.
Collapse
Affiliation(s)
- Michael W. Denham
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Michelle L. Arnold
- Department of Communication Sciences & Disorders, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Victoria A. Sanchez
- Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL
| | - Frank R. Lin
- Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lauren H. Tucker
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Michael C. Gomez
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Karla Fernandez
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Pamela Arpi
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Haley Neil
- Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL
| | - Suzannah Boyle
- Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL
| | - Sally Selevan
- Department of Communication Sciences & Disorders, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Tamara J. Sussman
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY
| | - Ione Fine
- Department of Psychology/Center for Human Neuroscience University of Washington, Seattle, WA
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Jeanne Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute and Department of Medicine, New York, NY
| | - James M. Noble
- Department of Neurology, GH Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
| | - Terry Goldberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Justin S. Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
4
|
Kawada T. Slow-wave sleep and subsequent risk of dementia. J Clin Sleep Med 2024; 20:1021. [PMID: 38415748 PMCID: PMC11145055 DOI: 10.5664/jcsm.11068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
5
|
Tsai Do BS, Bush ML, Weinreich HM, Schwartz SR, Anne S, Adunka OF, Bender K, Bold KM, Brenner MJ, Hashmi AZ, Kim AH, Keenan TA, Moore DJ, Nieman CL, Palmer CV, Ross EJ, Steenerson KK, Zhan KY, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Age-Related Hearing Loss Executive Summary. Otolaryngol Head Neck Surg 2024; 170:1209-1227. [PMID: 38682789 DOI: 10.1002/ohn.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.
Collapse
Affiliation(s)
| | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | | | | | - Kaye Bender
- Mississippi Public Health Association, Jackson, Mississippi, USA
| | | | | | | | - Ana H Kim
- Columbia University Medical Center, New York, USA
| | | | | | - Carrie L Nieman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
6
|
Ou H. Hearing healthcare utilisation among older adults with self-reported hearing loss during the COVID-19 pandemic in the United States. Int J Audiol 2024; 63:366-372. [PMID: 36905138 PMCID: PMC11234923 DOI: 10.1080/14992027.2023.2183353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To ascertain the prevalence, causes, and risk factors of hearing healthcare delays in older people with self-reported hearing loss in the United States. DESIGN This cross-sectional study used data from the National Health and Ageing Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries. A supplemental COVID-19 survey was mailed to the participants from June to October 2020. STUDY SAMPLE By January 2021, 3257 participants had returned completed COVID-19 questionnaires, with the majority having been self-administered between July and August 2020. RESULTS The participants in the study represented 32.7 million older adults in the US, with 29.1% reporting hearing loss. Among over 12.4 million older adults who put off needed or planned medical care, 19.6% of those with self-reported hearing loss and 24.5% of hearing aid or device users stated they delayed hearing appointments. Approximately 629,911 older adults with hearing devices were impacted by the COVID-19 outbreak for audiological services. The top three reasons were deciding to wait, service cancellation, and fear of going. Education and race/ethnicity were associated with delaying hearing healthcare. CONCLUSIONS The COVID-19 pandemic impacted hearing healthcare utilisation among older adults with self-reported hearing loss in 2020, with both patient- and provider- initiated delays.
Collapse
Affiliation(s)
- Hua Ou
- Epidemiology and Statistics Program, Division of Scientific Programs, NIDCD, NIH
| |
Collapse
|
7
|
Tsai Do BS, Bender K, Keenan TA, Palmer CV, Ross EJ, Reyes J, Dhepyasuwan N. Plain Language Summary: Age-Related Hearing Loss. Otolaryngol Head Neck Surg 2024; 170:1228-1233. [PMID: 38682759 DOI: 10.1002/ohn.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
The plain language summary explains age-related hearing loss to patients, families, and care partners. The summary is for any patient aged 50 years and older, families, and care partners. It is based on the 2024 "Clinical Practice Guideline: Age-Related Hearing Loss." This plain language summary is a companion publication to the full guideline, which provides greater detail for clinicians. Guidelines and their recommendations may not apply to every patient, but they can be used to find best practices and quality improvement opportunities.
Collapse
Affiliation(s)
| | - Kaye Bender
- Mississippi Public Health Association, Jackson, Mississippi, USA
| | | | | | | | - Joe Reyes
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
8
|
Tsai Do BS, Bush ML, Weinreich HM, Schwartz SR, Anne S, Adunka OF, Bender K, Bold KM, Brenner MJ, Hashmi AZ, Keenan TA, Kim AH, Moore DJ, Nieman CL, Palmer CV, Ross EJ, Steenerson KK, Zhan KY, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Age-Related Hearing Loss. Otolaryngol Head Neck Surg 2024; 170 Suppl 2:S1-S54. [PMID: 38687845 DOI: 10.1002/ohn.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.
Collapse
Affiliation(s)
| | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | | | | | - Kaye Bender
- Mississippi Public Health Association, Jackson, Mississippi, USA
| | | | | | | | | | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | | | - Carrie L Nieman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
9
|
Lin FR. Age-Related Hearing Loss. N Engl J Med 2024; 390:1505-1512. [PMID: 38657246 DOI: 10.1056/nejmcp2306778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Frank R Lin
- From the Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore
| |
Collapse
|
10
|
Gallagher TJ, Russel Z, Choi JS. Hearing Loss: Self-Reported Onset and Etiology Among Older Adults in the United States. OTO Open 2024; 8:e146. [PMID: 38846013 PMCID: PMC11154830 DOI: 10.1002/oto2.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
This study investigated self-reported age of onset and etiology of hearing loss among older adults in the United States. Study cohort included older adult (≥70 years) survey respondents from the 2017 to 2020 National Health and Nutrition Examination Survey (n = 797). Overall, 51.1% [95% confidence interval [CI]: 46.1-56.1] of older adults self-reported hearing loss. Among older adults who reported hearing loss, the most reported age of onset was age 70 or older (41.7% [95% CI: 38.1%-45.3%]), followed by sequentially younger age brackets including ages 60 to 69 years (27.3% [95% CI: 23.6%-31.3%]) and ages 40 to 59 years (15.7% [95% CI: 12.9%-19.0%]). The most common etiology of hearing loss was aging (66.3% [95% CI: 60.8%-71.4%]) followed by loud long-term noise (30.3% [95% CI: 26.2%-34.9%]) and loud brief noise (13.8% [95% CI: 10.3%-18.4%]). Our study describes the most common age of onset and etiologies of hearing loss among a representative sample of United States older adults.
Collapse
Affiliation(s)
- Tyler J. Gallagher
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ziphron Russel
- University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Janet S. Choi
- Caruso Department of Otolaryngology–Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| |
Collapse
|
11
|
Smith SL, Francis HW, Witsell DL, Dubno JR, Dolor RJ, Bettger JP, Silberberg M, Pieper CF, Schulz KA, Majumder P, Walker AR, Eifert V, West JS, Singh A, Tucci DL. A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement. Ear Hear 2024; 45:23-34. [PMID: 37599396 PMCID: PMC10841210 DOI: 10.1097/aud.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVES The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no). DESIGN We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider. RESULTS All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups. CONCLUSIONS The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.
