1
|
Humes LE. Demographic and Audiological Characteristics of Candidates for Over-the-Counter Hearing Aids in the United States. Ear Hear 2024:00003446-990000000-00288. [PMID: 38816904 DOI: 10.1097/aud.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
OBJECTIVES This report presents descriptive data on the demographic and audiological characteristics of US adults with perceived mild-to-moderate hearing loss, the primary candidates for over-the-counter (OTC) hearing aids. DESIGN The analyses are descriptive and present population-weighted responses for various self-reported demographic and audiological variables for adults with mild or moderate perceived hearing trouble. Results of pure-tone audiometry and immittance measures are also presented. Nationally representative datasets from the National Health and Nutrition Examination Surveys (NHANES) for 2011 to 2012, 2015 to 2016, and 2017 to 2020, the three most recent NHANES datasets with audiological information, were used. RESULTS The NHANES datasets indicated that there are 49.5 million adults in the United States with perceived mild-to-moderate hearing trouble. Results indicated that OTC hearing-aid candidates are most frequently 50 to 69 years of age, married, and identify as non-Hispanic White race/ethnicity. Most of these individuals graduated from high school, had several risk factors for hearing loss, had not had a hearing test in the past 5 years, and had never used hearing aids or assistive listening devices previously. The typical audiometric profile was a bilaterally symmetrical sloping hearing loss with slight to mild hearing loss above 2000 Hz. Group data showed normal immittance measures and absence of otoscopic abnormalities except for the presence of excessive (not impacted) cerumen in about 13% of the OTC hearing-aid candidates. CONCLUSIONS Tens of millions of US adults have perceived mild-to-moderate hearing trouble but have not pursued assistance, either through obtaining a hearing test or acquiring prescription hearing aids.
Collapse
Affiliation(s)
- Larry E Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, Indiana, USA
| |
Collapse
|
2
|
Tolan MM, Choi JS, Tibesar MT, Adams ME. Cerumen impaction: Prevalence and associated factors in the United States population. Laryngoscope Investig Otolaryngol 2024; 9:e1228. [PMID: 38525118 PMCID: PMC10958939 DOI: 10.1002/lio2.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To examine the prevalence of cerumen impaction in a nationally representative sample of the US population and the association of cerumen impaction with sociodemographic factors, hearing loss, and tinnitus. Methods The cohort included 14,230 individuals aged ≥12 years who completed otoscopy and audiometry in NHANES (2005-2016). Cerumen impaction (partial/complete) was determined by otoscopy. Hearing level was defined by speech-frequency pure-tone average (PTA). Multivariable regression analysis was performed to identify factors associated with cerumen impaction. Results The prevalence of any cerumen impaction was 18.6% [95% CI: 17.3%-19.9%] among individuals ≥12 years and 32.4% [29.9%-35.1%] among those ≥70 years. The prevalence of bilateral partial and complete cerumen impaction was 6.3% [5.6%-7.1%] and 1.2% [1.0%-1.9%], respectively. Any cerumen impaction was associated with male sex (OR 1.77 [1.5-2.1]), identifying as Black race (vs. Caucasian, OR: 1.78 [1.5-2.9]), lower level of education (OR: 0.84 [0.71-0.98]), and older age (OR: 1.02 [1.01-1.03]). After adjusting for sociodemographic and clinical factors, complete impaction was associated with increased PTA (right ear: β = 4.1 dB [2.4-5.8 dB], left ear: β = 1.9 dB [0.46-3.4 dB]), but not with tinnitus. Conclusions Cerumen impaction is highly prevalent in the US population, especially among older adults, and has disproportionate sociodemographic impacts. Complete impaction is associated with a small, statistically significant elevation in PTA, but there is no association with tinnitus. These findings emphasize the need to implement and disseminate best practices for ear hygiene and cerumen management broadly and equitably. Level of Evidence 2B.
