Hearing loss and cognitive decline in older adults

Hearing Loss Is Associated With Increased Mortality in a Cohort of Older Construction Trades Workers

BACKGROUND

Hearing loss has been associated with increased mortality, and there is evidence that regular use of hearing aids reduces the mortality risk. However, these associations have not been sufficiently studied in worker populations at high risk for noise-induced hearing loss.

METHODS

Medical examination data for 19,379 workers employed in US Department of Energy (DOE) facilities were used. Speech-frequency pure-tone average hearing loss and hearing aid use were ascertained. Mortality status through 2021 was obtained from the National Death Index. Cox regression examined the association between hearing loss and mortality and the impact of hearing aid use.

RESULTS

Eight thousand eighty-one workers (41.3%) had speech-frequency hearing loss and 2228 (15.3%) of these workers reported use of hearing aids. A total of 5398 deaths occurred over a median follow-up of 11.1 years. Hearing loss was an independent risk factor for higher mortality with an adjusted hazard ratio (HR) of 1.10 (95% CI = 1.03-1.17). The HR increased with hearing loss severity but the relationship was non-linear. Hearing aid users were at 30% reduced risk of mortality compared to those not using hearing aids (HR = 0.70, 95% CI = 0.63-0.77).

CONCLUSIONS

Results are consistent with research linking hearing loss with increased mortality and the preventive impact of hearing aid use. These findings should inform workers' compensation programs in favor of: (1) better coverage of hearing loss for noise-exposed workers, and (2) inclusion of hearing aids in medical benefits. Reduction in noise exposures is a priority and workers with hearing loss should be encouraged to use hearing aids.

Cognitive Changes Up to 4 Years After Cochlear Implantation in Older Adults: A Prospective Longitudinal Study Using the RBANS-H

OBJECTIVES

Hearing loss is a worldwide health problem that currently affects around 20% of the world's population. Untreated hearing loss can have a significant impact on daily life, it can cause social isolation, loneliness, frustration, and higher anxiety and depression rates. Furthermore, older adults with hearing impairment have a higher risk for accelerated cognitive decline compared with normal-hearing individuals. Previous research indicated a positive effect of cochlear implantation on Health-related Quality of life (HRQoL) and cognitive functioning 1 year after cochlear implantation. The aim of this study was to evaluate the long-term effect of cochlear implantation on cognition and HRQoL in older adults with severe-to-profound hearing loss.

DESIGN

All included subjects were 55 years or older with postlingual, bilateral, severe-to-profound hearing loss, and received a unilateral cochlear implant. Cognition was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing Impaired Individuals (RBANS-H), and HRQoL was evaluated using the following five questionnaires: Nijmegen Cochlear Implant Questionnaire (NCIQ); Hearing Implant Sound Quality Index (HISQUI); Speech, Spatial, and Qualities of Hearing Scale (SSQ12); Hospital Anxiety and Depression scale (HADS); and Type D questionnaire (DS14). Individuals were evaluated preoperatively, and annually up to 4 years after CI activation.

RESULTS

After cochlear implantation an improvement in hearing, cognition, and HRQoL was observed. When comparing preoperative and 12 months postoperative results a significant improvement was observed in the total RBANS-H score (mean [SD], 92.78 [±15.08] versus 98.35 [±14.18], p < 0.001) and the subdomain scores for "Immediate Memory" (94.13 [±18.75] versus 105.39 [±19.98], p = 0.005), "Attention" (86.17 [±19.02] versus 91.57 [±15.35], p = 0.048), and "Delayed memory" (97.91 [±14.51] versus 103.83 [±14.714], p = 0.017). When comparing preoperative results with 4 years postoperative results, a significant improvement was observed in "Immediate Memory" (94.13 [±18.75] versus 101.91 [±16.09], p = 0.020) and a significant decline was observed in "Visuospatial Memory" (97.04 [±17.47] versus 87.26 [±13.41], p = 0.013). Compared with the preoperative results, no significant improvement was observed in the total RBANS-H score 4 years after implantation. A significant improvement was observed for the HRQoL questionnaires, that is, NCIQ, HISQUI19, SSQ12, HADS, and DS14, 1 year after cochlear implantation. When comparing preoperative results with 4-year postoperative results, significant improvement was observed for the NCIQ and DS14 social inhibition scores. Long-term results of the SSQ12 and HISQUI19 were lacking.

CONCLUSIONS

Unilateral cochlear implantation in an adult population with bilateral severe-to-profound sensorineural hearing loss has a positive effect on cognitive functioning and HRQoL 1 year after activation. This positive effect on cognitive functioning was no longer observed 4 years after cochlear implantation. Further research is needed to explain individual variation in the evolution of cognitive functioning.

Associations Between Vestibular Perception and Cognitive Performance in Healthy Adults

OBJECTIVES

A growing body of evidence has linked vestibular function to the higher-order cognitive ability in aging individuals. Past evidence has suggested unique links between vestibular function and cognition on the basis of end-organ involvement (i.e., otoliths versus canals). However, past studies have only assessed vestibular reflexes despite the diversity of vestibular pathways. Thus, this exploratory study aimed to assess associations between vestibular perception and cognition in aging adults to determine potential relationships.

DESIGN

Fifty adults (21 to 84 years; mean = 52.9, SD = 19.8) were included in this cross-sectional study. All participants completed a vestibular perceptual threshold test battery designed to target perception predominantly mediated by each end-organ pair and intra-vestibular integration: 1 Hz y -translation (utricle), 1 Hz z -translation (saccule), 2 Hz yaw rotation (horizontal canals), 2 Hz right anterior, left posterior (RALP), and left anterior, right posterior (LARP) tilts (vertical canals), and 0.5 Hz roll tilt (canal-otolith integration). Participants also completed standard assessments of cognition and path integration: Digit Symbol Substitution Test (DSST), Trail Making Test (TMT), and the Gait Disorientation Test (GDT). Associations were assessed using Spearman rank correlation, and multivariable regression analyses.

RESULTS

For correlation analyses, DSST correlated to RALP/LARP tilt, roll tilt, and z -translation. TMT-A only correlated to z -translation, and TMT-B correlated to roll tilt and z -translation after correcting for multiple comparisons. GDT correlated to RALP/LARP tilt and y -translation. In age-adjusted regression analyses, DSST and TMT-B were associated with z -translation thresholds and GDT was associated with y -translation thresholds.

CONCLUSIONS

In this cross-sectional study, we identified associations between vestibular perceptual thresholds with otolith contributions and standard measures of cognition. These results are in line with past results suggesting unique associations between otolith function and cognitive performance.

Relationship between hearing thresholds and cognitive function in hearing aid non-users and long-term users post-midlife

The extent of hearing loss requiring hearing aid (HA) to prevent cognitive decline is unclear; we assessed this post-midlife along with the relationship between hearing thresholds and cognitive function in those who had never used HA (non-users) or used HAs for >3 years (long-term users). This study comprised 117 individuals ≥55 years with an average hearing threshold of ≥25 dB HL in their better ear and 55 of the non-users and 62 of the long-term users. The Mini-Mental State Examination, the Symbol Digit Modalities Test (SDMT), and pure-tone and sound-field audiometry were assessed. Mean ± SD hearing levels of the non-user and long-term user group were 40.83 ± 8.16 and 51.13 ± 14.80 dB HL. Non-users showed a significant association (P = 0.01) between the hearing thresholds and SDMT scores, with a cutoff value of above 38.75 dB HL identified as affecting cognitive function. There were no significant associations for long-term users.

Degradation in Binaural and Spatial Hearing, and Auditory Temporal Processing Abilities, as a Function of Aging

Objectives

Sensorineural hearing loss is common with advancing age, but even with normal or near-normal hearing in older persons, performance deficits are often seen for suprathreshold listening tasks such as understanding speech in background noise or localizing sound direction. This suggests there is also a more central source of the problem. Objectives of this study were to examine as a function of age (young adult to septuagenarian) performance on: 1) a spatial acuity task examining localization ability, and a spatial speech-in-noise (SSIN) recognition task, both measured in a hemi-anechoic sound field using a circular horizontal-plane loudspeaker array, and 2) a suprathreshold auditory temporal processing task and a spectro-temporal processing task, both measured under headphones. Further, we examined any correlations between age, hearing thresholds including extended high frequency (EHF: >8000 Hz), and these measures.

Design

Subjects were 48 adults, aged 21 to 78, with either normal hearing or only a mild sensorineural hearing loss through 4000 Hz. The localization task measured minimum audible angle (MAA) for 500 and 4000 Hz 1/3 rd octave narrowband noise (NBN) in diffuse background noise for both an on-axis (reference source 0°) and off-axis (reference source 45°) listening condition at signal-to-noise ratios (SNRs) of -3, -6, -9, and -12 dB. SSIN testing was also completed for key word recognition in sentences in multi-talker babble noise; specifically, the separation between speech and noise loudspeakers was adaptively varied to determine the difference needed for 40% and 80% correct performance levels. Finally, auditory temporal processing ability was examined using the Temporal Fine Structure (TFS) test, and the Spectro-Temporal Modulation (STM) test.

Results

Spatial acuity was poorer (larger MAAs) in older compared to younger subjects, particularly in the more adverse listening conditions (off-axis, and poorer SNRs). The SSIN data also showed declining mean performance with age at both criterion levels, emerging in the middle age group (> 40 years), but was not correlated with standard audiometric hearing thresholds. Decreased performance on the TFS and STM tasks was dependent on age, emerging only in the older (> 60 years) and middle (>40 years) age groups, respectively; neither was dependent on hearing thresholds. Results of multiple regression analyses suggest that SSIN recognition scales with the ability of the subjects to use both low-frequency binaural temporal fine structure as well as higher-frequency binaural envelope cues, both of which are impacted by aging but not necessarily audiometric hearing thresholds. Finally, EHF range hearing thresholds significantly decreased with age, but performance on tasks remained significantly correlated with age when controlled for EHF hearing.