Collapse
Affiliation(s)
- Sherri L. Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Howard W. Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - David L. Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Judy R. Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rowena J. Dolor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Mina Silberberg
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
| | - Carl F. Pieper
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Kristine A. Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | | | - Amy R. Walker
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Victoria Eifert
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Jessica S. West
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | | | - Debara L. Tucci
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD
| |
Collapse
|
12
|
Dillard LK, Matthews LJ, Dubno JR. The Revised Hearing Handicap Inventory and Pure-Tone Average Predict Hearing Aid Use Equally Well. Am J Audiol 2023; 33:1-10. [PMID: 38157291 PMCID: PMC10950317 DOI: 10.1044/2023_aja-23-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE This study aimed to (a) compare the Revised Hearing Handicap Inventory (RHHI) and pure-tone average (PTA) in their abilities to predict hearing aid use and (b) report the optimal cut-point values on the RHHI and PTA that predict hearing aid use. METHOD Participants were from a community-based cohort study. We evaluated the ability of the RHHI and PTA as (a) continuous variables and (b) binary variables characterized by the optimal cut point determined by the Youden Index to predict hearing aid use. RHHI scores range from 0 to 72, and PTA was defined as averaged thresholds at frequencies 0.5, 1.0, 2.0, and 4.0 kHz in the worse ear. We used logistic regression models and receiver operating characteristic curves with corresponding concordance statistics (c-statistics) and 95% confidence intervals (CIs) to determine the predictive ability of models and chi-square tests to determine whether c-statistics were significantly different. RESULTS This study included 581 participants (Mage = 72.9 [SD = 9.9] years; 59.9% female; 14.3% Minority race). The c-statistics for the RHHI (0.79, 95% CI [0.75, 0.83]) and PTA (0.81, 95% CI [0.78, 0.85]), as continuous variables, were not significantly different (p = .25). The optimal cut points for the RHHI and PTA to predict hearing aid use were 6 points and 32.5 dB HL, respectively. The c-statistics for the RHHI (0.72, 95% CI [0.68, 0.76]) and PTA (0.75, 95% CI [0.71, 0.79]), as binary variables, were not significantly different (p = .27). CONCLUSION The RHHI and PTA are similar in their ability to predict hearing aid use.
Collapse
Affiliation(s)
- Lauren K. Dillard
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Lois J. Matthews
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Judy R. Dubno
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| |
Collapse
|
13
|
Assi S, Zhang W, Carey JP, Deal JA, Huang A, Oh ES, Martinez-Amezcua P, Reed NS. The association of hearing loss with frailty among community-dwelling older adults: findings from the National Health and Aging Trends Study. BMC Geriatr 2023; 23:754. [PMID: 37978436 PMCID: PMC10656913 DOI: 10.1186/s12877-023-04465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The identification of modifiable risk factors is crucial for the prevention and/or reversal of frailty, which is associated with significant morbidity and mortality. Hearing loss affects two-thirds of older adults in the United States (U.S.) and is associated with physical and cognitive decline which may increase frailty risk. We investigated the association of hearing loss and hearing aid use with frailty and pre-frailty in a nationally representative sample of older adults in the U.S. METHODS Cross-sectional analysis of the National Health and Aging Trends Study (2021 round). The better-hearing ear pure-tone average (BPTA) at speech-frequencies (0.5-4 kHz) was modeled continuously (per 10 dB) and categorically (no ≤ 25 dB, mild 26-40 dB, moderate or greater > 40 dB hearing loss). Hearing aid use was self-reported. The physical frailty phenotype (frail, pre-frail, robust) was determined based on Fried criteria: unintentional weight loss, exhaustion, low physical activity, weakness, slow walking speed. We used multinomial multivariable regression adjusted for sociodemographic and health characteristics (odds ratios [95% Confidence Intervals]). RESULTS Among 2,361 participants (mean age = 81 years, 56% female, 19% Black), 860 (36%) had mild and 864 (37%) had moderate or greater hearing loss. Worse hearing was associated with greater odds of being frail versus robust (OR = 1.20 [1.05-1.38] per 10 dB difference). Categorically, moderate or greater hearing loss was associated with greater odds of being frail (OR = 1.84 [1.01-3.08]) and pre-frail (OR = 1.46 [1.01-2.10]) versus robust. Among 1,724 participants with hearing loss, compared to hearing aid users (N = 522), nonusers had greater odds of being frail (OR = 2.54 [1.54-4.18]) and pre-frail (OR = 1.51 [1.05-2.17]) versus robust, and frail versus pre-frail (OR = 1.68 [1.04-2.72]). CONCLUSIONS In a nationally representative sample of older adults in the U.S., using gold-standard hearing measures and a validated frailty phenotype, hearing loss and lack of hearing aid use was cross-sectionally associated with frailty and pre-frailty. Future longitudinal studies are needed to establish if hearing loss is a risk factor for frailty, which may have significant clinical importance.
Collapse
Affiliation(s)
- Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Wuyang Zhang
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison Huang
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo Martinez-Amezcua
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
14
|
Choi S. Association of hearing impairment with social participation restriction and depression: comparison between midlife and older adults. Aging Ment Health 2023; 27:2257-2266. [PMID: 37561088 DOI: 10.1080/13607863.2023.2245774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES This study examined the association between hearing impairment and depression, focusing on the role of restricted social engagement as a mediator and whether the mediating relationship differed between midlife individuals (45-64) and older adults (65+). METHODS Individuals aged 45 and older from the cross-sectional National Health and Nutrition Examination Survey 2017-2018 were analyzed (N = 3,020). A multiple-group path analysis was conducted to compare midlife individuals (n = 1,774) and older adults (n = 1,246). RESULTS The results indicated that among U.S. adults aged 45 or older, 12.3% reported having serious difficulty hearing (21.2% among older adults vs. 7.4% among midlife adults). In both age groups, significant direct relationship between hearing impairment and depression, as well as indirect relationship via social participation restriction, were found. However, a significant difference was found in the relationship between restricted social participation and depression by age group (i.e. moderated mediation): The coefficient was greater among midlife adults than among older adults (Δbmidlife-older=1.109-0.383 = 0.726, p<.001). CONCLUSION These findings highlight that adverse psychosocial effects of hearing impairment are also an important concern for midlife adults. As the importance of social engagement was greater among midlife adults with hearing impairment, age-specific interventions should be adopted to reduce depression associated with hearing impairment.
Collapse
Affiliation(s)
- Sunha Choi
- Department of Public Administration, Seoul National University of Science & Technology, Seoul, South Korea
| |
Collapse
|
15
|
Gathman TJ, Choi JS, Vasdev RMS, Schoephoerster JA, Adams ME. Machine Learning Prediction of Objective Hearing Loss With Demographics, Clinical Factors, and Subjective Hearing Status. Otolaryngol Head Neck Surg 2023; 169:504-513. [PMID: 36758959 DOI: 10.1002/ohn.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/17/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Hearing loss (HL) is highly prevalent, yet underrecognized and underdiagnosed. Lack of standardized screening, awareness, cost, and access to hearing testing present barriers to HL identification. To facilitate prescreening and selection of patients who warrant audiometric evaluation, we developed a machine learning (ML) model to predict speech-frequency pure-tone average (PTA). STUDY DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey (NHANES). METHODS The cohort included 8918 adults (≥20 years) who completed audiometric testing with NHANES (2012-2018). The primary outcome measure was the prediction of better hearing ear speech-frequency PTA. Relevant predictors included demographics, medical conditions, and subjective assessment of hearing. Supervised ML with a tree-based architecture was used. Regression performance was determined by the mean absolute error (MAE) with binary classification assessed with area under the receiver operating characteristic curve (AUC). RESULTS Using the full set of predictors, the test set MAE between the ML-predicted and actual PTA was 5.29 dB HL (95% confidence interval [CI]: 4.97-5.61). The 5 most influential predictors of higher PTA were increased age, worse subjective hearing, male gender, increased body mass index, and history of smoking. The 5-factor abbreviated model performed comparably to the extended feature set with MAE 5.36 (95% CI: 5.03-5.69) and AUC for PTA > 25 dB HL of 0.92 (95% CI: 0.90-0.94). CONCLUSION The ML model was able to predict PTA with patient demographics, clinical factors, and subjective hearing status. ML-based prediction may be used to identify individuals who could benefit most from audiometric evaluation.
