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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.
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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
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Pudrith C, Phillips S, Labban J. Association of self-reported noise exposure and audiograms processed with algorithms proposed to quantify noise-induced hearing loss. Int J Audiol 2021; 61:809-817. [PMID: 34634215 DOI: 10.1080/14992027.2021.1983216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess the association of self-reported noise exposure and audiograms processed with ten algorithms proposed to quantify noise-induced hearing loss using receiver operating characteristic (ROC) curves. DESIGN Participants were placed into groups based on self-reported noise exposure. Self-reported noise exposure served as a predictor for noise-induced hearing loss (NIHL). Audiograms were analysed with ten algorithms: The Guidelines, Brewster's Rules, two versions of military Noise-induced Hearing Loss, the Bulge Depth, the age-adjusted 8 kHz threshold and four versions of a new algorithm called the Adjusted Notch Depth (AND). The area under the ROC curves were calculated for each algorithm. STUDY SAMPLE Data were collected from three cycles of the National Health and Nutrition Examination Survey. RESULTS Only one version the AND significantly identified those with self-reported noise exposure with an area under the curve of 0.562. CONCLUSIONS The association between the AND and self-reported noise exposure was marginally better than the previous algorithms in identifying those with self-reported noise exposure. These findings do not support using puretone thresholds for identifying those with NIHL in a cross-sectional research study without stratifying the participants. More research is needed to determine how the AND can be applied to stratified designs.
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Affiliation(s)
- Charles Pudrith
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, IL, USA
| | - Susan Phillips
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jeffrey Labban
- School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
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Bae SH, Kwak SH, Choi JY, Jung J. Synergistic effect of smoking on age-related hearing loss in patients with diabetes. Sci Rep 2020; 10:18893. [PMID: 33144636 PMCID: PMC7641162 DOI: 10.1038/s41598-020-75880-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023] Open
Abstract
This study investigated the synergistic effects of risk factors on age-related hearing loss (ARHL) using nationwide cross-sectional data of 33,552 individuals from the 2010‒2013 Korea National Health and Nutrition Examination Survey. Patients with ARHL were selected based on their pure-tone audiometry results. Previously reported risk factors for ARHL were analyzed using logistic regression and propensity score-matching, and synergistic effects between risk factors were analyzed using propensity score-matching. Of the 12,570 individuals aged 40-79 years, 2002 (15.9%) met the criteria for ARHL. Male sex, exposure to occupational noise, and diabetes showed a significant relationship with ARHL (p < 0.05) in both the logistic regression and propensity score-matching analyses. Smoking and diabetes showed the strongest significant synergistic effect on ARHL (odds ratio [OR] 1.963, 95% confidence interval [CI] 1.285‒2.998; p = 0.002). In the subgroup analysis based on smoking status, current smokers with diabetes had a significant relationship with ARHL (OR 1.883, CI 1.191‒2.975; p = 0.009), whereas ex-smokers with diabetes did not (OR 1.250; CI 0.880‒1.775; p = 0.246). This implies that current smokers with diabetes may benefit from the cessation of smoking. In conclusion, patients with diabetes should strictly avoid or cease smoking to prevent the progression of ARHL.