Conclusions

Particularly for more adverse listening conditions, age-related deficits, but not hearing-threshold-related deficits, were found on both of the spatial hearing tasks and in temporal and spectro-temporal processing abilities. It may be that deficits in temporal processing ability contribute to poorer spatial hearing performance in older subjects due to inaccurate coding of binaural/interaural timing information sent from the periphery to the binaural brainstem. In addition, EHF hearing loss may be a coexisting factor in the reduced performance seen in older subjects.

Normative aging results in degradation of gene networks in a zebra finch basal ganglia nucleus dedicated to vocal behavior

Aging increases brain susceptibility to neurodegenerative diseases, but the mechanisms are not clear. Vocal behavior provides an accessible, reliable, and sensitive biomarker to address this because voice changes in middle age can be early indicators of neurodegenerative diseases. The adult male zebra finch is an excellent model organism for these studies due to well-characterized vocal brain circuitry and strong homology to human brain centers. We performed RNA sequencing of song-dedicated basal ganglia nucleus Area X followed by weighted gene co-expression network analyses to examine changes in gene patterns across younger adult, middle, and older ages. Song-correlated gene networks degrade with age, with modules losing their coherence and migrating to different sets of genes, and changes in connection strength particularly for hub genes including those associated with human speech, Parkinson's, and Alzheimer's diseases. Gene pathway enrichment analyses reveal a lack of ongoing metabolic and biogenic processes in older finches. Our findings provide a robust platform for targeting network hubs in the treatment of neurologically driven human vocal disorders.

SENSE-Cog Residential Care: hearing and vision support for residents with dementia in long-term care in Ireland-protocol for a pilot cluster-randomised controlled trial

BACKGROUND

Hearing and vision loss is highly prevalent in residents with dementia (RwD) living in long-term care (LTC) facilities. Sensory loss often has a negative impact on quality of life and other dementia-related outcomes. Optimising sensory function may improve dementia-related outcomes in LTC facilities. The SENSE-Cog Residential Care pilot trial will evaluate whether a multi-faceted hearing and vision intervention for RwD and concurrent sensory loss is suitable for definitive testing in a large-scale cluster-randomised control trial (RCT) in Ireland and how this can best be achieved.

METHODS

This is a 6-month feasibility-pilot, multicentre, cluster RCT. Between eight and 15 LTC facilities (with an average of 5 RwD recruited per home) will be randomly assigned to receive either 'care as usual' (CAU) or a multi-component sensory intervention comprising (1) personalised resident hearing and vision support, (2) staff training in sensory health, (3) fostering a 'sensory friendly' environment, and (4) mapping sensory care provision with community-based audiologists and opticians. The intervention's feasibility, acceptability, and tolerability for residents and staff will be examined. In addition, a battery of exploratory outcome measures will be evaluated for suitability for the definitive trial and to inform the choice of primary and secondary outcome measures.

DISCUSSION

If the SENSE-Cog Residential Care pilot trial demonstrates that the sensory support intervention for residential care is feasible and tolerated in LTC facilities in Ireland, a larger definitive trial to evaluate its effectiveness in improving dementia-related outcomes will be conducted. Training materials, resources, and information will be made available to health and social care providers to enable the implementation of sensory support for RwD in routine LTC, potentially improving the quality of such care in Ireland.

TRIAL REGISTRATION

ISRCTN, ISRCTN14462472. Registered 24 February 2022, https://doi.org/10.1186/ISRCTN14462472.

Feasibility and Repeatability of an Abbreviated Auditory Perceptual and Cognitive Test Battery

PURPOSE

Auditory perceptual and cognitive tasks can be useful as a long-term goal in guiding rehabilitation and intervention strategies in audiology clinics that mostly operate at a faster pace and on strict timelines. The rationale of this study was to assess test-retest reliability of an abbreviated test battery and evaluate age-related auditory perceptual and cognitive effects on these measures.

METHOD

Experiment 1 evaluated the test-retest repeatability of an abbreviated test battery and its use in an adverse listening environment. Ten participants performed two visits, each including four conditions: quiet, background noise, external noise, and background mixed with external noise. In Experiment 2, both auditory perceptual and cognitive assessments were collected from younger adults with normal hearing and older adults with and without hearing loss. The full test battery included measures of frequency selectivity, temporal fine structure and envelope processing, spectrotemporal and spatial processing and cognition, and an external measure of tolerance to background noise.

RESULTS

Results from Experiment 1 showed good test-retest repeatability and nonsignificant effects from background or external noise. In Experiment 2, effects of age and hearing loss were shown across auditory perceptual and cognitive measures, except in measures of temporal envelope perception and tolerance to background noise.

CONCLUSIONS

These data support the use of an abbreviated test battery in relatively uncontrolled listening environments such as clinic waiting rooms. With an efficient test battery, perceptual and cognitive deficits can be assessed with minimal resources and little clinician involvement due to the automated nature of the test and the use of consumer-grade technology.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28021070.

The trajectories of depression and multimorbidity affect the patterns of cognitive decline: a prospective cohort study

BACKGROUND

The course of decline of global cognitive function is heterogeneous, with patterns varying among individuals. The influence of depression, functional limitations and multimorbidity on patterns of decline of global cognitive function among community-dwelling older adults remains unknown. This study examines the relationship between these health conditions and the course of decline of global cognitive function.

METHODS

A prospective cohort of 4032 participants aged ≥60 years at baseline was constructed using the Health and Retirement Study (2006-20), through surveys every 2 years. Information on depression, functional limitations and multimorbidity was collected from 2006 to 2012. Data on cognitive function were collected between 2012 and 2020. Latent class trajectory models were used to identify the latent trajectories. Multinomial logistic regression models were employed to analyse the association between the latent trajectories and cognitive function.

RESULTS

Different trajectories were identified for depression (low-stable, decline-rise and rise-decline), activities of daily living (ADLs; low-stable, decline-rise and rise-decline), instrumental activities of daily living (IADLs; low-stable and rise), and multimorbidity (stable and rise). Three trajectories of cognitive decline were identified: high stable, modest and later steep. The trajectories of depression (for decline-rise: OR: 1.47, 95% CI: 1.11-1.95; for rise-decline: OR: 1.72, 95% CI: 1.24-2.38) and multimorbidity (OR: 1.63, 95% CI: 1.08-2.46) increased the risk of cognitive decline.

CONCLUSION

The trajectories of depression and multimorbidity affect cognitive decline patterns. Longitudinal surveillance of health conditions can be used to identify different patterns of cognitive decline and predict faster cognitive decline.

Hearing and cognitive scores measured with the Montreal Cognitive Assessment Scale in The HUNT Study, Norway

INTRODUCTION

Hearing impairment is associated with dementia. We aimed to clarify the association between hearing impairment and future cognitive test performance measured by the Montreal Cognitive Assessment Scale (MoCA), adjusted for confounders, avoiding reverse causation through long follow-up.

METHODS

We used the Norwegian population-based longitudinal cohort study, The Trøndelag Health Study (HUNT). At baseline, we invited all residents 20+ for an audiometric hearing assessment, and at 20+ years follow-up, we cognitively assessed all persons 70+ including MoCA adjusted for hearing impairment. We analyzed the association using linear regression.

RESULTS

We included 6879 persons (mean 56.1 years, standard deviation 6.2). At follow-up, the MoCA score was -0.25 (95% confidence interval [CI] -0.35, -0.14), per 10 dB increase in hearing threshold and for persons < 85 years, -0.31 (95% CI -0.42, -0.20).

DISCUSSION

This study finds a long-term association between hearing impairment and dose related reduced cognitive performance, particularly in those aged < 85.

CLINICAL TRIAL REGISTRATION

ID NCT04284384, hearing impairment as a risk factor for dementia in older adults.

HIGHLIGHTS

Hearing loss predicts long-term cognitive decline measured by MoCA over 20+ years. Long follow-up is crucial to avoid reverse causation in the hearing-cognition relationship. A 10 dB hearing threshold increase is linked to a 0.25-point reduction in MoCA score. Strongest cognitive decline associations are seen in people aged below 85 years. The association remained after excluding hearing-dependent tasks in the MoCA.

Evaluating the accuracy of a self-administered smartphone hearing test application in a geriatric population

BACKGROUND

As the global population ages, hearing loss becomes increasingly prevalent, and is associated with neurocognitive and psychiatric comorbidities, impacting quality of life. Early screening and timely intervention might prevent or delay cognitive decline, a gap in care that can potentially be addressed by self-administered smartphone hearing tests.

OBJECTIVE

This study aims to evaluate the accuracy of Mimi™ (Berlin, Germany), a commercially available self-administered smartphone hearing test compared to pure tone audiogram (PTA) in terms of both hearing levels and hearing thresholds in our local geriatric population > 65 years-old.

METHOD

Fifty-two participants above 65 years of age requiring conventional audiograms were recruited from a National Referral University Hospital Otolaryngology clinic from March to June 2022. All participants were administered the conventional PTA tests in a sound-proof booth conducted by audiology technicians followed by Mimi™ Hearing Test in a quiet clinic room. Comparisons between the hearing levels of both tests were analyzed using Spearman's rank correlation coefficient, Bland-Altman plots and Gwet's Kappa which looked at concordance. Hearing thresholds were then analysed using the Wilcoxon signed rank (SR) test.

RESULTS

Mimi™ showed strong to very strong correlation with good agreement compared to readings obtained from formal PTA. Concordance in determining hearing loss also showed substantial to almost perfect agreement at each individual frequency, with values of kappa falling between 0.735-0.857. In terms of thresholds, there were no significant differences in thresholds given by both tests except for 2.0 kHz, HFPTA and 4FPTA (p < 0.05).