Collapse
Affiliation(s)
- Tyler J Gathman
- School of Medicine, University of Minnesota, Minnesota, Minneapolis, USA
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Janet S Choi
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ranveer M S Vasdev
- School of Medicine, University of Minnesota, Minnesota, Minneapolis, USA
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Meredith E Adams
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
16
|
Cheung S, Henderson-Sabes J, Mastick J, Abrams G, Snowberg K, Alfaro E, Quinn M, Paul S, Cooper B, Wallhagen M, Conley Y, Levine J, Miaskowski C. Cancer survivors and neurotoxic chemotherapy: hearing loss and tinnitus. BMJ Support Palliat Care 2023; 13:345-353. [PMID: 35896321 PMCID: PMC9880249 DOI: 10.1136/spcare-2022-003684] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Little is known about hearing loss and tinnitus associated with neurotoxic chemotherapy. Study evaluated for differences in occurrence rates and effects of hearing loss and tinnitus in survivors who received a platinum alone, a taxane alone or a platinum and taxane containing regimen. METHODS Total of 273 survivors with breast, gastrointestinal, gynaecological or lung cancer completed self-report measures of hearing loss and tinnitus and had an audiometric assessment that obtained pure tone air conduction thresholds bilaterally at frequencies of between 0.25 kHz to 16.0 kHz. To adjust for age-related and gender-related changes in hearing, each survivor's audiogram was evaluated using the National Health and Nutrition Examination Survey-modified Occupational Safety and Health Administration standards. Survivor was classified as having hearing loss if at any frequency they scored poorer than the 50th percentile for their age and gender. Survivors were categorised as having tinnitus if they reported that for >10% of their time awake, they were consciously aware of their tinnitus. Differences among the chemotherapy groups were evaluated using parametric and non-parametric tests. RESULTS For most of the demographic and clinical characteristics, no differences were found among the three chemotherapy groups. Occurrence rates for audiogram-confirmed hearing loss ranged from 52.3% to 71.4%. Occurrence rates for tinnitus ranged from 37.1% to 40.0%. No differences were found among the three chemotherapy groups in the occurrence rates or effects of hearing loss and tinnitus. CONCLUSION These findings suggest that regardless of the chemotherapy regimen common mechanistic pathway(s) may underlie these two neurotoxicities.
Collapse
Affiliation(s)
- Steven Cheung
- School of Medicine, UCSF, San Francisco, California, USA
| | | | | | - Gary Abrams
- School of Medicine, UCSF, San Francisco, California, USA
| | | | - Emely Alfaro
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Marisa Quinn
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Steven Paul
- School of Nursing, UCSF, San Francisco, California, USA
| | - Bruce Cooper
- School of Nursing, UCSF, San Francisco, California, USA
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon Levine
- School of Medicine, UCSF, San Francisco, California, USA
| | | |
Collapse
|
17
|
Ge J, Geng S, Gao Y, Ren G, Sun X, Jiang H. Construction and Effect of the Three-Level and Two-Stage Screening Mode for Age-Related Hearing Loss: A Study Based on the Community in Shanghai, China. Clin Interv Aging 2023; 18:1309-1320. [PMID: 37583570 PMCID: PMC10424679 DOI: 10.2147/cia.s423822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
Background There is a high incidence rate of age-related hearing loss. Severe hearing loss may increase the prevalence of mental illness, cognitive impairment, and even the risk of all-cause death. Purpose Construction of the three-level and two-stage screening mode for age-related hearing loss of the community and to evaluate its effectiveness. Materials and Methods A total of 401 participants (aged 60 years or older) from five typical communities were enrolled in the study. The risk factors assessment of age-related hearing loss was completed by using a cross-sectional survey and receiver operating characteristic (ROC) curve. Multiple screening method was adopted and verified by serial and parallel tests, respectively. Based on research data, incorporate risk factors assessment, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-s) and pure tone audiometry (PTA) were used to construct the screening mode. Results Multiple screening series testing and multiple screening parallel testing, including risk factors assessment, HHIE-s, and PTA, were used for verification: the sensitivity, specificity, and Kappa index were 70.5% and 9.2%, 95.0% and 71.6%, 0.26 and 0.63, respectively. Finally, the three-level and two-stage screening mode for age-related hearing loss was established. "Three-level" was defined as the risk factors assessment/HHIE-s (high-risk population), PTA (suspect population), and comprehensive hearing loss assessment (confirmed population). "Two-stage" was defined as the population screening by general practitioner in the community and target screening by otolaryngologist of the tertiary hospitals. Conclusion The three-level and two-stage screening mode for age-related hearing loss consists of the following framework: from population screening to target screening, from suspicious diagnosis to accurate diagnosis, from primary health care to tertiary hospitals. The study objective is to structure a new secondary prevention and treatment mode for age-related hearing loss with primary health care as the core, so as to help the front-end management of healthy aging.
Collapse
Affiliation(s)
- Jianli Ge
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Shasha Geng
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Yang Gao
- Department of General Practice, Huamu Community Health Service Center, Shanghai, 201204, People’s Republic of China
| | - Guangwei Ren
- Science and Education Department, Sanlin Community Health Service Center, Shanghai, 200124, People’s Republic of China
| | - Xiaoming Sun
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
- Department of General Practice, Zhongshan Hospital, Fudan University Medical School, Shanghai, 200032, People’s Republic of China
| | - Hua Jiang
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| |
Collapse
|
18
|
Gao M, Feng T, Zhao F, Shen J, Zheng Y, Liang J, Yang H. Cognitive reserve disorder in age-related hearing loss: cognitive cortical compensatory to auditory perceptual processing. Cereb Cortex 2023; 33:9616-9626. [PMID: 37381582 DOI: 10.1093/cercor/bhad230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
The aim of this study is to ascertain the mechanisms of cognitive reserve disorder in age-related hearing loss (ARHL), to study the correlation between ARHL and cognitive decline via EEG, and to reverse the adverse remodeling of auditory-cognitive connectivity with hearing aids (HAs). In this study, 32 participants were enrolled, including 12 with ARHLs, 9 with HAs, and 11 healthy controls (HCs), to undergo EEG, Pure Tone Average (PTA), Montreal Cognitive Assessment (MoCA), and other general cognitive tests. There were the lowest MoCA in the ARHL group (P = 0.001), especially in language and abstraction. In the ARHL group, power spectral density of the gamma in right middle temporal gyrus was significantly higher than HC and HA groups, while functional connectivity between superior frontal gyrus and cingulate gyrus was weaker than HC group (P = 0.036) and HA group (P = 0.021). In the HA group, superior temporal gyrus and cuneus had higher connectivity than in the HC group (P = 0.036). In the ARHL group, DeltaTM_DTA (P = 0.042) and CTB (P = 0.011) were more frequent than in the HC group, while there was less DeltaTM_CTA (P = 0.029). PTA was found to be associated with MoCA (r = -0.580) and language (r = -0.572), DeltaTM_CTB had a likewise correlation with MoCA (r = 0.483) and language (r = 0.493), while DeltaTM_DTA was related to abstraction (r = -0.458). Cognitive cortexes compensate for worse auditory perceptual processing in ARHL, which relates to cognitive decline. The impaired functional connectivity between auditory and cognitive cortexes can be remodeled by HAs. DeltaTM may serve as a biomarker for early cognitive decline and decreased auditory speech perception in ARHL.