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Affiliation(s)
- Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang Hyun Kwak
- Department of Otorhinolaryngology, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Cruickshanks KJ, Nondahl DM, Fischer ME, Schubert CR, Tweed TS. A Novel Method for Classifying Hearing Impairment in Epidemiological Studies of Aging: The Wisconsin Age-Related Hearing Impairment Classification Scale. Am J Audiol 2020; 29:59-67. [PMID: 32011900 DOI: 10.1044/2019_aja-19-00021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Longitudinal population-based cohort data were used to develop a standardized classification system for age-related hearing impairment using thresholds for frequencies (0.5-8 kHz) typically measured in cohort studies. Method Audiometric testing data collected in the Epidemiology of Hearing Loss Study from participants (n = 1,369) with four visits (1993-1995, 1998-2000, 2003-2005, and 2009-2010) were included (10,952 audiograms). Cluster analyses (Wald's method) were used to identify audiometric patterns. Maximum allowable threshold values were defined for each cluster to create an ordered scale. Progression was defined as a two-step change. Results An eight-step scale was developed to capture audiogram shape and severity of hearing impairment. Of the 1,094 participants classified as having normal hearing based on a pure-tone average, only 25% (n = 277) were classified as Level 1 (all thresholds ≤ 20 dB HL) on the new scale, whereas 17% (n = 182) were Levels 4-6. During the 16-year follow-up, 64.9% of those at Level 1 progressed. There was little regression using this scale. Conclusions This is the first scale developed from population-based longitudinal cohort data to capture audiogram shape across time. This simple, standardized scale is easy to apply, reduces misclassification of normal hearing, and may be a useful method for identifying risk factors for early, preclinical, age-related changes in hearing.
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Affiliation(s)
- Karen J. Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - David M. Nondahl
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Mary E. Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Carla R. Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Ted S. Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
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Themann CL, Masterson EA. Occupational noise exposure: A review of its effects, epidemiology, and impact with recommendations for reducing its burden. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:3879. [PMID: 31795665 DOI: 10.1121/1.5134465] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Exposure to hazardous noise is one of the most common occupational risks, both in the U.S. and worldwide. Repeated overexposure to noise at or above 85 dBA can cause permanent hearing loss, tinnitus, and difficulty understanding speech in noise. It is also associated with cardiovascular disease, depression, balance problems, and lower income. About 22 million U.S. workers are currently exposed to hazardous occupational noise. Approximately 33% of working-age adults with a history of occupational noise exposure have audiometric evidence of noise-induced hearing damage, and 16% of noise-exposed workers have material hearing impairment. While the Mining, Construction, and Manufacturing sectors typically have the highest prevalence of noise exposure and hearing loss, there are noise-exposed workers in every sector and every sector has workers with hearing loss. Noise-induced hearing loss is preventable. Increased understanding of the biological processes underlying noise damage may lead to protective pharmacologic or genetic therapies. For now, an integrated public health approach that (1) emphasizes noise control over reliance on hearing protection, (2) illustrates the full impact of hearing loss on quality of life, and (3) challenges the cultural acceptance of loud noise can substantially reduce the impact of noise on worker health.
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Affiliation(s)
- Christa L Themann
- National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, MS C-27, Cincinnati, Ohio 45226, USA
| | - Elizabeth A Masterson
- National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, MS C-27, Cincinnati, Ohio 45226, USA
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Flamme GA, Stephenson MR, Deiters KK, Hessenauer A, VanGessel DK, Geda K, Wyllys K, McGregor KD. Short-term variability of pure-tone thresholds obtained with TDH-39P earphones. Int J Audiol 2014; 53 Suppl 2:S5-15. [PMID: 24564693 DOI: 10.3109/14992027.2013.857435] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the short-term variability and correlates of variability in pure-tone thresholds obtained using audiometric equipment designed for occupational use, and to examine the justification for excluding 8 kHz as a mandatory threshold in occupational hearing conservation programs. METHOD Pure-tone thresholds and other hearing-related tests (e.g. noise dosimetry, otoscopy, middle-ear assessment) were conducted with a group of 527 adults between 20 and 69 years of age. Five measurement visits were completed by participants within 14 days. RESULTS The 50% critical difference boundaries were - 5 and 0 dB at 4 kHz and below and - 5 and 5 dB at 6 and 8 kHz. The likelihood of spurious notches due to test-retest variability was substantially lower than the likelihood of failing to detect a notched configuration when present. Correlates of variability included stimulus frequency, baseline threshold, acoustic reflectance of the ear, average noise exposure during the previous eight hours, age, and the tester's level of education in audiology. CONCLUSION The short-term variability in 8-kHz pure-tone thresholds obtained with the TDH-39P earphone was slightly greater than at other frequencies, but this difference was not large enough to justify the disadvantages stemming from the inability to detect a 6-kHz notch.