Collapse
Affiliation(s)
- McKenzie M. Tolan
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Janet S. Choi
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
- Caruso Department of Otolaryngology—Head and Neck SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria T. Tibesar
- University of North Dakota Medical SchoolGrand ForksNorth DakotaUSA
| | - Meredith E. Adams
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| |
Collapse
|
3
|
Humes LE. Otoscopic Abnormalities for the U.S. Population Aged 6-80+ Years: Prevalence and Consequences for Hearing. Am J Audiol 2024:1-16. [PMID: 38241686 DOI: 10.1044/2023_aja-23-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
PURPOSE U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. METHOD Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. RESULTS Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logistic-regression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non-Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. CONCLUSION Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity.
Collapse
Affiliation(s)
- Larry E Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington
| |
Collapse
|
4
|
Humes LE, Zapala DA. Easy as 1-2-3: Development and Evaluation of a Simple yet Valid Audiogram-Classification System. Trends Hear 2024; 28:23312165241260041. [PMID: 38870447 PMCID: PMC11179497 DOI: 10.1177/23312165241260041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
Almost since the inception of the modern-day electroacoustic audiometer a century ago the results of pure-tone audiometry have been characterized by an audiogram. For almost as many years, clinicians and researchers have sought ways to distill the volume and complexity of information on the audiogram. Commonly used approaches have made use of pure-tone averages (PTAs) for various frequency ranges with the PTA for 500, 1000, 2000 and 4000 Hz (PTA4) being the most widely used for the categorization of hearing loss severity. Here, a three-digit triad is proposed as a single-number summary of not only the severity, but also the configuration and bilateral symmetry of the hearing loss. Each digit in the triad ranges from 0 to 9, increasing as the level of the pure-tone hearing threshold level (HTL) increases from a range of optimal hearing (< 10 dB Hearing Level; HL) to complete hearing loss (≥ 90 dB HL). Each digit also represents a different frequency region of the audiogram proceeding from left to right as: (Low, L) PTA for 500, 1000, and 2000 Hz; (Center, C) PTA for 3000, 4000 and 6000 Hz; and (High, H) HTL at 8000 Hz. This LCH Triad audiogram-classification system is evaluated using a large United States (U.S.) national dataset (N = 8,795) from adults 20 to 80 + years of age and two large clinical datasets totaling 8,254 adults covering a similar age range. Its ability to capture variations in hearing function was found to be superior to that of the widely used PTA4.
Collapse
Affiliation(s)
- Larry E Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, IN, USA
| | - David A Zapala
- Department of Otorhinolaryngology/Audiology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
5
|
Humes L. Development and Application of a Reference-Interval Approach to Tympanometric Norms Using U.S. Population Data for Ages 6-80+ Years. Am J Audiol 2023; 32:908-929. [PMID: 37889169 DOI: 10.1044/2023_aja-23-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
PURPOSE United States national data for tympanometric measures from 16,614 ears included in the National Health and Nutrition Examination Survey for 2015-2016 and 2017-2020 were analyzed and described. METHOD Analyses were primarily descriptive and relied on distribution-free medians and cumulative distribution functions (CDFs). Differences between CDFs were examined using Cohen's h effect size. Results are presented for the age range 6-80+ years. A reference interval (RI) approach was pursued in which the interval from the 2.5th to the 95th percentile for healthy ears was specified for peak-compensated static admittance (Ytm+), tympanometric peak pressure, tympanometric width, and equivalent acoustic ear-canal volume (Vea+). RESULTS Separate RIs were required for 6- to 13-year-olds compared to those 14-80+ years of age for all four tympanometric measures. For both age groups, a separate RI was warranted for each sex for Ytm+ and Vea+. For those 14-80+ years of age, a separate RI was also needed for non-Hispanic Asians for Ytm+. When these RIs were applied to the full data set, about 5%-10% of ears were found to be either below the lower limit or above the upper limit of the RI. Those ears outside the RI limits had about 5 dB higher low-frequency hearing thresholds than those within RI limits. Both Ytm+ and Vea+ were found to depend on body size. CONCLUSION RIs for tympanometric measures from individuals with healthy ears were established, and when applied to the general U.S. population 6-80+ years of age, 5%-10% of ears fell outside the RIs depending on the measure.