Collapse
Affiliation(s)
- Minqian Gao
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
- Department of Hearing and Speech-Language Science, Guangzhou Xinhua College, 19 of Hua Mei Road, Guangzhou 510520, China
| | - Tianci Feng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, School of Sport and Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff CF5 2YB, United Kingdom
| | - Jingxian Shen
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education, Institute for Brain Research and Rehabilitation, South China Normal University, 55 West of Zhongshan Avenue, Guangzhou 510631, China
- Department for Neuroradiology, School of Medicine, Technical University Munich, Ismaningerstr 22, Munich 81675, Germany
| | - Yiqing Zheng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
- Department of Hearing and Speech-Language Science, Guangzhou Xinhua College, 19 of Hua Mei Road, Guangzhou 510520, China
| | - Jiuxing Liang
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education, Institute for Brain Research and Rehabilitation, South China Normal University, 55 West of Zhongshan Avenue, Guangzhou 510631, China
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, Sun Yat-Sen University, 132 East of Waihuan Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, China
| | - Haidi Yang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, 107 West of Yan Jiang Road, Guangzhou 510120, China
- Department of Hearing and Speech-Language Science, Guangzhou Xinhua College, 19 of Hua Mei Road, Guangzhou 510520, China
| |
Collapse
|
19
|
Patro A, Perkins EL, Ortega CA, Lindquist NR, Dawant BM, Gifford R, Haynes DS, Chowdhury N. Machine Learning Approach for Screening Cochlear Implant Candidates: Comparing With the 60/60 Guideline. Otol Neurotol 2023; 44:e486-e491. [PMID: 37400135 PMCID: PMC10524241 DOI: 10.1097/mao.0000000000003927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To develop a machine learning-based referral guideline for patients undergoing cochlear implant candidacy evaluation (CICE) and to compare with the widely used 60/60 guideline. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS 772 adults undergoing CICE from 2015 to 2020. INTERVENTIONS Variables included demographics, unaided thresholds, and word recognition score. A random forest classification model was trained on patients undergoing CICE, and bootstrap cross-validation was used to assess the modeling approach's performance. MAIN OUTCOME MEASURES The machine learning-based referral tool was evaluated against the 60/60 guideline based on ability to identify CI candidates under traditional and expanded criteria. RESULTS Of 587 patients with complete data, 563 (96%) met candidacy at our center, and the 60/60 guideline identified 512 (87%) patients. In the random forest model, word recognition score; thresholds at 3000, 2000, and 125; and age at CICE had the largest impact on candidacy (mean decrease in Gini coefficient, 2.83, 1.60, 1.20, 1.17, and 1.16, respectively). The 60/60 guideline had a sensitivity of 0.91, a specificity of 0.42, and an accuracy of 0.89 (95% confidence interval, 0.86-0.91). The random forest model obtained higher sensitivity (0.96), specificity (1.00), and accuracy (0.96; 95% confidence interval, 0.95-0.98). Across 1,000 bootstrapped iterations, the model yielded a median sensitivity of 0.92 (interquartile range [IQR], 0.85-0.98), specificity of 1.00 (IQR, 0.88-1.00), accuracy of 0.93 (IQR, 0.85-0.97), and area under the curve of 0.96 (IQR, 0.93-0.98). CONCLUSIONS A novel machine learning-based screening model is highly sensitive, specific, and accurate in predicting CI candidacy. Bootstrapping confirmed that this approach is potentially generalizable with consistent results.
Collapse
Affiliation(s)
- Ankita Patro
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L. Perkins
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Nathan R. Lindquist
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benoit M. Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - René Gifford
- Department of Hearing and Speech Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S. Haynes
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Naweed Chowdhury
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
20
|
Apa E, Sacchetto L, Palma S, Cocchi C, Gherpelli C, Genovese E, Monzani D, Nocini R. Italian validation of the Hearing Handicap Inventory for Elderly - Screening version (HHIE-S-It). ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:262-272. [PMID: 37488990 PMCID: PMC10366563 DOI: 10.14639/0392-100x-n2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/22/2023] [Indexed: 07/26/2023]
Abstract
Objective Validate the Italian version of the Hearing Handicap Inventory for Elderly - Screening version (HHIE-S-It). Methods After translation, psychometric properties and attributes were analysed by administering the HHIE-S-It to 167 elderly outpatients together with the Psychological General Well-Being Index (PGWBI). Results The Cronbach's α coefficient was 0.908 for the total score, and 0.832 and 0.816 for its two subscales. Significant test-retest reliability was observed (p < 0.001). Moderate to high correlations were found between HHIE-S-It and pure tone average in the better ear (p < 0.001). The ANOVA test confirmed the significant difference in HHIE-S-It scores across groups according to the degree of hearing loss (p < 0.001). Only very low and low significant correlations were observed between HHIE-S-It and PGWBI. The criterion HHIE-S-It > 11 was observed as the best cut-off with highest sensitivity (86.4%), specificity (72.4%), positive predictive value (52.8%), negative predictive value (93.7%) and likelihood ratios (3.12 and 0.19). Conclusions Since the HHIE-S-It presented acceptable psychometric properties, its adoption is justified for both clinical and research purposes. Acceptable diagnostic attributes allow its use as a screening tool for age-related hearing loss.
Collapse
Affiliation(s)
- Enrico Apa
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Luca Sacchetto
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Borgo Roma Hospital, Verona, Italy
| | - Silvia Palma
- Audiology, Primary Care Department; AUSL of Modena, Modena, Italy
| | - Chiara Cocchi
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Chiara Gherpelli
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Elisabetta Genovese
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Daniele Monzani
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Borgo Roma Hospital, Verona, Italy
| | - Riccardo Nocini
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Borgo Roma Hospital, Verona, Italy
| |
Collapse
|
21
|
Danyluk A, Jacob R. Hearing Loss Diagnosis and Management in Adults with Intellectual and Developmental Disabilities. Adv Med 2023; 2023:6825476. [PMID: 37251596 PMCID: PMC10225271 DOI: 10.1155/2023/6825476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/06/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
Hearing loss is a common concern in patients with intellectual and developmental disabilities (IDD), and early detection and intervention are crucial to prevent negative impacts on communication, cognition, socialization, safety, and mental health. Despite a lack of the literature specifically focused on hearing loss in adults with IDD, there is a substantial body of research demonstrating the prevalence of hearing loss in this population. This literature review examines the diagnosis and management of hearing loss in adult patients with IDD, with a focus on primary care considerations. Primary care providers must be aware of the unique needs and presentations of patients with IDD to ensure appropriate screening and treatment. This review highlights the importance of early detection and intervention, as well as the need for further research to guide clinical practice in this patient population.
Collapse
Affiliation(s)
| | - Rafik Jacob
- University of Florida-Jacksonville, Department of Internal Medicine, Jacksonville, USA
| |
Collapse
|
22
|
Oosthuizen I, Frisby C, Chadha S, Manchaiah V, Swanepoel DW. Combined hearing and vision screening programs: A scoping review. Front Public Health 2023; 11:1119851. [PMID: 36998276 PMCID: PMC10043331 DOI: 10.3389/fpubh.2023.1119851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
Background and aim The World Health Organization (WHO) estimates that 1.5 billion and 2.2 billion people have hearing and vision impairment, respectively. The burden of these non-communicable diseases is highest in low- and middle-income countries due to a lack of services and health professionals. The WHO has recommended universal health coverage and integrated service delivery to improve ear and eye care services. This scoping review describes the evidence for combined hearing and vision screening programs. Method A keyword search of three electronic databases, namely Scopus, MEDLINE (PubMed), and Web of Science, was conducted, resulting in 219 results. After removing duplicates and screening based on eligibility criteria, data were extracted from 19 included studies. The Joanna Briggs Institute Reviewer Manual and the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) Extension for Scoping Reviews were followed. A narrative synthesis was conducted. Results Most studies (63.2%) were from high-income countries, with 31.6% from middle-income and 5.2% from low-income countries. The majority of studies (78.9%) involved children and the four studies reporting on adults all included adults above 50 years of age. Vision screening was most commonly performed with the "Tumbling E" and "Snellen Chart," while hearing was typically screened using pure tone audiometry. Studies reported referral rates as the most common outcome with sensitivity and specificity rates not reported in any included articles. Reported benefits of combined vision and hearing screenings included earlier detection of vision and hearing difficulties to support functioning and quality of life as well as resource sharing for reduced costs. Challenges to combined screening included ineffective follow-up systems, management of test equipment, and monitoring of screening personnel. Conclusions There is limited research evidence for combined hearing and vision screening programs. Although potential benefits are demonstrated, especially for mHealth-supported programs in communities, more feasibility and implementation research are required, particularly in low- and middle-income countries and across all age groups. Developing universal, standardized reporting guidelines for combined sensory screening programs is recommended to enhance the standardization and effectiveness of combined sensory screening programs.