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Affiliation(s)
- Gregory A Flamme
- * Department of Speech Pathology and Audiology, Western Michigan University , Kalamazoo , USA
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Cardiovascular disease mortality among retired workers chronically exposed to intense occupational noise. Int Arch Occup Environ Health 2014; 88:123-30. [PMID: 24792922 DOI: 10.1007/s00420-014-0943-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/03/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study, conducted among retired workers (≥65 years), is to estimate the association between long-term risk of cardiovascular disease (CVD) death and (1) duration of occupational noise exposure in career and (2) noise-induced hearing loss (NIHL), the latter being used as an indicator of adverse effects for long-term exposure to occupational noise. METHODS Data from screening activities of occupational NIHL were paired to data from death records and were used for this study. A nested case-control analysis was performed. Each case was matched with three controls for length of follow-up and economic sector. A total of 161 CVD deaths occured during an average follow-up of 6.8 years. Conditional logistic regression models were used to estimate the risk (OR) of CVD death by tertiles of duration of noise exposure and of NIHL. RESULTS Conditional logistic regression models indicated that prolonged duration of noise exposure (≥36.5 years) (3rd tertile) was associated with an increased risk of CVD death (OR 1.70; 95 % CI 1.10-2.62), as compared with shorter duration (<27 years) (first tertile). Moderate NIHL (2nd tertile) (OR 1.64; 95 % CI 1.04-2.6) and severe NIHL (3rd tertile) (OR 1.66; 95 % CI 1.06-2.60) were also associated with an increase in risk of CVD death. CONCLUSIONS Results are consistent with recent findings on the chronic effects of occupational noise exposure persisting after retirement although it is less than during active working life.
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Marlenga B, Linneman JG, Pickett W, Wood DJ, Kirkhorn SR, Broste SK, Knobloch MJ, Berg RL. Randomized trial of a hearing conservation intervention for rural students: long-term outcomes. Pediatrics 2011; 128:e1139-46. [PMID: 21987700 DOI: 10.1542/peds.2011-0770] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We had the rare opportunity to conduct a cluster-randomized controlled trial to observe the long-term (16-year) effects of a well-designed hearing conservation intervention for rural high school students. This trial assessed whether the intervention resulted in (1) reduced prevalence of noise-induced hearing loss (NIHL) assessed clinically and/or (2) sustained use of hearing protection devices. METHODS In 1992-1996, 34 rural Wisconsin schools were recruited and 17 were assigned randomly to receive a comprehensive, 3-year, hearing conservation intervention. In 2009-2010, extensive efforts were made to find and contact all students who completed the original trial. Participants in the 16-year follow-up study completed an exposure history questionnaire and a clinical audiometric examination. Rates of NIHL and use of hearing protection were compared. RESULTS We recruited 392 participants from the original trial, 200 (53%) from the intervention group and 192 (51%) from the control group. Among participants with exposure to agricultural noise, the intervention group reported significantly greater use of hearing protection compared with the control group (25.9% vs 19.6%; P = .015). The intervention group also reported significantly greater use of hearing protection for shooting guns (56.2% vs 41.6%; P = .029), but the groups reported similar uses of protection in other contexts. There was no significant difference between groups with respect to objective measures of NIHL. CONCLUSION This novel trial provides objective evidence that a comprehensive educational intervention by itself may be of limited effectiveness in preventing NIHL in a young rural population.
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Affiliation(s)
- Barbara Marlenga
- National Farm Medicine Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA.