CONCLUSION

Mimi™ serves as a good screening tool for detection of moderate hearing loss for early pickup and treatment except at higher frequencies. The smartphone hearing test is also less accurate in determining the extent of hearing loss and formal PTA after hearing loss is detected on screening should still be standard of care.

Establishment of self-reported hearing cut-off value on the Chinese version of short form of speech, spatial and qualities of hearing scale (SSQ12)

OBJECTIVE

The aim of this study was to evaluate the efficacy of the Chinese version of Speech, Spatial and Qualities of Hearing Scale (C-SSQ12) in the Chinese Mandarin-speaking population and to determine its screening cut-off value by comparing measured pure-tone average (PTA), the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) scores and C-SSQ12 scores.

DESIGN

All participants completed the C-SSQ12 questionnaire and underwent the pure-tone audiometry. Older subjects aged ≧ 60 years completed the HHIE-S questionnaire. The optimal cut-off value for the C-SSQ12 as a hearing screening tool was calculated by comparing different cut-offs and hearing thresholds.

STUDY SAMPLE

A total of 300 subjects were recruited.

RESULTS

There was a negative correlation between C-SSQ12 scores and HHIE-S scores (r = -0.749). C-SSQ12 scores were negatively correlated with PTA (r = -0.507; r = -0.542). The best cut-off value for the C-SSQ12 was 6.0, with a sensitivity of 78.2%, specificity of 80.3%, positive predictive value of 63.7% and negative predictive value of 97.0% (PTA > 40dBHL for bilateral ears).

CONCLUSIONS

Compared to mild hearing loss, the C-SSQ12 is a reliable and validated hearing screening tool with increased sensitivity for detecting moderate-to-severe hearing loss.

The Prevalence and Related Factors of Hearing Loss Among Adults: A Systematic Review and Meta-Analyses

OBJECTIVES

We aimed to estimate the global prevalence of hearing loss among adults and to explore its associated factors.

METHODS

Our systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). We retrieved corresponding documents published up to Sep 24, 2021 in PubMed and Web of Science. Random-effects models were used to calculate the pooled prevalence of hearing loss. Subgroup analyses were conducted to explore potential heterogeneity.

RESULTS

The pooled prevalence of any hearing loss across 100 studies was 31.0% (95% CI: 26.9-35.1, P < .001, I2 = 99.9%), and the pooled prevalence of disabling hearing loss across 34 studies was 15.9% (95% CI: 11.1-20.7, P < .001, I2 = 99.9%). The prevalence of hearing loss was higher in the year range of 2000 to 2009, among the elder (≥70) or males, in studies using either ear side of hearing loss definition or in the region of the Americas. Ear disease or surgery, job noise exposure, current smoking, off-work noise exposure, males, cardiovascular disease, past drinking, diabetes mellitus, hypertension, older age, and past smoking are risk factors of hearing loss while education level surpasses high school acts as a protect factor for hearing.

CONCLUSION

Our results demonstrate high prevalence of hearing loss among adults worldwide and verify several related factors of the disease. Prevention and intervention measures should be implemented.

Time-Driven Activity Based Costing of an Annual Canadian Cochlear Implant Program

OBJECTIVE

To define the cost necessary to run an adult cochlear implant (CI) program, including assessment, subsequent implantation, and follow from the Canadian provincial government perspective.

STUDY DESIGN

Time-driven activity based costing (TDABC) of a CI program.

SETTING

Adult provincial CI referral center.

METHODS

Clinical scenario pathways were developed and verified with stakeholders. TDABC was then applied to all steps involved in the pathway. Costing was based on all patients referred to the CI program in 2019. All costs were calculated in Canadian (and American) dollars as of 2023.

RESULTS

This is the first TDABC model of a CI program to the authors knowledge. In 2019, 296 referrals were placed to our CI program and 154 were surgical candidates. The calculated total annual cost for patients referred in 2019 was $4.542 million ($3.365 million USD), or $29,511 ($21,865 USD) per patient implanted. The largest cost contributors to patient cycles were surgical day costs ($23,164 [$17,185 USD] for unilateral, $43,356 [$32,165 USD] for bilateral), switch-on day costs ($1068 [$791 USD] for unilateral, $1511 [$1120 USD] for bilateral), and audiological assessment costs ($692 [$512 USD]). The highest single cost on the pathway was due to the actual CI device when used. Across other patient steps, the highest costs were related to labor.

CONCLUSION

This TDABC evaluation of a CI program found the annual cost required to meet all referrals was $4.542 million ($3.365 million USD), or $29,511 ($21,865 USD) per patient implanted. The highest single-cost was associated with the CI device itself.

Acquired hypothyroidism, iodine status and hearing impairment in adults: A pilot study

OBJECTIVES

Hearing impairment can have major impacts on behavior, educational attainment, social status, and quality of life. In congenital hypothyroidism, the incidence of hearing impairment reaches 35-50%, while in acquired hypothyroidism there is a reported incidence of 25%. Despite this, knowledge of the pathogenesis, incidence and severity of hearing impairment remains greatly lacking. The aim of our study was to evaluate hearing in patients with acquired hypothyroidism.

METHODS

30 patients with untreated and newly diagnosed peripheral hypothyroidism (H) and a control group of 30 healthy probands (C) were enrolled in the study. Biochemical markers were measured, including median iodine urine concentrations (IUC) µg/L. The hearing examination included a subjective complaint assessment, otomicroscopy, tympanometry, transitory otoacoustic emission (TOAE), tone audiometry, and brainstem auditory evoked potential (BERA) examinations. The Mann-Whitney U test, Fisher's Exact test and multivariate regression were used for statistical analysis.

RESULTS

The H and C groups had significantly different thyroid hormone levels (medians with 95% CI) TSH mU/L 13.3 (8.1, 19.3) vs. 1.97 (1.21, 2.25) p =  0 and fT4 pmol/L 10.4 (9.51, 11.1) vs. 15 (13.8, 16.7) p =  0. The groups did not significantly differ in age 39 (34, 43) vs. 41 (36,44) p =  0.767 and IUC 142 (113, 159) vs. 123 (101, 157) p =  0.814. None of the hearing examinations showed differences between the H and C groups: otomicroscopy (p =  1), tympanometry (p =  1), TOAE (p =  1), audiometry (p =  0.179), and BERA (p =  0.505).

CONCLUSIONS

We did not observe any hearing impairment in adults with acquired hypothyroidism, and there were no associations found between hearing impairment and the severity of hypothyroidism or iodine status. However, some forms of hearing impairment, mostly mild, were very common in both studied groups.

Cochlear implantation and cognitive function in the older adult population: current state of the art and future perspectives

OBJECTIVES

Hearing loss is associated with increased cognitive decline and incident dementia in older adults. Given the rapidly rising incidence of dementia, management of modifiable risk factors such as hearing loss, is essential to mitigate the impact on the individual and society in general. In this narrative review, we discuss the current state-of-art with respect to studying cognitive function before and after cochlear implantation in the elderly population. Future perspectives are considered to shed light into the pathophysiology of cognitive decline due to hearing loss and how objective measures may contribute to this field.

METHODS

The existing literature on cochlear implantation and cognition is reviewed. The potential limitations and objective measures for cognitive functioning are discussed. Relevant studies were identified through a broad search of academic databases, including Pubmed and Web of Science. Given the narrative nature of this review, no strict inclusion or exclusion criteria were applied, allowing for a broad overview of the current state-of-the-art literature on the effects of cochlear implantation on cognitive functioning, the challenges of studying cognition in this population and future research directions.

RESULTS

Multiple studies have been able to demonstrate an improvement of cognitive functioning in older adults with severe-to-profound hearing loss after cochlear implantation. However, it is important to consider the challenges of studying cognition in this population. Evoked response potentials might have potential as an objective marker for cognition in this study population.

CONCLUSION

Although there is no standardized study protocol to investigate cognition after cochlear implantation, a significant improvement in cognition is observed in the majority of studies one year after cochlear implantation. The identification of an objective marker of cognitive functioning will help unravel how cochlear implantation affects cognition.

Association of hearing loss with cognitive function and mental health in Africa: A systematic review

OBJECTIVE

To summarize the evidence for the associations between hearing loss and mental health and cognitive function in Africa.

METHODS

This systematic review was prepared following the PRISMA guidelines. Cohort, case‒control and cross-sectional studies were considered for inclusion if they reported the prevalence of any mental health conditions or levels of cognitive functioning among persons with hearing loss/deafness in comparison to those without hearing loss. No age restriction was applied. Articles not published in English or not from the African subcontinent were excluded. The initial search yielded a total of 2,822 articles from electronic databases. After title, abstract and full-text screening, seven articles were found to be eligible, with a total of 2,761 participants across Africa.

RESULTS

Five studies reported that hearing difficulties were significantly associated with an increased prevalence of poor mental health. Two studies reported on cognition, one on higher odds (2.22; 95%CI) of developing cognitive decline among persons with hearing difficulties than among those with normal hearing. The majority of studies were conducted among special populations (i.e., retirement homes and special schools), with most participants being female.

CONCLUSION

This study revealed an increased risk of mental health disorders and/or cognitive decline for people with hearing impairment in African populations. However, the number of relevant studies is small, and more research is needed to provide evidence for public health interventions across the continent.

TRIAL REGISTRATION

PROSPERO-CRD42024520957.

Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States

BACKGROUND

Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes.

OBJECTIVES

To investigate the associations between self-recognition of hearing loss and hospitalization outcomes.

RESEARCH DESIGN AND SUBJECTS

This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study.

EXPOSURES AND OUTCOMES

The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss.