Collapse
Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
| | - Caitlin Frisby
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
| | - Shelly Chadha
- WHO Programme for Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland
| | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- Ear Science Institute Australia, Subiaco, WA, Australia
| |
Collapse
|
23
|
Ashikali EM, Ludwig C, Mastromauro L, Périvier S, Tholomier A, Ionita I, Graf C, Busnel C. Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4382. [PMID: 36901392 PMCID: PMC10002353 DOI: 10.3390/ijerph20054382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.
Collapse
Affiliation(s)
| | - Catherine Ludwig
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Laura Mastromauro
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Samuel Périvier
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1226 Geneva, Switzerland
| | - Aude Tholomier
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
| | - Irina Ionita
- PLATEFORME du Réseau Seniors Genève, 1227 Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1226 Geneva, Switzerland
| | - Catherine Busnel
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
| |
Collapse
|
24
|
Borre ED, Dubno JR, Myers ER, Emmett SD, Pavon JM, Francis HW, Ogbuoji O, Sanders Schmidler GD. Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA. J Gen Intern Med 2023; 38:978-985. [PMID: 35931909 PMCID: PMC10039166 DOI: 10.1007/s11606-022-07735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested. OBJECTIVE We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA. DESIGN Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5-8%/year) and discontinuation (13-4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30-120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening. PARTICIPANTS Forty-year-old persons in US primary care across their lifetime. INTERVENTION Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05-2.25-fold). MAIN MEASURES Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs). KEY RESULTS CD resulted in 1.20 average person-years of hearing aid use compared to 1.27-1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness. LIMITATION Input uncertainty around screening effectiveness. CONCLUSIONS We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.
Collapse
Affiliation(s)
- Ethan D Borre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Evan R Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Susan D Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Juliessa M Pavon
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
| | - Howard W Francis
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Osondu Ogbuoji
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, USA
| | - Gillian D Sanders Schmidler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
25
|
Kobewka D, Ruller S, Daly B, Mark Fraser AE, Bromwich M, Sveistrup H, Wilson K. Usability, acceptability and clinical utility of a mobile app to screen for hearing loss in older adults in a geriatric rehabilitation hospital. J Eval Clin Pract 2023; 29:392-396. [PMID: 36420708 DOI: 10.1111/jep.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
RATIONALE Hearing loss is a common problem for older adults entering rehabilitation hospitals. AIMS AND OBJECTIVES To pilot a hearing loss screening device to determine feasibility, usability, and impact on patient outcomes. METHODS We screened all patients newly admitted to a geriatric day hospital for hearing loss using the SHOEBOX® QuickTest (SHOEBOX Ltd.) app as part of a quality improvement programme. We measured the time it took for each patient to complete screening and recorded any issues they had using the app. We recorded the number of patients who screened positive who did not have a previous diagnosis and changes in physician behaviours after they received their patients' results. RESULTS Seventy-four patients with a mean age of 83.4 years used the hearing screener. All patients were able to complete the screening with a mean time to completion of 10 min and 48 s. Ninety-nine percent of patients screened positive for hearing loss. Of these positives 56% were in participants not already known to have hearing loss. Physicians often changed their behaviour after receiving results by using assistive devices during visits and referring to audiology for formal testing. CONCLUSIONS Screening for hearing loss is feasible in a geriatric day hospital. The SHOEBOX QuickTest app is acceptable, usable, resulting in the identification of undiagnosed hearing loss and in changes to physician behaviour.
Collapse
Affiliation(s)
- Daniel Kobewka
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sydney Ruller
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Blake Daly
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Matt Bromwich
- SHOEBOX Ltd, Ottawa, Ontario, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
26
|
Zhao C, Yang Z, Gong S, Du Z. Adenovirus-mediated SIRT1 protects cochlear strial marginal cells in a D-gal-induced senescent model in vitro. Mol Biol Rep 2023; 50:541-551. [PMID: 36350417 DOI: 10.1007/s11033-022-08032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND A primary obstacle in age-related hearing loss (ARHL) study is the lack of accelerated senescent models in vitro that explore the precise underlying mechanism in different types of ARHL. The damage to strial marginal cells (SMCs) is a subset of strial presbycusis-associated pathological changes. We aimed to establish a D-galactose (D-gal)-induced SMCs senescent model and study the effect of deacetylase sirtuin 1 (SIRT1) on presbycusis in vitro. METHODS SMCs from C57BL/6J neonatal mice were cultured and treated with D-gal to establish accelerated senescent models. And then D-gal-induced SMCs were transfected with adenovirus (Ad)-SIRT1-GFP or Ad-GFP. Oxidative stress and mitochondrial DNA (mtDNA) damage were determined by histological analysis or RT-PCR. Western blotting (WB) and RT-PCR were used to evaluate protein and mRNA levels of superoxide dismutase 2 (SOD2) and SIRT1, respectively. Additionally, apoptosis was investigated by WB and TUNEL staining. RESULTS D-gal-induced SMCs exhibited several characteristics of senescence, including increased the level of 8-hydroxy-2'-deoxyguanosine, which is a marker of DNA oxidative damage, and elevated the amount of mtDNA 3860-bp deletion, which is a common type of mtDNA damage in the auditory system of mice. SIRT1 overexpression effectively inhibited these changes by upregulating the level of SOD2, thereby inhibiting cytochrome c translocation from mitochondria to cytoplasm, inhibiting cell apoptosis, and ultimately delaying aging in the D-gal-induced senescent SMCs. CONCLUSIONS Altogether, the evidence suggests that the D-gal-induced SMCs accelerated aging model is successfully established, and SIRT1 overexpression protects SMCs against oxidative stress by enhancing SOD2 expression in ARHL.
Collapse
Affiliation(s)
- Chunli Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China.,Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China
| | - Zijing Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China.,Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China. .,Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China.
| | - Zhengde Du
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China. .,Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China.
| |
Collapse
|
27
|
Park CH, Yoon KJ, Lee YT, Jin SM, Lee SH, Kim TH. Impact of Low Skeletal Muscle Mass and Obesity on Hearing Loss in Asymptomatic Individuals: A Population-Based Study. Healthcare (Basel) 2022; 10:healthcare10102022. [PMID: 36292469 PMCID: PMC9601859 DOI: 10.3390/healthcare10102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022] Open
Abstract
The relationship between low muscle mass (LMM) with obesity and hearing loss has been poorly studied. We aimed to investigate the association of LMM and obesity on hearing loss in the general population. A total of 265,792 adults who underwent a hearing test and body composition analyses were included. Pre-sarcopenia was defined as having an appendicular muscle mass index <5.7 kg/m2 for women and <7.0 kg/m2 for men, and obesity as a body mass index ≥25 kg/m2, while pre-sarcopenic obesity was defined as the co-presence of LMM and obesity. Participants were divided into four groups according to the presence of pre-sarcopenia and/or obesity. The prevalence of hearing loss was 1.8% in the control, 2.5% in the pre-sarcopenia alone, 3.0% in the obesity alone, and 6.2% in the pre-sarcopenic obesity group (p < 0.001). Hearing Thresholds were the highest in the pre-sarcopenic obesity group compared with the other three groups. In multivariable-adjusted models, the risk of hearing loss was the highest in the pre-sarcopenic obesity group (odds ratio: 1.30 [95% confidence interval: 1.10−1.56]), followed by the obesity alone (1.20 [1.12−1.28]) and pre-sarcopenia alone (1.19 [1.06−1.34]) group compared with the control group (p < 0.001). Pre-sarcopenic obesity was independently associated with a higher prevalence of hearing loss, supporting pre-sarcopenic obesity itself as a risk for the decline in hearing function.