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Helleman HW, Jansen EJM, Dreschler WA. Otoacoustic emissions in a hearing conservation program: general applicability in longitudinal monitoring and the relation to changes in pure-tone thresholds. Int J Audiol 2010; 49:410-9. [PMID: 20192875 DOI: 10.3109/14992020903527616] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hearing status of workers (N = 233) in a printing office was assessed twice within seventeen months by pure-tone audiometry and otoacoustic emissions (OAEs). One of the questions was how a quality criterion of OAE-measurements based on a minimum signal-to-noise-ratio (SNR) would affect the applicability on the entire population. Secondly, effects of noise exposure were investigated in overall changes in audiogram and OAE-measurements. For TEOAEs (transient evoked OAEs) in the frequency band of 4 kHz, only 55% of the data points meet the SNR-inclusion criterion. For DPOAEs (distortion product OAEs) around 6 kHz approximately 80% of the data points satisfy the criterion. Thus OAEs have a limited applicability for monitoring the hearing status of this entire population. Audiometry shows significant deteriorations at 6 and 8 kHz. TEOAEs show a significant decline at all frequency bands (1-4 kHz), DPOAEs between 4 and 8 kHz and less pronounced between 1 and 2 kHz. On group level, OAEs show a decline in a larger frequency region than the audiogram, suggesting an increased sensitivity of OAEs compared to audiometry.
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Affiliation(s)
- Hiske W Helleman
- Clinical and Experimental Audiology, ENT Department, Academic Medical Centre, Amsterdam, The Netherlands.
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Demeester K, van Wieringen A, Hendrickx JJ, Topsakal V, Huyghe J, Fransen E, Van Laer L, Van Camp G, Van de Heyning P. Heritability of audiometric shape parameters and familial aggregation of presbycusis in an elderly Flemish population. Hear Res 2010; 265:1-10. [PMID: 20303401 DOI: 10.1016/j.heares.2010.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 02/27/2010] [Accepted: 03/14/2010] [Indexed: 11/29/2022]
Abstract
This study describes the heritability of audiometric shape parameters and the familial aggregation of different types of presbycusis in a healthy, otologically screened population between 50 and 75 years old. About 342 siblings of 64 families (average family-size: 5.3) were recruited through population registries. Audiometric shape was mathematically quantified by objective parameters developed to measure size, slope, concavity, percentage of frequency-dependent and frequency-independent hearing loss and Bulge Depth. The heritability of each parameter was calculated using a variance components model. Logistic regression models were used to estimate the odds ratios (ORs). Estimates of sibling recurrence risk ratios (lambda(s)) are also provided. Heritability estimates were generally higher compared to previous studies. ORs and lambda(s) for the parameters Total Hearing Loss (size), Uniform Hearing Loss (percentage of frequency-dependent hearing loss) and Bulge Depth suggest a higher heredity for severe types of presbycusis compared to moderate or mild types. Our results suggest that the separation of the parameter 'Total Hearing Loss' into the two parameters 'Uniform Hearing Loss' and 'Non-uniform Hearing Loss' could lead to the discovery of different genetic subtypes of presbycusis. The parameter 'Bulge Depth', instead of 'Concavity', seemed to be an important parameter for classifying subjects into 'susceptible' or 'resistant' to societal or intensive environmental exposure.
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Affiliation(s)
- Kelly Demeester
- Department of Otolaryngology, University (UA) and University Hospital of Antwerp (UZA), Wilrijkstraat 10, 2650 Edegem, Belgium.
