Accuracy of automated pure-tone audiometry in population-based samples of older adults.

OBJECTIVE: Automated pure-tone audiometry is frequently used in teleaudiology and hearing screening. Given the high prevalence of age-related hearing loss, older adults are an important target population. This study aimed to investigate the accuracy of automated audiometry in older adults, and to examine the influence of test frequency, age, sex, hearing and cognitive status. DESIGN AND STUDY SAMPLE: In a population-based study, two age-homogeneous samples of 70-year-olds (n = 238) and 85-year-olds (n = 114) were tested with automated audiometry in an office using circum-aural headphones and, around 4 weeks later, with manual audiometry conducted to clinical standards. The differences were analysed for individual frequencies (range: 0.25-8 kHz) and pure-tone averages. RESULTS: The mean difference varied across test frequencies and age groups, the overall figure being -0.7 dB (SD = 8.8, p < 0.001), and 68% to 94% of automated thresholds corresponded within ±10 dB of manual thresholds. The poorest accuracy was found at 8 kHz. Age, sex, hearing and cognitive status were not associated with the accuracy (ordinal regression analysis). CONCLUSIONS: Automated audiometry seems to produce accurate assessments of hearing sensitivity in the majority of older adults, but with larger error margins than in younger populations, and is not affected by relevant patient factors associated with old age.

Pathophysiological and Clinical Aspects of Hearing Loss Among 85-Year-Olds.

PURPOSE: This study aimed to identify the prevalence of conductive/mixed and sensorineural hearing loss, with an attempt to differentiate between sensory and neural components in 85-year-olds. METHOD: A comprehensive auditory test protocol, including pure-tone audiometry, speech audiometry, auditory brainstem response (ABR), and distortion product otoacoustic emission (DPOAE), was used to identify different types of hearing loss in 85-year-olds. This study comprised a subsample (n = 125) selected from an unscreened cohort of 85-year-olds born in 1930, within the Gothenburg H70 Birth Cohort Studies in Sweden. RESULTS: Test results were reported descriptively. Sensorineural hearing loss was present in one or both ears in almost all participants (98%), and the majority had absent DPOAEs. Only approximately 6% had additional conductive hearing loss, that is, mixed hearing loss. Approximately 20% of the participants with a pure-tone average at 0.5-4 kHz < 60 dB HL had worse word recognition scores compared with predicted scores by the Speech Intelligibility Index (SII), whereas only two participants were classified with neural dysfunction with the use of ABR. CONCLUSIONS: Sensorineural hearing loss, likely related to outer hair cell loss, was present in the vast majority of 85-year-olds. Conductive/mixed hearing loss appears to be relatively rare in advanced age. Poor word recognition scores in relation to SII-predicted scores were relatively common (20%) in 85-year-olds, whereas auditory neuropathy was only rarely identified (1.6%) by the use of ABR latencies. To explain abnormal word recognition and to identify the neural component of hearing loss among the older-old population, future research should consider factors such as listening effort and cognition among the older-old population.

Prevalence of hearing loss and need for aural rehabilitation in 85-year-olds: a birth cohort comparison, almost three decades apart.

OBJECTIVE: Many individuals >80 years have difficulties with speech communication due to age-related hearing loss and would benefit from aural rehabilitation. As the proportion of older people increases, there is a need to investigate the prevalence of "disabling hearing loss" to calculate future rehabilitation need. The aims are to determine the prevalence of hearing loss in an unscreened birth cohort of 85-year olds, and to identify differences in audiometric results between two birth cohorts, born 28-29 years apart. DESIGN: This is a population-based, cross-sectional study that is part of the Gothenburg H70 Birth Cohort Studies. STUDY SAMPLE: Hearing thresholds were measured and compared between 85-year olds born in 1930 (n = 286) and 1901-1902 (n = 249). RESULTS: Based on the WHO criteria, the prevalence of "disabling hearing loss" was 45% for men and 43% for women in the latest birth cohort. Hearing thresholds (0.5-4 kHz) for men improved compared with the earlier birth cohort. No such difference was observed for women. CONCLUSION: The prevalence of age-related hearing loss over three decades has decreased among 85-year-old men, but has been retained in women. The improvement for men occurred predominantly in the low-mid frequencies. An increased need for aural rehabilitation is expected due to demographic changes.

Cross-sectional assessment of hearing acuity of an unscreened 85-year-old cohort - Including a 10-year longitudinal study of a sub-sample.

As the proportion of older people increases, it is important to investigate hearing acuity in older individuals and to calculate hearing decline for older ages, using standardised test protocols. The main aim of this study was to determine pure-tone hearing thresholds in an unscreened birth cohort of 85-year-olds born in 1930, living in an industrial Swedish city. A further aim was to describe hearing decline in men and women from 75 to 85 years of age with the aid of longitudinal data. The study was part of the Gothenburg H70 Birth Cohort Studies in Sweden. Hearing thresholds (0.25-8 kHz) were measured using automated pure-tone audiometry for 286 85-year-old participants. A subsample (n = 182) was hearing examined at 75 years of age and studied longitudinally from 75 to 85 years. At age 85 years, men had better hearing at low frequencies but poorer hearing at high frequencies than women. The longitudinal study showed a considerable decline between 75 and 85 years at mid-high frequencies (>1 kHz) and the amount of decline was similar between sexes. The results contribute to the estimation of the future need for hearing health services.