Collapse
Affiliation(s)
- Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Sung Min Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Sang Hyuk Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Tae Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-3579
| |
Collapse
|
28
|
A Five-Year Update on the Profile of Adults Undergoing Cochlear Implant Evaluation and Surgery-Are We Doing Better? Otol Neurotol 2022; 43:e992-e999. [PMID: 36047696 DOI: 10.1097/mao.0000000000003670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the influence of expanding indications on the profile of adults undergoing cochlear implantation (CI) at a high-volume CI center. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS 774 adults undergoing CI evaluation from August 2015 to August 2020. MAIN OUTCOME MEASURES Demographics; audiometry; speech recognition; speech, spatial, and qualities of hearing scale (SSQ-12). RESULTS Of 745 (96.3%) patients qualifying for implantation, 642 (86.6%) pursued surgery. Median age at evaluation was 69 years; 56.3% were men; 88.2% were Caucasian. Median distance to our center was 95 miles. The majority (51.8%) had public insurance (Medicare, Medicaid), followed by private (47.8%) and military (0.4%). Mean PTA, CNC, and AzBio in quiet and noise for the ear to be implanted were 85.2 dB HL, 15.0%, and 19.2% and 3.5%, respectively. Hybrid/EAS criteria were met by 138 (18.5%) CI candidates, and 436 (77.0%) unilateral CI recipients had aidable contralateral hearing for bimodal hearing configurations. Younger age (odds ratio [OR], 0.96; 95% confidence interval, 0.93-0.99) and non-Caucasian race (OR, 6.95; 95% confidence interval, 3.22-14.98) predicted candidacy. Likelihood of surgery increased for Caucasian (OR, 8.08; 95% confidence interval, 4.85-13.47) and married (OR, 2.28; 95% confidence interval, 1.50-3.47) patients and decreased for those with public insurance (OR, 0.45; 95% confidence interval, 0.29-0.69). A lower SSQ-12 score predicted both candidacy and surgery. CONCLUSION Despite expansions in criteria, speech understanding remained extremely low at CI evaluation. Younger age and non-Caucasian race predicted candidacy, and Caucasian, married patients with private insurance and lower SSQ scores were more likely to pursue surgery.
Collapse
|
29
|
Hearing Aid Usage and Reported Hearing Difficulty in Americans With Subclinical Hearing Loss. Otol Neurotol 2022; 43:e951-e956. [PMID: 36047683 DOI: 10.1097/mao.0000000000003683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Subclinical hearing loss (SCHL) (previously defined by our group as a four-frequency pure tone average [PTA4] >0 to ≤25 dB) has recently been associated with depressive symptoms and cognitive decline. This suggests that the common 25 dB adult cutpoint in the United States for normal hearing may not be sensitive enough. We aim to characterize real-world hearing difficulties, as measured by hearing aid use and self-reported hearing difficulty, among individuals with SCHL. STUDY DESIGN Analysis of biennial cross-sectional epidemiologic survey (National Health and Nutrition Examination Survey, 1999-2012, 2015-2016). SETTING Community, multicentered, national. SUBJECTS Noninstitutionalized US citizens ≥12 years old, n = 19,246. MEASURES PTA4 (500, 1,000, 2,000, 4,000 Hz), high-frequency pure tone average (PTAhf) (6,000, 8,000 Hz), reported hearing aid use, subjective difficulty hearing. RESULTS There were 806,705 Americans with SCHL who wore hearing aids (or 0.35% of the 227,324,096 Americans with SCHL; 95% confidence interval = 0.23%-0.54%). Among those with SCHL, 14.6% (33.1 million Americans) perceived a little trouble hearing and 2.29% (5.21 million Americans) perceived moderate/a lot of trouble hearing. When restricted to the borderline subcategory (>20 to ≤25 dB), 42.43% (6.64 million Americans) had at least a little trouble hearing. Among those with SCHL who wore hearing aids, 81% had a PTAhf >25 dB. CONCLUSION Despite hearing loss traditionally being defined by PTA4 ≤ 25 dB in the United States, nearly 1 million adults and adolescents with SCHL wore hearing aids, and nearly half with borderline HL had subjective difficulty hearing. To better reflect real-world difficulties, stricter definitions of hearing loss should be explored, including a lower cutpoint for the PTA4 or by using the more sensitive PTAhf.
Collapse
|
30
|
Hua JC, Xu XM, Xu ZG, Xue Y, Xu JJ, Hu JH, Wu Y, Chen YC. Abnormal cerebellar network and effective connectivity in sudden and long-term sensorineural hearing loss. Front Aging Neurosci 2022; 14:964349. [PMID: 36034151 PMCID: PMC9403534 DOI: 10.3389/fnagi.2022.964349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a common otology emergency and some SSNHL will develop into a long-term hearing loss (LSNHL). However, whether SSNHL and LSNHL have similar psychiatric patterns remains unknown, as well as the neural substrates. Increasing evidence has proved that the cerebellar network plays a vital role in hearing, cognition processing, and emotion control. Thus, we recruited 20 right SSNHL (RSSNHL), 20 right LSNHL (RLSNHL), and 24 well-matched healthy controls to explore the cerebellar patterns among the three groups. Every participant underwent pure tone audiometry tests, neuropsychological evaluations, and MRI scanning. Independent component analysis (ICA) was carried out on the MRI data and the cerebellar network was extracted. Granger causality analysis (GCA) was conducted using the significant cerebellar region as a seed. Pearson’s correlation analysis was computed between imaging characteristics and clinical features. ICA found the effect of group on right cerebellum lobule V for the cerebellar network. Then, we found decreased outflow from right cerebellum lobule V to right middle orbitofrontal cortex, inferior frontal gyrus, anterior cingulate cortex, superior temporal gyrus, and dorsal lateral prefrontal cortex in RSSNHL group in GCA analysis. No significance was found in RLSNHL subjects. Additionally, the RSSNHL group showed increased effective connectivity from the right middle frontal gyrus (MFG) and the RLSNHL group showed increased effective connectivity from the right insula and temporal pole to the right cerebellum lobule V. Moreover, connections between right cerebellum lobule V and mean time series of the cerebellar network was negatively correlated with anxiety score in RSSNHL and negatively correlated with depression scores in RLSNHL. Effective connectivity from right MFG to right cerebellum lobule V could predict anxiety status in RSSNHL subjects. Our results may prove potential imaging biomarkers and treatment targets for hearing loss in future work.
Collapse
Affiliation(s)
- Jin-Chao Hua
- Department of Otolaryngology, Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Xiao-Min Xu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen-Gui Xu
- Department of Otolaryngology, Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Yuan Xue
- Department of Otolaryngology, Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing-Hua Hu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuanqing Wu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Yu-Chen Chen Yuanqing Wu
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Yu-Chen Chen Yuanqing Wu
| |
Collapse
|
31
|
Lenatti M, Moreno-Sánchez PA, Polo EM, Mollura M, Barbieri R, Paglialonga A. Evaluation of Machine Learning Algorithms and Explainability Techniques to Detect Hearing Loss From a Speech-in-Noise Screening Test. Am J Audiol 2022; 31:961-979. [PMID: 35877954 DOI: 10.1044/2022_aja-21-00194] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to analyze the performance of multivariate machine learning (ML) models applied to a speech-in-noise hearing screening test and investigate the contribution of the measured features toward hearing loss detection using explainability techniques. METHOD Seven different ML techniques, including transparent (i.e., decision tree and logistic regression) and opaque (e.g., random forest) models, were trained and evaluated on a data set including 215 tested ears (99 with hearing loss of mild degree or higher and 116 with no hearing loss). Post hoc explainability techniques were applied to highlight the role of each feature in predicting hearing loss. RESULTS Random forest (accuracy = .85, sensitivity = .86, specificity = .85, precision = .84) performed, on average, better than decision tree (accuracy = .82, sensitivity = .84, specificity = .80, precision = .79). Support vector machine, logistic regression, and gradient boosting had similar performance as random forest. According to post hoc explainability analysis on models generated using random forest, the features with the highest relevance in predicting hearing loss were age, number and percentage of correct responses, and average reaction time, whereas the total test time had the lowest relevance. CONCLUSIONS This study demonstrates that a multivariate approach can help detect hearing loss with satisfactory performance. Further research on a bigger sample and using more complex ML algorithms and explainability techniques is needed to fully investigate the role of input features (including additional features such as risk factors and individual responses to low-/high-frequency stimuli) in predicting hearing loss.