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Abstract
OBJECTIVE Using data from a population-based cohort study, we compared four published algorithms for identifying notched audiograms and compared their resulting classifications with noise exposure history. DESIGN Four algorithms: (1) , (2) , (3) , and (4) were used to identify notched audiograms. Audiometric evaluations were collected as a part of the 10-yr follow-up examinations of the Epidemiology of Hearing Loss Study, in Beaver Dam, WI (2003-2005, N = 2395). Detailed noise exposure histories were collected by interview at the baseline examination (1993-1995) and updated at subsequent visits. An extensive history of occupational noise exposure, participation in noisy hobbies, and firearm usage was used to evaluate consistency of the notch classifications with the history of noise exposure. RESULTS The prevalence of notched audiograms varied greatly by definition (31.7, 25.9, 47.2, and 11.7% for methods 1, 2, 3, and 4, respectively). In this cohort, a history of noise exposure was common (56.2% for occupational noise, 71.7% for noisy hobbies, 13.4% for firearms, and 81.2% for any of these three sources). Among participants with a notched audiogram, almost one-third did not have a history of occupational noise exposure (31.4, 33.0, 32.5, and 28.1% for methods 1, 2, 3, and 4, respectively), and approximately 11% did not have a history of exposure to any of the three sources of noise (11.5, 13.6, 10.3, and 7.6%). Discordance was greater in women than in men. CONCLUSIONS These results suggest that there is a poor agreement across existing algorithms for audiometric notches. In addition, notches can occur in the absence of a positive noise history. In the absence of an objective consensus definition of a notched audiogram and in light of the degree of discordance in women between noise history and notches by each of these algorithms, researchers should be cautious about classifying noise-induced hearing loss by notched audiograms.
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Berg RL, Pickett W, Fitz-Randolph M, Broste SK, Knobloch MJ, Wood DJ, Kirkhorn SR, Linneman JG, Marlenga B. Hearing conservation program for agricultural students: short-term outcomes from a cluster-randomized trial with planned long-term follow-up. Prev Med 2009; 49:546-52. [PMID: 19800914 DOI: 10.1016/j.ypmed.2009.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/16/2009] [Accepted: 09/27/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES (1) To conduct a contemporary analysis of historical data on short-term efficacy of a 3-year hearing conservation program conducted from 1992 to 1996 in Wisconsin, USA, with 753 high school students actively involved in farm work; (2) to establish procedures for assessment of hearing loss for use in a recently funded follow-up of this same hearing conservation program cohort. METHODS We analyzed a pragmatic cluster-randomized controlled trial, with schools as the unit of randomization. Thirty-four rural schools were recruited and randomized to intervention or control. The intervention included classroom instruction, distribution of hearing protection devices, direct mailings, noise level assessments, and yearly audiometric testing. The control group received the audiometric testing. RESULTS Students exposed to the hearing conservation program reported more frequent use of hearing protection devices, but there was no evidence of reduced levels of noise-induced hearing loss (NIHL). CONCLUSION Our analysis suggests that, since NIHL is cumulative, a 3-year study was likely not long enough to evaluate the efficacy of this intervention. While improvements in reported use of hearing protection devices were noted, the lasting impact of these behaviors is unknown and the finding merits corroboration by longer term objective hearing tests. A follow-up study of the cohort has recently been started.
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Affiliation(s)
- Richard L Berg
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA
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Demeester K, van Wieringen A, Hendrickx JJ, Topsakal V, Fransen E, van Laer L, Van Camp G, Van de Heyning P. Audiometric shape and presbycusis. Int J Audiol 2009; 48:222-32. [PMID: 19363723 DOI: 10.1080/14992020802441799] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to describe the prevalence of specific audiogram configurations in a healthy, otologically screened population between 55 and 65 years old. The audiograms of 1147 subjects (549 males and 598 females between 55 and 65 years old) were collected through population registries and classified according to the configuration of hearing loss. Gender and noise/solvent-exposure effects on the prevalence of the different audiogram shapes were determined statistically. In our population 'Flat' audiograms were most dominantly represented (37%) followed by 'High frequency Gently sloping' audiograms (35%) and 'High frequency Steeply sloping' audiograms (27%). 'Low frequency Ascending' audiograms, 'Mid frequency U-shape' audiograms and 'Mid frequency Reverse U-shape' audiograms were very rare (together less than 1%). The 'Flat'-configuration was significantly more common in females, whereas the 'High frequency Steeply sloping'-configuration was more common in males. Exposure to noise and/or solvents did not change this finding. In addition, females with a 'Flat' audiogram had a significantly larger amount of overall hearing loss compared to males. Furthermore, our data reveal a significant association between the prevalence of 'High frequency Steeply sloping' audiograms and the degree of noise/solvent exposure, despite a relatively high proportion of non-exposed subjects showing a 'High frequency Steeply sloping' audiogram as well.