RESULTS

Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss.

CONCLUSIONS

In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.

Blood Neurofilament Light Chain and Phospho-Tau 181 in Subjects with Mild Cognitive Impairment Due to Age-Related Hearing Loss

Background: Mild cognitive impairment is increasingly recognized as a precursor to more severe neurodegenerative conditions, particularly in the context of aging. Recent studies have highlighted the intersection of hearing loss and cognitive decline, suggesting that auditory deficits may exacerbate cognitive impairments in older adults, proposing the use of hearing aids to mitigate cognitive decline, and indicating that early intervention in hearing loss could be crucial for preserving cognitive function. The underlying mechanisms of the relationship between hearing and cognitive impairment may involve neuroinflammatory processes and neurodegeneration. Recent studies have evidenced the role of tau proteins and neurofilaments as biomarkers in the onset and progression of neurodegenerative diseases. Methods: We selected 30 subjects with age-related hearing loss, and we evaluated their cognitive status through the administration of screening tests, which also measured neurofilament light chain and phospho-tau 181 serum levels as biomarkers of neurodegeneration. The subjects were re-evaluated six months after the hearing aid fitting. Results: Patients with hearing impairment presented slightly altered results on cognitive tests, typical of a mild cognitive impairment. At the same time, serum levels of neurofilament light chain and phospho-tau 181 were significantly increased compared to the matched control group. After the hearing aids fitting, auditory, cognitive, and serum values results improved. Conclusions: The results of the study highlight the cognitive involvement in patients with hearing impairment and identify neurofilament light chain and phospho-tau 181 as serum biomarkers of neurodegeneration useful in monitoring the pathology.

Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing

Background

Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional.

Objective

We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release.

Methods

We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2-5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities.

Results

Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety.

Conclusions

This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss.

Montreal Cognitive Assessment Hearing Impairment (MoCA-H): cross-cultural adaptation to Brazilian Portuguese

PURPOSE

This study aimed to adapt the Montreal Cognitive Assessment Hearing Impaired (MoCA-H) into Brazilian Portuguese (BP).

METHODS

This was a descriptive, cross-sectional, quantitative, and qualitative study involving participants selected by convenience. The instrument was adapted from its original version, in a six-stage process consisting of the following: Stage 1 - Translation and back translation of the MoCA-H; Stage 2 - Stimulus analysis and selection; Stage 3 - Semantic analysis of stimuli; Stage 4 - Analysis by non-expert judges, part 1; Stage 5 - Analysis by non-expert judges, part 2; Stage 6 - Pilot study. The following statistical methods were used in this study: parametric T-test, Gwet's first-order Agreement Coefficient (AC1), and the Content Validity Ratio (CVR).

RESULTS

Cultural and linguistic adaptations were made to the instrument as well as changes to administration procedures to improve respondent comprehension. Participants with and without hearing loss had some comprehension difficulties in the visualspatial/executive domain task. This was observed not only in Stage 6 but also from the beginning of the adaptation process.

CONCLUSION

The adaptation process yielded an instrument with satisfactory content validity.

The opportunities in implementing assistive technology in oral health care for individuals with sensory impairments: a systematic review

PURPOSE

People with sensory impairments (SI) face unique challenges in out-of-home care, especially in oral health (OH) care, compared to the general population. Various assistive technologies (ATs) and media are used to influence OH behaviors and outcomes for individuals with SI. This systematic review (SR) aimed to identify the types of ATs and assess their effectiveness for individuals with SI.

METHODS

A comprehensive search strategy was applied across Scopus, PubMed, Cochrane Library, ProQuest, and Scopus databases, using expert-validated keywords, with manual searches for relevant articles published from June 2013 to June 2023. The SR followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies focused on the use of ATs as OH education tools for individuals with SI and assessed their impact on OH behavior and status.

RESULTS

Eighteen of the 1298 identified studies were included in the data synthesis. ATs, such as images, software, multimedia, audio, video, audio-tactile performance, and combination methods, were effective for OH care in individuals with SI. However, this SR limitations include study heterogeneity in sample sizes, intervention types, and outcomes, as well as the exclusion of non-English studies.

CONCLUSIONS

Oral health education using a combination of video training and audio-tactile performance is particularly effective for individuals with SI, engaging multiple senses for learning. Future research should focus on standardizing methodologies and incorporating larger sample sizes to enhance the efficacy of these technologies in improving OH care for individuals with SI. PROSPERO REG. NO.: CRD42023485523.

Exploring the cognitive effects of hearing loss in adult rats: Implications for visuospatial attention, social behavior, and prefrontal neural activity

Age-related hearing loss in humans has been associated with cognitive decline, though the underlying mechanisms remain unknown. We investigated the long-term effects of hearing loss on attention, impulse control, social interaction, and neural activity within medial prefrontal cortex (mPFC) subregions. Hearing loss was induced in adult rats via intracochlear neomycin injection (n = 13), with non-operated rats as controls (n = 10). Rats were tested for motor activity (open field), coordination (Rotarod), and social interaction (including ultrasonic vocalization, USV) before surgery and at weeks 1, 2, 4, 8, 16, and 24 post-surgery. From week 8 on, rats were trained in the five-choice serial reaction time task (5-CSRTT) to assess visuospatial attention and impulse control. Finally, oscillatory neuronal activity in mPFC subregions was recorded with multielectrode arrays during anesthesia, followed by immunohistological staining for NeuN+ and Parvalbumin+ cells. Deafened rats were more active than controls, whereas social interaction and USV were temporarily reduced. They also had difficulties to learn the concept of the 5-CSRTT paradigm and made more incorrect responses. Electrophysiology showed decreased power in theta, alpha, and beta frequency, and enhanced high gamma band in the mPFC in deafened rats, which was most pronounced in the cingulate subregion (Cg1). The number of NeuN+ and Parvalbumin+ cells, however, did not differ between groups. The behavioral deficits together with the altered neuronal activity found in the Cg1 subregion of the mPFC in adult deafened rats may be used as an endophenotype to elucidate the mechanisms behind the cognitive decline seen in older patients with hearing loss.

Integrated digit in noise test (iDIN) for rapid hearing and cognitive screening: a preliminary exploration

BACKGROUND

Hearing and cognitive impairments are common amongst older adults, both affecting communication and are not easy to distinguish from each other.

OBJECTIVE

To preliminarily evaluate the efficacy of the integrated Digit in Noise Test (iDIN) for rapid screening of hearing and cognitive functions in older adults.

DESIGN

This cross-sectional cohort study was conducted at multiple clinical sites.

SETTING

Data collection occurred in sound-treated booths and quiet rooms at several outpatient clinics and elderly community centres.

SUBJECTS

The study included 107 older adults, aged 58-96, who were long-term residents of Hong Kong and native Cantonese speakers. Participants were selected through convenience sampling.

METHODS

Primary outcomes were the speech reception thresholds (SRTs) for 2-, 3- and 5-digit sequences with forward and 3-digit sequences with backward recall measured on iDIN. Hearing level was assessed using pure-tone audiometry. Cognitive function was assessed using the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA).

RESULTS

The 2-digit and 3-digit SRTs effectively distinguished participants with hearing loss, demonstrating high sensitivity (0.815 and 0.908, respectively) and specificity (0.905 and 0.853, respectively). The SRT3b-3f index effectively discriminated between participants who passed or failed the MoCA, with sensitivities of 0.727 and 0.781, and specificities of 0.885 and 0.787 using the two MoCA scoring methods. No significant correlation was found between SRT3b-3f and hearing levels after adjustment for educational background.

CONCLUSIONS

iDIN demonstrates significant promise for rapid and effective screening of both hearing and cognitive impairments in older adults.

Establishing a robust triangulation framework to explore the relationship between hearing loss and Parkinson's disease

The relationship between hearing loss (HL) and Parkinson's disease (PD) remains unclear. Using individual-level and summary-level data from the UK Biobank and the largest genome-wide association studies, we examined this link through observational, Mendelian randomization and genetic pleiotropy analyses. Among 158,229 participants, PD risk rose with HL severity especially in elder and males, and hearing aids significantly reduced PD risk in males. Although our results did not support a causal association, genetic correlation analysis suggested a localized genetic overlap (17q21.31). We identified 1545 SNPs and 63 genes with pleiotropic effects on HL and PD, including 79 novel SNPs across 6 loci, with 3 showing strong co-localization. These loci were enriched in key tissues like brain, heart, liver and pancreas, linked to the dihydrolipoyl dehydrogenase complex pathway, and targeted by drugs such as Warfarin and Phenprocoumon. Overall, this study reveals the risk association, genetic basis, and pleiotropic loci connecting HL and PD.

Association between age-related hearing loss and depression: A systematic review and meta-analysis

INTRODUCTION

This meta-analysis examined the relationship between age-related hearing loss (ARHL) and depression in older adults, and further explored whether this relationship is moderated by age and gender.

METHODS

We searched in 4 English databases: PubMed, Embase, Web of Science, and Cochrane Library. Ultimately, we identified 9 studies, involving 3 cohort studies and 6 cross-sectional studies. We used Hedges' g as the effect size, and all pooled analyses were performed using random-effects models.

RESULTS

ARHL patients had higher depressive symptom scores than non-ARHL older adults (g = 0.52). When divided into subgroups based on study type, a large effect size was demonstrated in the cross-sectional study group (g = 0.68) and was not statistically different in the cohort study group (g = 0.06). Meta-regression results showed that the effect size of depression in older adults with ARHL was significantly associated with the percentage of females (t = 5.97, p = 0.000) and not significantly associated with age (t = 0.94, p = 0.364).

CONCLUSIONS

Patients with ARHL are more likely to be depressed than older adults with normal hearing, and this relationship is influenced by the gender of the patients.