Collapse
Affiliation(s)
- Marta Lenatti
- Institute of Electronics, Information Engineering and Telecommunications, National Research Council of Italy, Milan
| | - Pedro A Moreno-Sánchez
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Finland.,Faculty of Medicine and Health Technology, Tampere University, Seinäjoki, Finland
| | - Edoardo M Polo
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Italy
| | - Maximiliano Mollura
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Riccardo Barbieri
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Alessia Paglialonga
- Institute of Electronics, Information Engineering and Telecommunications, National Research Council of Italy, Milan
| |
Collapse
|
32
|
Dubno JR, Majumder P, Bettger JP, Dolor RJ, Eifert V, Francis HW, Pieper CF, Schulz KA, Silberberg M, Smith SL, Walker AR, Witsell DL, Tucci DL. A pragmatic clinical trial of hearing screening in primary care clinics: cost-effectiveness of hearing screening. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:26. [PMID: 35751122 PMCID: PMC9233354 DOI: 10.1186/s12962-022-00360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hearing loss is a high prevalence condition among older adults, is associated with higher-than-average risk for poor health outcomes and quality of life, and is a public health concern to individuals, families, communities, professionals, governments, and policy makers. Although low-cost hearing screening (HS) is widely available, most older adults are not asked about hearing during health care visits. A promising approach to addressing unmet needs in hearing health care is HS in primary care (PC) clinics; most PC providers (PCPs) do not inquire about hearing loss. However, no cost assessment of HS in community PC settings has been conducted in the United States. Thus, this study conducted a cost-effectiveness analysis of HS using results from a pragmatic clinic trial that compared three HS protocols that differed in the level of support and encouragement provided by the PC office and the PCPs to older adults during their routine visits. Two protocols included HS at home (one with PCP encouragement and one without) and one protocol included HS in the PC office. METHODS Direct costs of the HS included costs of: (1) educational materials about hearing loss, (2) PCP educational and encouragement time, and (3) access to the HS system. Indirect costs for in-office HS included cost of space and minimal staff time. Costs were tracked and modeled for each phase of care during and following the HS, including completion of a diagnostic assessment and follow-up with the recommended treatment plan. RESULTS The cost-effectiveness analysis showed that the average cost per patient is highest in the patient group who completed the HS during their clinic visit, but the average cost per patient who failed the HS is by far the lowest in that group, due to the higher failure rate, that is, rate of identification of patients with suspected hearing loss. Estimated benefits of HS in terms of improvements in quality of life were also far greater when patients completed the HS during their clinic visit. CONCLUSIONS Providing HS to older adults during their PC visit is cost-effective and accrues greater estimated benefits in terms of improved quality of life. TRIAL REGISTRATION clinicaltrials.gov (Registration Identification Number: NCT02928107).
Collapse
Affiliation(s)
- Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rowena J Dolor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Eifert
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Howard W Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Carl F Pieper
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Kristine A Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Mina Silberberg
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Sherri L Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Amy R Walker
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - David L Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Debara L Tucci
- National Institute On Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
33
|
Lisan Q, Goldberg M, Lahlou G, Ozguler A, Lemonnier S, Jouven X, Zins M, Empana JP. Prevalence of Hearing Loss and Hearing Aid Use Among Adults in France in the CONSTANCES Study. JAMA Netw Open 2022; 5:e2217633. [PMID: 35713903 PMCID: PMC9206187 DOI: 10.1001/jamanetworkopen.2022.17633] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Although hearing loss is common in the population worldwide, the prevalence of hearing loss and hearing aid use is not known. OBJECTIVE To estimate the prevalence of hearing loss and hearing aid use in the adult French population. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the CONSTANCES cohort, a representative sample of the French population. Volunteers aged 18 to 75 years were recruited at 21 preventive health centers between January 1, 2012, and December 31, 2019. The present study included participants with audiometric data. MAIN OUTCOMES AND MEASURES The main outcomes were prevalence of hearing loss and disabling hearing loss overall and by sex and age group and prevalence of self-reported hearing aid use among those with disabling hearing loss. Hearing loss was defined as a pure-tone average (PTA) in the better ear of 20 dB or higher, and disabling hearing loss was defined as a PTA in the better ear of 35 dB or higher. RESULTS Of 200 870 participants in the CONSTANCES study, 186 460 had full audiometric data and were included in this study (mean [SD] age, 47.1 [13.5] years); 100 330 (53.8%) were female, and 86 130 (46.2%) were male. Of these participants, 24.8% (95% CI, 24.6%-25.0%) had hearing loss and 4.3% (95% CI, 4.2%-4.4%) had disabling hearing loss. The prevalence rates of hearing loss increased from 3.4% (95% CI, 2.8%-3.9%) at age 18 to 25 years to 73.3% (95% CI, 69.5%-77.2%) at age 71 to 75 years among men and from 4.4% (95% CI, 3.9%-5.0%) at age 18 to 25 years to 64.1% (95% CI, 59.7%-68.4%) at age 71 to 75 years among women. The prevalence of disabling hearing loss increased from 0.3% (95% CI, 0.2%-0.4%) among participants aged 18 to 25 years to 23.3% (95% CI, 20.7%-26.0%) among participants aged 71 to 75 years. Among the 8050 participants with disabling hearing loss, 36.8% (95% CI, 35.8%-37.9%) reported using hearing aids, including 56.7% (95% CI, 38.9%-74.4%) aged 18 to 25 years and 32.9% (95% CI, 26.8%-39.2%) aged 71 to 75 years. CONCLUSIONS AND RELEVANCE In this cohort study, hearing loss was prevalent in France, and the prevalence of hearing loss increased with age among both men and women. Hearing aids were underused, particularly among older individuals. These findings suggest that hearing loss prevention and screening in the French population are needed.
Collapse
Affiliation(s)
- Quentin Lisan
- Department of Head and Neck Surgery, Foch Hospital, Suresnes, France
- Université Paris Cité, INSERM, U970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease, Paris, France
| | - Marcel Goldberg
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Ghizlene Lahlou
- Assistance Publique–Hôpitaux de Paris Sorbonne Université, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Département d’Oto-Rhino-Laryngologie, Unité Fonctionnelle Implants Auditifs, Paris, France
- Institut de l’Audition/Institut Pasteur, Équipe Technologies and Gene Therapy for Deafness, Paris, France
| | - Anna Ozguler
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Sylvie Lemonnier
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Xavier Jouven
- Université Paris Cité, INSERM, U970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease, Paris, France
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Marie Zins
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Jean-Philippe Empana
- Université Paris Cité, INSERM, U970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease, Paris, France
| |
Collapse
|
34
|
Tonelli M, Warick R. Focusing on the Needs of People With Hearing Loss During the COVID-19 Pandemic and Beyond. JAMA 2022; 327:1129-1130. [PMID: 35238871 DOI: 10.1001/jama.2022.3026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruth Warick
- International Federation of Hard of Hearing People, Hamburg, Germany
| |
Collapse
|
35
|
Myers C, Reed NS, Lin FR, Willink A. A Broad Examination of Health Policy Barriers to Access and Affordability of Hearing Treatment for Medicare Beneficiaries. Semin Hear 2022; 43:13-19. [PMID: 35719747 DOI: 10.1055/s-0042-1743122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In 2016, the National Academies on Science, Engineering, and Medicine (NASEM) released a report titled, "Hearing Health Care for Adults," which detailed the challenges and provided recommendations for improving the access to affordable hearing care for adults in the United States. Arguably the most significant outcome from this report was the subsequent passage of the Over-the-Counter Hearing Aid Act in 2017, which requires the Food and Drug Administration to develop regulations for a class of hearing aids that address mild to moderate hearing loss to be available for sale over the counter (OTC). While this presents an important step toward improving access and affordability of hearing treatment, it does not represent a complete solution. In fact, optimizing the new landscape of hearing care for individuals with hearing loss also may require new policy solutions. This article reflects on the progress achieved since the NASEM report and the policy issues that remain to improve accessibility and affordability of hearing care among older adults.