Collapse
Affiliation(s)
- Larry Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington
| |
Collapse
|
6
|
Zeng J, Kang W, Chen S, Lin Y, Deng W, Wang Y, Chen G, Ma K, Zhao F, Zheng Y, Liang M, Zeng L, Ye W, Li P, Chen Y, Chen G, Gao J, Wu M, Su Y, Zheng Y, Cai Y. A Deep Learning Approach to Predict Conductive Hearing Loss in Patients With Otitis Media With Effusion Using Otoscopic Images. JAMA Otolaryngol Head Neck Surg 2022; 148:612-620. [PMID: 35588049 DOI: 10.1001/jamaoto.2022.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Otitis media with effusion (OME) is one of the most common causes of acquired conductive hearing loss (CHL). Persistent hearing loss is associated with poor childhood speech and language development and other adverse consequence. However, to obtain accurate and reliable hearing thresholds largely requires a high degree of cooperation from the patients. Objective To predict CHL from otoscopic images using deep learning (DL) techniques and a logistic regression model based on tympanic membrane features. Design, Setting, and Participants A retrospective diagnostic/prognostic study was conducted using 2790 otoscopic images obtained from multiple centers between January 2015 and November 2020. Participants were aged between 4 and 89 years. Of 1239 participants, there were 209 ears from children and adolescents (aged 4-18 years [16.87%]), 804 ears from adults (aged 18-60 years [64.89%]), and 226 ears from older people (aged >60 years, [18.24%]). Overall, 679 ears (54.8%) were from men. The 2790 otoscopic images were randomly assigned into a training set (2232 [80%]), and validation set (558 [20%]). The DL model was developed to predict an average air-bone gap greater than 10 dB. A logistic regression model was also developed based on otoscopic features. Main Outcomes and Measures The performance of the DL model in predicting CHL was measured using the area under the receiver operating curve (AUC), accuracy, and F1 score (a measure of the quality of a classifier, which is the harmonic mean of precision and recall; a higher F1 score means better performance). In addition, these evaluation parameters were compared to results obtained from the logistic regression model and predictions made by three otologists. Results The performance of the DL model in predicting CHL showed the AUC of 0.74, accuracy of 81%, and F1 score of 0.89. This was better than the results from the logistic regression model (ie, AUC of 0.60, accuracy of 76%, and F1 score of 0.82), and much improved on the performance of the 3 otologists; accuracy of 16%, 30%, 39%, and F1 scores of 0.09, 0.18, and 0.25, respectively. Furthermore, the DL model took 2.5 seconds to predict from 205 otoscopic images, whereas the 3 otologists spent 633 seconds, 645 seconds, and 692 seconds, respectively. Conclusions and Relevance The model in this diagnostic/prognostic study provided greater accuracy in prediction of CHL in ears with OME than those obtained from the logistic regression model and otologists. This indicates great potential for the use of artificial intelligence tools to facilitate CHL evaluation when CHL is unable to be measured.
Collapse
Affiliation(s)
- Junbo Zeng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weibiao Kang
- The second Hospital, Medical College, Shantou University, Shantou, Guangdong Province, China
| | - Suijun Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Lin
- Jarvis Lab, Tencent, Shen Zhen city, Guangdong Province, China.,Hong Kong University of Science and Technology, Hong Kong, China
| | - Wenting Deng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yajing Wang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guisheng Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kai Ma
- Jarvis Lab, Tencent, Shen Zhen city, Guangdong Province, China
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, United Kingdom
| | - Yefeng Zheng
- Jarvis Lab, Tencent, Shen Zhen city, Guangdong Province, China
| | - Maojin Liang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linqi Zeng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weijie Ye
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Peng Li
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yubin Chen
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guoping Chen
- Department of Otolaryngology, Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong Province, China
| | - Jinliang Gao
- Department of Otolaryngology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong Province, China
| | - Minjian Wu
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuejia Su
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiqing Zheng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Shenzhen-Shanwei Central Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei City, Guangdong Province, China
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Shenzhen-Shanwei Central Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei City, Guangdong Province, China
| |
Collapse
|