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Affiliation(s)
- Kelly Demeester
- Department of Otolaryngology, University and University Hospital of Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium.
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Fransen E, Topsakal V, Hendrickx JJ, Van Laer L, Huyghe JR, Van Eyken E, Lemkens N, Hannula S, Mäki-Torkko E, Jensen M, Demeester K, Tropitzsch A, Bonaconsa A, Mazzoli M, Espeso A, Verbruggen K, Huyghe J, Huygen PLM, Kunst S, Manninen M, Diaz-Lacava A, Steffens M, Wienker TF, Pyykkö I, Cremers CWRJ, Kremer H, Dhooge I, Stephens D, Orzan E, Pfister M, Bille M, Parving A, Sorri M, Van de Heyning P, Van Camp G. Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study. J Assoc Res Otolaryngol 2008; 9:264-76; discussion 261-3. [PMID: 18543032 PMCID: PMC2492985 DOI: 10.1007/s10162-008-0123-1] [Citation(s) in RCA: 186] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 04/21/2008] [Indexed: 11/27/2022] Open
Abstract
A multicenter study was set up to elucidate the environmental and medical risk factors contributing to age-related hearing impairment (ARHI). Nine subsamples, collected by nine audiological centers across Europe, added up to a total of 4,083 subjects between 53 and 67 years. Audiometric data (pure-tone average [PTA]) were collected and the participants filled out a questionnaire on environmental risk factors and medical history. People with a history of disease that could affect hearing were excluded. PTAs were adjusted for age and sex and tested for association with exposure to risk factors. Noise exposure was associated with a significant loss of hearing at high sound frequencies (>1 kHz). Smoking significantly increased high-frequency hearing loss, and the effect was dose-dependent. The effect of smoking remained significant when accounting for cardiovascular disease events. Taller people had better hearing on average with a more pronounced effect at low sound frequencies (<2 kHz). A high body mass index (BMI) correlated with hearing loss across the frequency range tested. Moderate alcohol consumption was inversely correlated with hearing loss. Significant associations were found in the high as well as in the low frequencies. The results suggest that a healthy lifestyle can protect against age-related hearing impairment.
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Affiliation(s)
- Erik Fransen
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Jan-Jaap Hendrickx
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Lut Van Laer
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Jeroen R. Huyghe
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Els Van Eyken
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Nele Lemkens
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Samuli Hannula
- Department of Otorhinolaryngology, University of Oulu, 90014 Oulu, Finland
| | - Elina Mäki-Torkko
- Department of Otorhinolaryngology, University of Oulu, 90014 Oulu, Finland
| | - Mona Jensen
- Department of Audiology, Bispebjerg Hospital, 2400 NV Copenhagen, Denmark
| | - Kelly Demeester
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Anke Tropitzsch
- Department of Otorhinolaryngology, University of Tübingen, 72074 Tübingen, Germany
| | - Amanda Bonaconsa
- Department of Oto-Surgery, University Hospital Padova, 35128 Padova, Italy
| | - Manuela Mazzoli
- Department of Oto-Surgery, University Hospital Padova, 35128 Padova, Italy