Experts' discussion: implications of the World Health Organization's World report on hearing for the cochlear implant field

OBJECTIVE

This review aims to analyse the implications of the World Health Organization's 2021 world report on hearing, with a particular focus on the cochlear implant field. The objective is to understand the challenges and opportunities highlighted in the report and propose viable solutions for effective implementation within the cochlear implant community.

METHODS

Following the release of the World Health Organization's world report on hearing, cochlear implant professionals explored and discussed the implications of the report with examples from various countries to understand the disparities in access, reimbursement policies, and social stigma associated with hearing loss.

RESULTS

The world hearing report identifies hearing loss as a major global health issue, with an estimate of 1.5 billion people currently affected and a projected increase to 2.5 billion by 2050. Key challenges in the cochlear implantation field include disparities in access to services, particularly in low- and middle-income countries, lack of reimbursement policies in many regions, and the social stigma surrounding hearing loss.

CONCLUSION

A multi-faced approach is needed to address the rising prevalence of hearing loss and policy makers must prioritize ear and hearing care as a public health concern. Organizations like the HEARRING group can promote education, awareness, and training, and act as advocates for changes in healthcare systems to expand access to hearing care services.

Nationwide Hearing Loss Trends Over Two Decades

OBJECTIVES

Hearing loss (HL) is one of the most common chronic health conditions in the United States (US). This study aims to evaluate trends in HL prevalence among US adults over the past two decades.

METHODS

Audiometric data of adults from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were analyzed in 2-year intervals to evaluate changes in HL (defined as pure tone average greater than 25 dB in at least one ear) over time in using odds ratios (ORs). Multivariate logistic regression was used to control for age and sex, and linear regression was used to evaluate trends in HL prevalence over time.

RESULTS

The study included 13,468 participants. In adult participants (20-69 years old), HL remained stable over time, with some fluctuations ranging from 14.8% to 16.8%. In elderly participants (70-years and older), HL remained stable over time, with some fluctuations ranging from 71.7% to 77.1%. Based on univariate and linear regression analysis, there were no differences in HL rates in the adult and elderly cohorts. Subjects 40-49 years old and adults with education level of less than high school had significant downward trends in HL prevalence over two decades (p < 0.001 and p = 0.029).

CONCLUSIONS

HL prevalence may be declining in the adult population when correcting for age and gender; however, there has not been a significant downward trend for the elderly population. HL may be decreasing over time among adults 40-49 years old and with shorter education backgrounds.

LEVEL OF EVIDENCE

4 Laryngoscope, 135:277-285, 2025.

Clinician Perspectives on the Management of Hearing Loss in Patients With Limited English Proficiency

OBJECTIVE

Clinicians face challenges in managing the growing population of patients with limited English proficiency (LEP) and hearing loss (HL) in the United States. This study seeks to investigate provider perspectives on evaluating, counseling, and treating HL in LEP patients.

STUDY DESIGN

Prospective descriptive study.

SETTING

Tertiary care center.

METHODS

Researchers employed a mixed methods design: (1) structured clinician interviews, (2) cross-sectional, national electronic survey, both regarding perspectives on managing hearing loss in LEP patients. Structured interviews were analyzed using modified grounded theory.

RESULTS

Twenty-nine providers participated in interviews (16 otologists, 13 audiologists). The most reported non-English language was Spanish, followed by Chinese languages. Four thematic domains were derived: barriers to care, cochlear implant (CI) candidacy evaluation, counseling, and ideal resources. Major barriers were patient desire (97%; n = 28), and lack of validated tests (72%; n = 21). Methods of CI evaluation included improvising on validated speech perception testing (59%; n = 17) and use of non-speech evaluation (52%; n = 15). One-quarter forgoes speech testing in non-Spanish-speaking patients (24%; n = 7). Suggestions to improve management include in-person interpreters (62%; n = 18) and testing battery in all languages (31%; n = 9). National survey results (n = 87 providers) demonstrated that respondents were significantly less confident in the methods of speech perception testing and in counseling on surgical hearing rehabilitation in LEP.

CONCLUSION

Clinicians encounter challenges in managing LEP patients with HL, including limitations in audiometric and CI candidacy assessment, communication barriers, information accessibility, and cultural competency. Opportunities for improving care include developing language-specific test batteries, linguistically and culturally appropriate education materials, and cultural competency training.

Hearing modulation affects Alzheimer's disease progression linked to brain inflammation: a study in mouse models

BACKGROUND

Recent studies have identified hearing loss (HL) as a primary risk factor for Alzheimer's disease (AD) onset. However, the mechanisms linking HL to AD are not fully understood. This study explored the effects of drug-induced hearing loss (DIHL) on the expression of proteins associated with AD progression in mouse models.

METHODS

DIHL was induced in 5xFAD and Tg2576 mice aged 3 to 3.5 weeks using kanamycin (700 mg/kg, subcutaneous) and furosemide (600 mg/kg, intraperitoneal). The accumulation and expression of beta-amyloid (Aβ), ionized calcium-binding adaptor molecule 1 (Iba1), and glial fibrillary acidic protein (GFAP) were measured through immunohistochemistry and immunoblotting. Additionally, the expression of proteins involved in the mammalian target of rapamycin (mTOR) pathway, including downstream effectors p70 ribosomal S6 kinase (p70S6K) and S6, as well as proinflammatory cytokines, was analyzed.

RESULTS

Compared to control conditions, HL led to a significant increase in the accumulation of Aβ in the hippocampus and cortex. Elevated levels of neuroinflammatory markers, including Iba1 and GFAP, as well as proinflammatory cytokines such as interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α), were observed. Moreover, DIHL enhanced phosphorylation of mTOR, p70S6K, and S6, indicating activation of the mTOR pathway.

CONCLUSIONS

HL significantly increases Aβ accumulation in the brain. Furthermore, HL activates astrocytes and microglia, leading to increased neuroinflammation and thereby accelerating AD progression. These findings strongly suggest that HL contributes autonomously to neuroinflammation, highlighting the potential for early intervention in HL to reduce AD risk.

Comparison of subjective self-reported hearing and objective speech-in-noise perception as predictors of social isolation and loneliness in adults 60 years and older

OBJECTIVE

Hearing decline in ageing increases the risk of loneliness and social isolation. This correlation is most often observed when hearing is measured by subjective self-report, and less often for objectively measured speech listening ability, raising questions about differences between self-assessments and behavioural performance. This study compared self-reported hearing ability and objective speech-in-noise performance as predictors of loneliness and social isolation in adults older than 60.

DESIGN

This was an observational, cross-sectional online study. Participants were instructed to complete a speech-in-noise task to measure objective listening ability, as well as four questionnaires that measured subjective self-rated hearing, feelings of loneliness, perceived social support, and depression and anxiety.

STUDY SAMPLE

One-hundred fifteen individuals aged above 60 with no treated hearing loss.

RESULTS

No correlation was found between loneliness scores and subjective self-rated hearing or objective speech-in-noise perception after adjusting demographic variables and overall psychological distress (anxiety and depression). However, self-rated hearing was positively correlated with social support when anxiety/depression scores were low. When anxiety/depression scores were high, this relationship was attenuated. Objective speech-in-noise perception did not correlate with perceived social support.

CONCLUSIONS

Self-rated hearing ability positively predicts ratings of social support in older adults with low levels of psychological distress.

Association between tinnitus and hearing impairment among older adults with age-related hearing loss: a multi-center cross-sectional study

Objective

The relationship between tinnitus in the elderly with hearing loss remains elusive. This study aimed to reveal the association between tinnitus and hearing impairment among older adults with age-related hearing loss (ARHL).

Methods

This cross-sectional study was conducted among a population of outpatients diagnosed with ARHL at four medical centers in different regions of China, from June 2020 to June 2023. ARHL patients were divided into two groups based on their self-reported tinnitus: tinnitus and non-tinnitus. Multivariable linear regression models were used to assess the association between tinnitus and hearing impairment in ARHL patients. Subgroup analyses, stratified by gender and age, were performed to further evaluate the association.

Results

A total of 418 older adults with ARHL were included in the study. Compared to the non-tinnitus group, ARHL patients with tinnitus had lower hearing thresholds (β = -5.07; 95% confidence interval (CI) -9.32 to -0.81; p = 0.020). On subgroup analyses stratified by gender and age, the male ARHL patients with tinnitus still had lower hearing thresholds compared to those without tinnitus (β = -6.96; 95% CI -12.70 to 1.22; p = 0.018). In females, tinnitus was not associated with hearing thresholds (β = -3.69; 95% CI -10.11 to 2.74, p = 0.262). There was no association between tinnitus and hearing thresholds in both the age group of ≥70 years (β = -4.31; 95% CI -9.65 to 1.03; p = 0.116) and the age group of <70 years (β = -3.54; 95% CI -9.96 to 2.89; p = 0.282).

Conclusion

Based on this multi-center cross-sectional study, we reveal that there is no evidence for the assumption that tinnitus may exacerbate hearing loss in the elderly for the first time. On the contrary, tinnitus is associated with better hearing in the male elderly with ARHL. More extensive longitudinal studies are needed to give a comprehensive insight of the present findings and the underlying mechanisms.