Collapse
Affiliation(s)
- Clarice Myers
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Frank R Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amber Willink
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland.,Menzies Centre for Health Policy and Economics, University of Sydney, New South Wales, Australia
| |
Collapse
|
36
|
Zhao C, Chen Z, Liang W, Yang Z, Du Z, Gong S. D-Galactose-Induced Accelerated Aging Model on Auditory Cortical Neurons by Regulating Oxidative Stress and Apoptosis in Vitro. J Nutr Health Aging 2022; 26:13-22. [PMID: 35067698 DOI: 10.1007/s12603-021-1721-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Age-related hearing loss (ARHL) is much more prevalent with age, affecting not only peripheral but central auditory system. We have previously established an aging model of peripheral auditory system in vitro using cultured cochlear basilar membrane. However, there is no ideal accelerated aging model on central auditory system in vitro. To establish the aging model, auditory cortical neurons (ACNs) were primary cultured and treated with either vehicle or different doses of D-galactose (D-gal). We studied the effect of D-gal on ACNs by evaluating the hallmarks of aging, including cell proliferation, oxidative stress, mitochondrial function, and neuronal apoptosis. Compared with the control group, cell viability was significantly inhibited in the D-gal-treated group in a dose-dependent manner. The production of reactive oxygen species was strongly increased in the D-gal-treated group. Meanwhile, the level of 8-hydroxy-2'-deoxyguanosine, which is a biomarker of DNA oxidative damage, was even higher in the D-gal-treated group than that in the control group. Conversely, the levels of ATP and mitochondrial membrane potential were notably decreased in the D-gal-treated group contrast to that in the control group. Furthermore, the number of neuronal apoptosis in the D-gal-treated group, compared with that in the control group, was dramatically increased in a dose-dependent approach. Together, our results demonstrate that ACNs treated with D-gal in vitro display senescence characteristics by regulating oxidative stress and apoptosis, indicating accelerated aging model on ACNs are successfully established. And the model provides a promising approach for exploring underlying mechanisms of the ARHL.
Collapse
Affiliation(s)
- C Zhao
- Dr. Zhengde Du and Dr. Shusheng Gong: , Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing 100050, China
| | | | | | | | | | | |
Collapse
|
37
|
Grewal M, Dragon J, Golub JS. Age-Related Disparities in the Treatment of Borderline/Mild Hearing Loss in the United States. OTO Open 2022; 6:2473974X221083092. [PMID: 35274074 PMCID: PMC8902192 DOI: 10.1177/2473974x221083092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/29/2022] [Indexed: 11/15/2022] Open
Abstract
To investigate disparities in hearing aid use across the life span for borderline/mild hearing loss, a cross-sectional epidemiologic study in the National Health and Nutrition Examination Survey was conducted. Multivariable logistic regressions controlling for hearing level analyzed the association between hearing aid use and age in borderline/mild hearing loss. Age was grouped into quartiles. Of 2470 subjects, 2.0% (n = 50) were <25 years old; 12.0% (n = 297), 25 to 49 years; 65.5% (n = 1618), 50 to 74 years; and 20.5% (n = 505), ≥75 years. When compared with the youngest quartile and while controlling for hearing level, those in the second quartile were 4.6 times less likely to use hearing aids (P < .01); those in the third were 4.2 times less likely (P < .01); and those in the fourth were 4.7 times less likely (P < .001). The dramatically lower hearing aid usage of all older age groups as compared with children/younger adults represents a large unaddressed age-related disparity in the treatment of borderline/mild hearing loss.
Collapse
Affiliation(s)
- Maeher Grewal
- Department of Otolaryngology–Head and
Neck Surgery, Vagelos College of Physicians and Surgeons,
NewYork–Presbyterian/Columbia University Irving Medical Center, Columbia University,
New York, New York, USA
| | - Jacqueline Dragon
- Department of Otolaryngology–Head and
Neck Surgery, Vagelos College of Physicians and Surgeons,
NewYork–Presbyterian/Columbia University Irving Medical Center, Columbia University,
New York, New York, USA
| | - Justin S. Golub
- Department of Otolaryngology–Head and
Neck Surgery, Vagelos College of Physicians and Surgeons,
NewYork–Presbyterian/Columbia University Irving Medical Center, Columbia University,
New York, New York, USA
| |
Collapse
|
38
|
Babajanian EE, Patel NS, Gurgel RK. The Impact of Cochlear Implantation: Cognitive Function, Quality of Life, and Frailty in Older Adults. Semin Hear 2021; 42:342-351. [PMID: 34912162 PMCID: PMC8660171 DOI: 10.1055/s-0041-1739367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This review examines the relationship between cochlear implantation and cognition and quality of life in older adults, as well as how frailty affects outcomes for older patients with cochlear implants. A growing body of evidence suggests that there is a strong association between hearing loss and cognitive impairment. Preliminary studies suggest that cochlear implantation in older adults may be protective against cognitive decline. While studies have observed a positive impact of cochlear implantation on quality of life, currently it is unclear what factors contribute the most to improved quality of life. Frailty, as a measurement of general health, likely plays a role in complication rates and quality-of-life outcomes after cochlear implantation, though larger prospective studies are required to further elucidate this relationship.
Collapse
Affiliation(s)
- Eric E Babajanian
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Neil S Patel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
39
|
Man J, Chen H, Zhang T, Yin X, Yang X, Lu M. Global, regional, and national burden of age-related hearing loss from 1990 to 2019. Aging (Albany NY) 2021; 13:25944-25959. [PMID: 34910687 PMCID: PMC8751586 DOI: 10.18632/aging.203782] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
The global distribution and temporal trend of age-related hearing loss (ARHL) are unknown, and we aimed to investigate magnitudes and temporal trends of ARHL burden and its influencing factors at the national, regional, and global levels. Based on the information of Global Burden of Disease Study 2019, we calculated the estimated annual percentage change to quantify the global, regional, and national temporal trends of age-standardized rates (ASRs) of ARHL by gender, age, and severity. The number of prevalent cases and disability-adjusted life years (DALYs) of ARHL increased from 751.50 million and 22.01 million in 1990 to 1456.66 million and 40.24 million in 2019, respectively. Except for a few countries such as Niger and Burkina Faso, the age-standardized prevalence rate and age-standardized DALYs rate showed a downward trend in most countries and regions. Mild ARHL accounted for the largest proportion in all ARHL, and only mild ARHL showed an upward trend in ASRs. In most regions, the proportion of ARHL disease burden attributable to occupational noise showed a downward trend in the past 30 years. In 2019, ARHL disease burden attributable to occupational noise declined with the increase of socio-demographic index in countries. Although the ASR of ARHL in most parts of the world is declining, the absolute disease burden of ARHL is still heavy. Understanding the real-time disease burden of ARHL and its temporal trend is of great significance for formulating more effective preventive measures and reducing the ARHL burden.
Collapse
Affiliation(s)
- Jinyu Man
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongchao Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaolin Yin
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ming Lu
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
40
|
Nassiri AM, Marinelli JP, Sorkin DL, Carlson ML. Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery. Semin Hear 2021; 42:311-320. [PMID: 34912159 PMCID: PMC8660164 DOI: 10.1055/s-0041-1739281] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Persistent underutilization of cochlear implants (CIs) in the United States is in part a reflection of a lack of hearing health knowledge and the complexities of care delivery in the treatment of sensorineural hearing loss. An evaluation of the patient experience through the CI health care delivery process systematically exposes barriers that must be overcome to undergo treatment for moderate-to-severe hearing loss. This review analyzes patient-facing obstacles including diagnosis of hearing loss, CI candidate identification and referral to surgeon, CI evaluation and candidacy criteria interpretation, and lastly CI surgery and rehabilitation. Pervasive throughout the process are several themes which demand attention in addressing inequities in hearing health disparities in the United States.
Collapse
Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John P. Marinelli
- Department of Otolaryngology - Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | | | - Matthew L. Carlson
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|