| | - Angeles Espeso
- College of Medicine, Cardiff University, CF14 4XW Cardiff, UK
| | - Katia Verbruggen
- Department of Otorhinolaryngology, University Hospital of Ghent, 9000 Ghent, Belgium
| | - Joke Huyghe
- Department of Otorhinolaryngology, University Hospital of Ghent, 9000 Ghent, Belgium
| | - Patrick L. M. Huygen
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Sylvia Kunst
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Minna Manninen
- Department of Otorhinolaryngology, University of Tampere, 33014 Tampere, Finland
| | - Amalia Diaz-Lacava
- Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53105 Bonn, Germany
| | - Michael Steffens
- Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53105 Bonn, Germany
| | - Thomas F. Wienker
- Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53105 Bonn, Germany
| | - Ilmari Pyykkö
- Department of Otorhinolaryngology, University of Tampere, 33014 Tampere, Finland
| | - Cor W. R. J. Cremers
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hannie Kremer
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, University Hospital of Ghent, 9000 Ghent, Belgium
| | - Dafydd Stephens
- College of Medicine, Cardiff University, CF14 4XW Cardiff, UK
| | - Eva Orzan
- Department of Oto-Surgery, University Hospital Padova, 35128 Padova, Italy
| | - Markus Pfister
- Department of Otorhinolaryngology, University of Tübingen, 72074 Tübingen, Germany
| | - Michael Bille
- Department of Audiology, Bispebjerg Hospital, 2400 NV Copenhagen, Denmark
| | - Agnete Parving
- Department of Audiology, Bispebjerg Hospital, 2400 NV Copenhagen, Denmark
| | - Martti Sorri
- Department of Otorhinolaryngology, University of Oulu, 90014 Oulu, Finland
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Guy Van Camp
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
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15
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Rabinowitz PM, Galusha D, Slade MD, Dixon-Ernst C, Sircar KD, Dobie RA. Audiogram Notches in Noise-Exposed Workers. Ear Hear 2006; 27:742-50. [PMID: 17086083 DOI: 10.1097/01.aud.0000240544.79254.bc] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Diagnostic criteria for noise-induced hearing loss include the audiometric notch, yet no standardized definition exists. This study tested whether objective notch metrics could match the clinical judgments of an expert panel. DESIGN A panel of occupational physicians, otolaryngologists, and audiologists reviewed audiograms of noise-exposed workers. In a two-sample process, the panel judged whether a notch was present and whether hearing loss had progressed in a notch pattern. Quantitative notch metrics were compared against expert decisions. RESULTS At least five of six experts agreed about notch identification in 71 and 72% of the cases in the two samples, and agreement about notch progression was 61 and 67%. Notch depth and professional specialty appeared to affect notch judgments. Despite this variability, a notch metric showed excellent agreement with expert notch consensus in each sample (94.7 and 96.6%; kappa = 0.88 and 0.92). CONCLUSIONS Audiogram notch metrics can agree with expert clinical consensus and assist in the surveillance of noise-exposed workers.
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Affiliation(s)
- Peter M Rabinowitz
- Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, 135 College Street, Suite 392, New Haven, CT 06510, USA.