Individual control of input rate improves recall of spoken discourse by adult users of cochlear implants: An exploratory study

Although cochlear implants (CI) successfully replace the sense of hearing, they do not restore natural hearing. Still, CI users adapt to this novel signal, reaching meaningful levels of speech recognition in clinical tests that focus on repetition of words and short sentences. However, many patients who score above average in clinical speech perception tests complain that everyday speech interactions are both difficult and cognitively draining. In part, this difficulty may be due to the naturally rapid pace of everyday discourse. We report a study in which 12 CI users aged 23 to 77, recalled multi-sentence discourse presented without interruption, or in the condition of interest, when passages were paused at major linguistic boundaries, with participants given control of when to initiate the next segment. Comprehension of the discourse structure was based on a formalised representational system that organises discourse elements hierarchically to index the relative importance of different elements to the overall understanding of the discourse. Results showed (a) better recall when CI users were allowed to control the discourse pace; (b) an overall effect of aging, with older CI users recalling discourse less accurately; (c) better recall for passages with higher average inter-word predictability; (d) a "semantic hierarchy effect" reflected by better recall of main ideas versus minor details; (e) an attenuation of the semantic hierarchy effect for low predictability passages. Results underscore the benefits of extra processing time in addressing CI listening challenges and highlight the limited ecological validity of single-word or single-sentence speech recognition tests.

Taringa Whakarongo: Kaumātua & whānau experiences of hearing loss & hearing healthcare in Tāmaki Makaurau

The 'Taringa Whakarongo' [TW] project presents the first narratives on hearing loss and hearing healthcare [HHC] among kaumātua and whānau. The purpose behind the project was to explore kaumātua and their whānau lived experiences of hearing loss and HHC. Hearing health care professionals' and Māori health professionals' perspectives were also examined. Through a Kaupapa Māori lens and reflexive thematic analysis, the sense of hearing was identified as a taonga among kaumātua. However, colonisation, societal stigma of hearing loss, and barriers to accessing whānau-centred HHC and hearing technology continue to impact kaumātua with hearing difficulties and their whānau. Hard-of-hearing kaumātua can thrive in their communities when they and their whānau are supported. Highlighted in this article are key recommendations for the Crown and health sector based on research partner narratives including valuing and prioritising whānau-centered care; supporting whakawhanaungatanga, Māori HHC leadership and culturally safe care; continuing Kaupapa Māori research endeavours and adopting an Indigenous rights-based approach to hearing health. Glossary of kupu Māori (Māori words): Hauora Māori: Māori health; Ihirangaranga: Healing sound vibrations; Iwi: Tribe/s; Kanohi ki te kanohi: Face-to-face; Karakia: Prayer/blessing; Karanga: Ceremonial call or summoning; Kaumātua: Māori elder/s; Kaupapa: Main purpose of the encounter or collective vision; Kaupapa Māori: Embedded within Māori practices, values, beliefs, it is a by Māori, for Māori, with Māori, philosophical and relational way of doing, connecting, being, and thinking; Kaupapa whānau: Members with a common purpose or disabling experience who provide supporting and nurturing roles that traditional whānau provide; Koha: Gift; Kōrero: speak/discussion; Mana: Power; Mana motuhake: Independence, autonomy; Manaakitanga: The act of support and showing respect; Māori: The Indigenous people of Aotearoa New Zealand also refers to normal/ordinary; Māori-ki-te-Māori: Māori to Māori; Marae: Māori communal and sacred meeting grounds where Māori values and philosophy are reaffirmed; Mātauranga Māori: Māori body of knowledge, epistemology, and worldview; Me rongo i te whanaungatanga: Feeling connected; Mihimihi: Greeting; Mokopuna: Grandchildren; Paepae: Place on the marae where orators sit, stand, and deliver their speeches; Rōpū: Group/s; Taha hinengaro: Mental and emotional wellbeing; Tāmaki Makaurau: Auckland region, Tāmaki-desired-by-many or Tāmaki of 100 lovers; Tamariki Māori: Māori child/ren; tanga: Being in the state of; Tāngata whaikaha: People with lived experiences of disability; Tāngata whaikaha kaumātua: Kaumātua with lived experiences of disability; Tangata whenua: People of the land; Taonga: a treasure to be valued and preserved; Te Ao Māori: The Māori world; Te reo Māori: The Māori language; Te Taiao: The natural world; Te Tiriti o Waitangi (Te Tiriti): Te reo Māori version of a fundamental binding agreement in New Zealand between Māori and the British Crown; Tino rangatiratanga: Sovereignty, self-determination, sovereignty; Waiata: songs; Whaikōrero: Formal speech; Whakamā: Shy and ashamed; Whakapapa: Genealogical relation to all things living and non-living; Whakapapa whānau: Members genealogically connected by common ancestors; Whakarongo: Listen; Whakawātea: Reflections and clearing the pathway forward; Whakawhanaungatanga: The process of establishing and maintaining relationships; Whānau: Immediate and extended family network; Whanaunga: Relation; Whenua: Lands.

Hearing and cognitive decline in aging differentially impact neural tracking of context-supported versus random speech across linguistic timescales

Cognitive decline and hearing loss are common in older adults and often co-occur while investigated separately, affecting the neural processing of speech. This study investigated the interaction between cognitive decline, hearing loss, and contextual cues in speech processing. Participants aged 60 years and older were assessed for cognitive decline using the Montreal Cognitive Assessment and for hearing ability using a four-frequency pure tone average. They listened to in-house-designed matrix-style sentences that either provided supportive context or were random, while we recorded their electroencephalography. Neurophysiological responses were analyzed through auditory evoked potentials and speech tracking at different linguistic timescales (i.e., phrase, word, syllable and phoneme rate) using phase-locking values. The results showed that cognitive decline was associated with decreased response accuracy in a speech recognition task. Cognitive decline significantly impacted the P2 component of auditory evoked potentials, while hearing loss influenced speech tracking at the word and phoneme rates, but not at the phrase or syllable rates. Contextual cues enhanced speech tracking at the syllable rate. These findings suggest that cognitive decline and hearing loss differentially affect the neural mechanisms underlying speech processing, with contextual cues playing a significant role in enhancing syllable rate tracking. This study emphasises the importance of considering both cognitive and auditory factors when studying speech processing in older people and highlights the need for further research to investigate the interplay between cognitive decline, hearing loss and contextual cues in speech processing.

The relationship between visual impairment and insomnia among people middle-aged and older in India

The correlation between insomnia and visual impairment has not been extensively studied. This study aims to investigate this relationship among individuals aged 45 and above in India. This investigation utilized data from the 2017-2018 Wave 1 of the Longitudinal Aging Study in India (LASI). Visual impairment was self-reported, including presbyopia, cataracts, glaucoma, myopia, and hyperopia. Insomnia symptoms were determined by at least one of the following: difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), or early morning awakening (EMA) occurring three or more times per week. Analytical methods involved multivariate logistic regression, subgroup analyses, and interaction tests to interpret the data. In our cohort of 65,840 participants, 29.6% reporting insomnia symptoms demonstrated a higher risk for visual impairment. There was a significant association between visual impairment and increased risk of insomnia symptoms after adjustment for confounders. Furthermore, age in the relationship between insomnia and cataracts, sex in the relationship between insomnia and myopia, and age, sex, and smoking status in the relationship between insomnia and hyperopia, was found to have a significant interaction effect, respectively. Visual impairment was significantly associated with a higher incidence of insomnia among middle-aged and older adults in India. These findings underscore the importance of timely interventions to improve sleep quality and overall well-being in visually impaired populations.

A Prospective Association Between Sensory Impairment and Cognitive Performance Among Older Community-Dwelling Adults: The Role of Depressive Symptoms

We examined whether vision impairment (VI) and hearing impairment (HI) and dual sensory impairment (DSI) affect cognitive performance and whether depression mediates that effect. We examined 55,340 participants from the Survey of Health, Aging and Retirement in Europe, which assessed 32,325 participants in 2011 (baseline, Time 1), 2015 (follow-up, Time 2), sociodemographic data and health factors, self-reported VI, HI, and DSI at baseline, depression, and cognitive performance after four years. A multiple mediator model was tested using bootstrapping and resampling. At baseline, 22.9% had VI, 10.2% HI, and 10.4% had DSI. We found a significant negative association between VI (b = -0.023, p = .001) and DSI (b = -0.083, p = .001) and cognitive performance; both were also associated with depression, which was linked with poor cognition. VI or DSI among older adults are associated with poor cognitive function directly and indirectly by increasing depression symptoms.

Association Between Social Determinants of Health and Hearing Loss and Hearing Intervention in Older US Adults

OBJECTIVE

Estimate the prevalence of hearing loss and hearing assistance device use among older adults in the United States, and assess for associations with select social determinants of health (SDOH).

STUDY DESIGN

Cross-sectional US population-based study using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 (pre-pandemic) data.

SETTING

Non-institutionalized civilian adult US population.

METHODS

US adults aged ≥70 years who completed NHANES audiometry exams were included. Sample weights were applied to provide nationally representative prevalence estimates of hearing loss and hearing assistance device use. Logistic regression analyses assessed associations between SDOH and both hearing loss and hearing assistance device use.

RESULTS

The overall prevalence of hearing loss was 73.7%. Among those with nonprofound hearing loss, the prevalence of hearing assistance device use was 31.3%. Older individuals (odds ratio [OR], 6.3 [3.668-10.694] comparing ages 80+ versus 70-74 yr) and with lower education (OR, 3.8 [1.455-9.766] comparing

CONCLUSION

The prevalence of hearing loss among older adults in the United States remains roughly stable compared with previous population-based estimates, whereas the prevalence of hearing assistance device use is slightly increased. Population-level disparities exist both in the prevalence of hearing loss and hearing assistance device use across SDOH.

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Key Words Collapse

MESH Headings

• Humans
• Male
• Female
• Aged
• Hearing Loss/epidemiology
• United States/epidemiology
• Cross-Sectional Studies
• Aged, 80 and over
• Social Determinants of Health
• Hearing Aids/statistics & numerical data
• Nutrition Surveys
• Prevalence

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Affiliation(s)

Samantha Terhaar Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York
Dhruv Patel Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
Ethan Fung Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
Febronia Mansour Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
Josh F Wallace Department of Public Health and Preventative Medicine, SUNY Upstate Medical University, Syracuse, New York
Martin Corsten Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
James Ted McDonald Department of Economics, University of New Brunswick, Frederickton, New Brunswick, Canada
Stephanie Johnson-Obaseki Department of Otolaryngology-Head & Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
Alexandra E Quimby Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York

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Alzheimer's Disease-Related Analytes Amyloid-β and Tau in Perilymph: Correlation With Patient Age and Cognitive Score

OBJECTIVE

To describe the collection methods for perilymph fluid biopsy during cochlear implantation, detect levels of amyloid β 42 and 40 (Aβ42 and Aβ40), and total tau (tTau) analytes with a high-precision assay, to compare these levels with patient age and Montreal Cognitive Assessment (MoCA) scores, and explore potential mechanisms and relationships with otic pathology.

STUDY DESIGN

Prospective study.

SETTING

Tertiary referral center.

METHODS

Perilymph was collected from 25 patients using polyimide tubing to avoid amyloid adherence to glass, and analyzed with a single-molecule array advanced digital enzyme-linked immunosorbent assay platform for Aβ40, Aβ42, and tTau. Cognition was assessed by MoCA.

RESULTS

Perilymph volumes ranged from ∼1 to 13 µL, with analyte concentrations spanning 2.67 to 1088.26 pg/mL. All samples had detectable levels of tTau, Aβ40, and Aβ42, with a significant positive correlation between Aβ42 and Aβ40 levels. Levels of Aβ42, Aβ40, and tTau were positively correlated with age, while MoCA scores were inversely correlated with age. tTau and Aβ42/Aβ40-ratios were significantly correlated with MoCA scores.

CONCLUSION

Alzheimer's disease-associated peptides Aβ42, Aβ40, and tau analytes are detectable in human perilymph at levels approximately 10-fold lower than those found in cerebrospinal fluid (CSF). These species increase with age and correlate with cognitive impairment indicators, suggesting their potential utility as biomarkers for cognitive impairment in patients undergoing cochlear implantation. Future research should investigate the origin of these analytes in the perilymph and their potential links to inner ear pathologies and hearing loss, as well as their relationships to CSF and plasma levels in individuals.

Verbal Fluency as a Measure of Executive Function in Middle-Aged Adults with Mild Sensorineural Hearing Loss

This study investigates verbal fluency as an indicator of executive function in middle-aged adults with mild sensorineural hearing loss, comparing them to age-matched controls with normal hearing. In this study, 50 middle-aged participants were recruited, comprising 25 with bilateral unaided mild hearing loss and 25 age-matched controls with normal hearing. Demographic information, including age, gender, and health-related factors, was collected. Audiological evaluations confirmed the participants' hearing status, and verbal fluency tests were conducted, encompassing semantic, phonemic, and alternate fluency tasks. Significant differences in audiological measures were observed between both groups. Verbal fluency tests revealed lower mean ranks between the groups on almost all tasks suggesting distinct accuracy and error patterns. This study establishes a link between mild sensorineural hearing loss and executive function in middle-aged adults, evidenced by deficits in verbal fluency tasks. The findings underscore the need for targeted interventions to address cognitive impairments, emphasizing the importance of comprehensive care strategies for individuals in this population.

Sleep characteristics and hearing loss in middle-aged and older adults: The National Health and Nutrition Examination Survey 2015-2018✰

Background

Population-based evidence linking sleep characteristics with hearing is limited and how the associations change with age remains unknown. We aim to investigate cross-sectional associations between sleep characteristics and hearing by age in a nationally representative sample of U.S. adults.

Methods

We included 3,100 participants aged 40 years and older from the National Health and Nutrition Examination Survey 2015-18. Audiometric hearing thresholds at 0.5, 1, 2 and 4 kilohertz were averaged to calculate better-ear pure-tone average (PTA). Sleep questions were self-reported, including sleep duration on weekdays or workdays, snoring, snorting or stopping breathing, trouble sleeping, and daytime sleepiness. Multivariable-adjusted linear regression with an interaction term between sleep characteristic (categorical) and age (continuous in years) was used. Primary models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors in secondary models.

Results

There was no association of reported sleep duration with PTA at age 50; however, compared to those reporting 7-8 h of sleep, there was a borderline-significant association at age 60 (<7 h: 1.72 dB, 95 % confidence interval [CI], -0.21, 3.66; >8 h: 1.25 dB, 95 % CI, -0.01, 2.51), and a significant association at age 70 (<7 h: 2.52 dB, 95 % CI, -0.27, 5.31; >8 h: 2.67 dB, 95 % CI, 0.56, 4.79). No consistent associations for other sleep characteristics were found.

Conclusions

Long sleep duration is associated with worse hearing among middle-aged and older adults and the association differs by age. Longitudinal evidence is needed to establish temporality and examine changes in hearing associated with sleep characteristics.

The mediational role of hearing acuity in the association between personality and memory: Evidence from the health and retirement study and the English Longitudinal Study of Ageing

OBJECTIVES

Personality traits (i.e., the enduring patterns of thoughts, feelings, and behaviors) are associated with cognition across adulthood. There is interest in identifying potential mechanisms to explain this association, but none has focused on sensory function. Therefore, the present study examined whether an objective measure of hearing acuity mediates the association between personality and memory.

METHODS

Participants were from the Health and Retirement Study (HRS, N = 5497, 60 % women, Mean age = 65.66, SD = 9.00) and the English Longitudinal Study of Ageing (ELSA, N = 4706, 57 % women, Mean age = 64.47, SD = 7.59). In the HRS, participants had data on personality and demographic variables in 2012/2014, hearing acuity in 2016/2018, and memory in 2020. In ELSA, participants had data on personality and demographic variables measured in 2010/2011, hearing acuity in 2014/2015, and memory in 2018/2019.

RESULTS

In both HRS and ELSA, higher hearing acuity partially mediated the association between lower neuroticism (4 % and 5 % proportion effect mediated), higher conscientiousness (6 % and 15 %) and higher openness (3 % and 7 %) and better memory performances at follow-up.

CONCLUSIONS

The present study provides novel evidence that hearing acuity mediates the association between personality and cognition.

Does experience with hearing aid amplification influence electrophysiological measures of speech comprehension?

OBJECTIVE

To explore if experience with hearing aid (HA) amplification affects speech-evoked cortical potentials reflecting comprehension abilities.

DESIGN

N400 and late positive complex (LPC) responses as well as behavioural response times to congruent and incongruent digit triplets were measured. The digits were presented against stationary speech-shaped noise 10 dB above individually measured speech recognition thresholds. Stimulus presentation was either acoustic (digits 1-3) or first visual (digits 1-2) and then acoustic (digit 3).

STUDY SAMPLE

Three groups of older participants (N = 3 × 15) with (1) pure-tone average hearing thresholds <25 dB HL from 500-4000 Hz, (2) mild-to-moderate sensorineural hearing loss (SNHL) but no prior HA experience, and (3) mild-to-moderate SNHL and >2 years of HA experience. Groups 2-3 were fitted with test devices in accordance with clinical gain targets.

RESULTS

No group differences were found in the electrophysiological data. N400 amplitudes were larger and LPC latencies shorter with acoustic presentation. For group 1, behavioural response times were shorter with visual-then-acoustic presentation.

CONCLUSION

When speech audibility is ensured, comprehension-related electrophysiological responses appear intact in individuals with mild-to-moderate SNHL, regardless of prior experience with amplified sound. Further research into the effects of audibility versus acclimatisation-related neurophysiological changes is warranted.

Visual and Auditory Sensory Impairments Differentially Relate with Alzheimer's Pathology

Objective

We intended to investigate the relationships between visual sensory impairment (VSI) or auditory sensory impairment (ASI) and brain pathological changes associated with cognitive decline in older adults.

Methods

We primarily tried to examine whether each sensory impairment is related to Alzheimer's disease (AD) pathology, specifically beta-amyloid (Aβ) deposition, through both cross-sectional and longitudinal approaches in cognitively unimpaired older adults. Self-report questionnaires on vision and hearing status were administered at the baseline. Neuroimaging scans including brain [11C] Pittsburgh Compound B PET and MRI, as well as clinical assessments, were performed at baseline and 2-year follow-up.

Results

Cross-sectional analyses showed that the VSI-positive group had significantly higher Aβ deposition than the VSI-negative group, whereas there was no significant association between ASI positivity and Aβ deposition. Longitudinal analyses revealed that VSI positivity at baseline was significantly associated with increased Aβ deposition over 2 years (β = 0.153, p = 0.025), although ASI positivity was not (β = 0.045, p = 0.518). VSI positivity at baseline was also significantly associated with greater atrophic changes in AD-related brain regions over the 2-year follow-up period (β = -0.207, p = 0.005), whereas ASI positivity was not (β = 0.024, p = 0.753). Neither VSI nor ASI positivity was related to cerebrovascular injury, as measured based on the white matter hyperintensity volume.

Conclusion

The findings suggest that VSI is probably related to AD-specific pathological changes, which possibly mediate the reported relationship between VSI and cognitive decline. In contrast, ASI appears not associated with AD pathologies but may contribute to cognitive decline via other mechanisms.

Associations of hearing and visual loss with cognitive decline and dementia risk: a 25-year follow-up of the Maastricht Aging Study

BACKGROUND

Hearing loss (HL) and visual loss (VL) are recently identified as promising dementia risk factors, but long-term studies with adequate control of other modifiable dementia risk factors are lacking. This 25-year follow-up study investigated the association between objectively measured HL and VL with cognitive decline and incident dementia.