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16
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Dobie RA. Methodological Issues When Comparing Hearing Thresholds of a Group With Population Standards: The Case of the Ferry Engineers. Ear Hear 2006; 27:526-37. [PMID: 16957502 DOI: 10.1097/01.aud.0000233863.39603.f5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To discuss appropriate and inappropriate methods for comparing distributions of hearing thresholds of a study group with distributions in population standards and to determine whether the thresholds of Washington State Ferries engineers are different from those of men in the general population, using both frequency-by-frequency comparisons and analysis of audiometric shape. DESIGN The most recent hearing conservation program audiograms of 321 noise-exposed engineers, ages 35 to 64, were compared with the predictions of Annexes A, B, and C from ANSI S3.44. There was no screening by history or otoscopy; all audiograms were included. 95% confidence intervals (95% CIs) were calculated for the engineers' median thresholds for each ear, for the better ear (defined two ways), and for the binaural average. For Annex B, where 95% CIs are also available, it was possible to calculate z scores for the differences between Annex B and the engineers' better ears. Bulge depth, an audiometric shape statistic, measured curvature between 1 and 6 kHz. RESULTS Engineers' better-ear median thresholds were worse than those in Annex A but (except at 1 kHz) were as good as or better than those in Annexes B and C, which are more appropriate for comparison to an unscreened noise-exposed group like the engineers. Average bulge depth for the engineers was similar to that of the Annex B standard (no added occupational noise) and was much less than that of audiograms created by using the standard with added occupational noise between 90 and 100 dBA. CONCLUSIONS Audiograms from groups that have been selected for a particular exposure, but, without regard to severity, can appropriately be compared with population standards, if certain pitfalls are avoided. For unscreened study groups with large age-sex subgroups, a simple method to assess statistical significance, taking into consideration uncertainties in both the study group and the comparison standard, is the calculation of z scores for the proportion of better-ear thresholds above the Annex B median. A less powerful method combines small age-sex subgroups after age correction. Small threshold differences, even if statistically significant, may not be due to genuine differences in hearing sensitivity between study group and standard. Audiometric shape analysis offers an independent dimension of comparison between the study group and audiograms predicted from the ANSI S3.44 standard, with and without occupational noise exposure. Important pitfalls in comparison to population standards include nonrandom selection of study groups, inappropriate choice of population standard, use of the right and left ear thresholds instead of the better-ear threshold for comparison to Annex B, and comparing means with medians. The thresholds of the engineers in this study were similar to published standards for an unscreened population.
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Affiliation(s)
- Robert A Dobie
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis Medical Center, Sacramento, CA 95817, USA.
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17
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Topsakal V, Fransen E, Schmerber S, Declau F, Yung M, Gordts F, Van Camp G, Van de Heyning P. Audiometric Analyses Confirm a Cochlear Component, Disproportional to Age, in Stapedial Otosclerosis. Otol Neurotol 2006; 27:781-7. [PMID: 16885785 DOI: 10.1097/01.mao.0000231500.46534.79] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the preoperative audiometric profile of surgically confirmed otosclerosis. STUDY DESIGN Retrospective, multicenter study. SETTING Four tertiary referral centers. PATIENTS One thousand sixty-four surgically confirmed patients with otosclerosis. INTERVENTIONS Therapeutic ear surgery for hearing improvement. MAIN OUTCOME MEASURES Preoperative audiometric air conduction (AC) and bone conduction (BC) hearing thresholds were obtained retrospectively for 1064 patients with otosclerosis. A cross-sectional multiple linear regression analysis was performed on audiometric data of affected ears. Influences of age and sex were analyzed and age-related typical audiograms were created. Bone conduction thresholds were corrected for Carhart effect and presbyacusis; in addition, we tested to see if separate cochlear otosclerosis component existed. Corrected thresholds were than analyzed separately for progression of cochlear otosclerosis. RESULTS The study population consisted of 35% men and 65% women (mean age, 44 yr). The mean pure-tone average at 0.5, 1, and 2 kHz was 57 dB hearing level. Multiple linear regression analysis showed significant progression for all measured AC and BC thresholds. The average annual threshold deterioration for AC was 0.45 dB/yr and the annual threshold deterioration for BC was 0.37 dB/yr. The average annual gap expansion was 0.08 dB/year. The corrected BC thresholds for Carhart effect and presbyacusis remained significantly different from zero, but only showed progression at 2 kHz. CONCLUSION The preoperative audiological profile of otosclerosis is described. There is a significant sensorineural component in patients with otosclerosis planned for stapedotomy, which is worse than age-related hearing loss by itself. Deterioration rates of AC and BC thresholds have been reported, which can be helpful in clinical practice and might also guide the characterization of allegedly different phenotypes for familial and sporadic otosclerosis.
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Affiliation(s)
- Vedat Topsakal
- Department of Otorhinolaryngology, Antwerp University Hospital UZA, Belgium.
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