METHODS

1823 participants (age 24-82 years) of the Maastricht Aging Study were assessed at baseline, 6, 12 and 25 years. Baseline HL was defined as pure-tone hearing loss ≥20 dB at frequencies of 1, 2 and 4 kHz and VL as binocular, corrected visual acuity <0.5. Associations with cognitive decline (verbal memory, information processing speed, executive function) and incident dementia were tested using linear mixed models and Cox proportional hazard models, respectively. Analyses were adjusted for demographics and 11 modifiable dementia risk factors (LIfestyle for BRAin health index).

RESULTS

Participants with HL (n = 520, 28.7%) showed faster decline in all cognitive domains than participants without HL. No consistent association was found for VL (n = 58, 3.2%), but below-average visual acuity (<1) showed significant associations with information processing speed and executive function. No significant associations with dementia risk were found. Findings were independent of demographics and modifiable dementia risk factors.

CONCLUSIONS

HL predicts faster cognitive decline but not dementia risk in adults aged 24-82 years. VL shows no consistent associations, though below-average visual acuity is linked to faster cognitive decline. This study supports HL as an independent risk factor for cognitive decline. Future studies should further evaluate the roles of HL and VL in dementia risk reduction.

Psychometric appraisal of the Kurdish version of the Revised Hearing Handicap Inventory-Screening

The Revised Hearing Handicap Inventory-Screening (RHHI-S) is a robust 10-item Patient-Reported Outcome Measure (PROM) that can quantify impacts of hearing loss (HL). Employing a cross-sectional study, the psychometric properties of a cross-culturally adapted Kurdish version of RHHI-S (RHHI-S-CK) were investigated. According to the degrees of HL, 168 enrollees (64.3% male; mean-age 63.1 ± 12.6 years) were divided into three subgroups; that is, mild (n = 56; 67.9% male; mean-age 60 ± 12.5 years), moderate (n = 64; 60.9% male; mean-age 64.6 ± 12.5), & moderately-severe (n = 48; 64.6% male; mean-age 63.1 ± 12.6). The internal cohesion among the items was confirmed by Cronbach's alpha (0.94). Confirmatory factor analysis recognised structural validity when a strong unidimensional factor was extracted. Convergent validity was verified (P-value < 0.001) via Spearman's correlation between the scale and a subjective correlator (visual analogue scale). A large effect size (0.88) from Kruskal-Wallis & Dunn-Bonferroni post-hoc tests established the discrimination between different degrees of HL. Lastly, intraclass correlation coefficient (ICC) proved the external reliability of the adapted version of the tool (Test-retest ICC = 0.95). RHHI-S-CK is a robust PROM that can measure the impacts of HL in adults across all age ranges. Accordingly, RHHI-S-CK augmented the clinical and academic practice of the Kurdish medical community.

Cortical region-specific recovery of auditory temporal processing following noise-induced hearing loss

Noise-induced hearing loss (NIHL) studies have focused on the lemniscal auditory pathway, but little is known about how NIHL impacts different cortical regions. Here we compared response recovery trajectories in the auditory and frontal cortices (AC, FC) of mice following NIHL. We recorded EEG responses from awake mice (male n = 15, female n = 14) before and following NIHL (longitudinal design) to quantify event related potentials and gap-in-noise temporal processing. Hearing loss was verified by measuring the auditory brainstem response (ABR) before and at 1-, 10-, 23-, and 45-days after noise-exposure. Resting EEG, event related potentials (ERP) and auditory steady state responses (ASSR) were recorded at the same time-points after NIHL. The inter-trial phase coherence (ITPC) of the ASSR was measured to quantify the ability of AC and FC to synchronize responses to short gaps embedded in noise. Despite the absence of click-evoked ABRs up to 90 dB SPL and up to 45-days post-exposure, ERPs from the AC and FC showed full recovery in ∼ 50 % of the mice to pre-NIHL levels in both AC and FC. The ASSR ITPC was reduced following NIHL in AC and FC in all the mice on day 1 after NIHL. The AC showed full recovery of ITPC over 45-days. Despite ERP amplitude recovery, the FC does not show recovery of ASSR ITPC. These results indicate post-NIHL plasticity with similar response amplitude recovery across AC and FC, but cortical region-specific trajectories in temporal processing recovery.

A comprehensive evaluation on the associations between hearing and vision impairments and risk of all-cause and cause-specific dementia: results from cohort study, meta-analysis and Mendelian randomization study

BACKGROUND

Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia.

METHODS

We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer's disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence.

RESULTS

In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31-1.77; severe: HR1.80, 95%CI 1.36-2.38), AD (mild: HR1.63, 95%CI 1.30-2.04; severe: HR2.18, 95%CI 1.45-3.27), VD (mild: HR1.68, 95%CI 1.19-2.37; severe: HR1.47, 95%CI 1.22-1.78), and NAVD (mild: HR1.47, 95%CI 1.22-1.78; severe: HR1.98, 95%CI 1.43-2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18-2.04) and NAVD (HR1.51, 95%CI 1.07-2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21-1.40; AD: HR1.30, 95%CI 1.21-1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14-2.12; AD: HR 2.55, 95%CI 1.19-3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16-1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01-2.99), AD (OR1.56, 95%CI 1.09-2.23), and NAVD (OR1.14, 1.02-1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13-2.33).

CONCLUSIONS

Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies.

Risk factors for mild cognitive impairment in patients with age-related hearing loss: a meta-analysis

OBJECTIVES

One of the most common sensory impairments in the elderly is age-related hearing loss, and individuals with this condition have a higher risk of mild cognitive impairment than the overall aged population. The purpose of this study was to conduct a systematic review of the literature in order to evaluate the evidence supporting the hypothesis that mild cognitive impairment may be developed in patients with age-related hearing loss.

METHODS

The PRISMA principles were followed when searching the databases of the China Knowledge Network, Wanfang, China Biomedical Literature Database, Pub Med, Cochrane Library, Embase, and Web of Science. Two investigators independently carried out the quality assessment, data extraction, and literature review of the eligible studies. Stata 17.0 was used to finish the statistical analysis and descriptive results.

RESULTS

A total of 13 articles containing 2,222,036 individuals who were evaluated for demographic traits, factors associated with age-related hearing loss, vascular neurologic factors, and psychological factors were included after 2166 search records were found in the database. In patients with age-related hearing loss, eleven factors were found to be risk factors for the development of mild cognitive impairment: age (OR = 1.63; 95% CI 1.09-2.43), male (OR = 1.29; 95% CI 1.14-1.47), degree of hearing loss (OR = 1.35; 95% CI 1.03-1.75), not wearing hearing aids (OR = 1.56; 95% CI 1.37-1.79), cerebrovascular disease (OR = 1.41; 95% CI 1.17-1.69), cardiovascular disease (OR = 1.29; 95% CI 1.07-1.55), diabetes mellitus (OR = 1.28; 95% CI 1.20-1.35), head injury (OR = 1.22; 95% CI 1.13-1.33), alcohol consumption (OR = 1.28; 95% CI 1.14-1.43), and tobacco use (OR = 1.19; 95% CI 1.14-1.25), and depression (OR = 1.63; 95% CI 1.47-1.81).

CONCLUSION

Caregivers can customize care strategies to decrease the occurrence of mild cognitive impairment in elderly deaf patients by considering demographic traits, factors associated with age-related hearing loss, vascular-neurologic factors, and psychological factors.

A Scoping Review and Meta-Analysis of the Relations Between Cognition and Cochlear Implant Outcomes and the Effect of Quiet Versus Noise Testing Conditions

OBJECTIVES

Evidence continues to emerge of associations between cochlear implant (CI) outcomes and cognitive functions in postlingually deafened adults. While there are multiple factors that appear to affect these associations, the impact of speech recognition background testing conditions (i.e., in quiet versus noise) has not been systematically explored. The two aims of this study were to (1) identify associations between speech recognition following cochlear implantation and performance on cognitive tasks, and to (2) investigate the impact of speech testing in quiet versus noise on these associations. Ultimately, we want to understand the conditions that impact this complex relationship between CI outcomes and cognition.

DESIGN

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on published literature evaluating the relation between outcomes of cochlear implantation and cognition. The current review evaluates 39 papers that reported associations between over 30 cognitive assessments and speech recognition tests in adult patients with CIs. Six cognitive domains were evaluated: Global Cognition, Inhibition-Concentration, Memory and Learning, Controlled Fluency, Verbal Fluency, and Visuospatial Organization. Meta-analysis was conducted on three cognitive assessments among 12 studies to evaluate relations with speech recognition outcomes. Subgroup analyses were performed to identify whether speech recognition testing in quiet versus in background noise impacted its association with cognitive performance.

RESULTS

Significant associations between cognition and speech recognition in a background of quiet or noise were found in 69% of studies. Tests of Global Cognition and Inhibition-Concentration skills resulted in the highest overall frequency of significant associations with speech recognition (45% and 57%, respectively). Despite the modest proportion of significant associations reported, pooling effect sizes across samples through meta-analysis revealed a moderate positive correlation between tests of Global Cognition ( r = +0.37, p < 0.01) as well as Verbal Fluency ( r = +0.44, p < 0.01) and postoperative speech recognition skills. Tests of Memory and Learning are most frequently utilized in the setting of CI (in 26 of 39 included studies), yet meta-analysis revealed nonsignificant associations with speech recognition performance in a background of quiet ( r = +0.30, p = 0.18), and noise ( r = -0.06, p = 0.78).

CONCLUSIONS

Background conditions of speech recognition testing may influence the relation between speech recognition outcomes and cognition. The magnitude of this effect of testing conditions on this relationship appears to vary depending on the cognitive construct being assessed. Overall, Global Cognition and Inhibition-Concentration skills are potentially useful in explaining speech recognition skills following cochlear implantation. Future work should continue to evaluate these relations to appropriately unify cognitive testing opportunities in the setting of cochlear implantation.