Hearing loss and verbal memory assessment among older adults.

OBJECTIVE: Research has found that adults with hearing loss perform worse on cognitive testing than adults without hearing loss; however, heavy emphasis on tests involving auditory stimuli may overdiagnose cognitive impairment among individuals with hearing loss. This study compared visual- and auditory-verbal memory tests among adults with and without hearing loss. METHOD: Forty-one adults with hearing loss (HL) and 41 age-matched adults with normal hearing (NH) completed a neuropsychological battery that included auditory and visual versions of the Hopkins Verbal Learning Testing-Revised (HVLT-R). A natural auditory condition presented HVLT-R stimuli at normal speaking volume. A crossed auditory condition presented HVLT-R stimuli to individuals with hearing loss with amplified acoustic intensity and to individuals with normal hearing under hearing loss simulation. RESULTS: Mixed-model ANOVA indicated significant group (HL vs. NH) by condition (visual, natural auditory, crossed auditory) interactions for HVLT-R performance, with large effect sizes. The HL group performed significantly worse than the NH group on the natural auditory version; however, the NH group performed significantly worse than the HL group on the crossed condition. The groups were equivalent on the visual condition and all other cognitive tests, showing small effect sizes. Moreover, for the HL group, visual HVLT-R correlated with other cognitive tests whereas auditory versions did not. CONCLUSION: Cognitively intact older adults with hearing loss appeared impaired on auditory-verbal memory assessment under typical administration conditions. Visual assessment of verbal memory showed evidence of superior validity and is a viable alternative method to assess memory function especially in older populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Bilateral hearing loss heralding sporadic Creutzfeldt-Jakob disease: a case report and literature review.

OBJECTIVE: To report a case of sporadic Creutzfeldt-Jakob disease (CJD) with bilateral hearing loss at onset and literature review of the scarce cases of CJD with similar audiologic manifestations at presentation. CASE REPORT: A 67-yr-old man presented to the hospital for evaluation of rapid progression of behavioral decline, unsteady gait, and bilateral hearing loss. Three months before admission, he abruptly developed bilateral hypoacusis without associated tinnitus or vertigo. Shortly after, his family noted an ataxic gait and behavioral changes, for example, paranoid delusions. Initial workup, including a complete autoimmune panel and heavy metals, infectious, toxicology, and paraneoplastic panel (e.g., anti-Hu, anti-VGKC), was conducted. Electroencephalography revealed diffuse generalized slowing without periodic complexes. The presence of distortion product otoacoustic emissions bilaterally was consistent with normal cochlear function, suggesting a retrocochlear origin for symptoms of hearing loss. In the meantime, the patient developed startle myoclonus. The brain magnetic resonance imaging demonstrated asymmetric cortical ribbon along with T2 FLAIR signal hyperintensities of bilateral basal ganglia. Later on, the protein 14-3-3 in the cerebrospinal fluid came back positive, which supported the diagnosis of CJD. Only three cases of CJD with deafness at onset have been published: one sporadic, associated with symptoms suggestive of polyneuropathy; and the other two familial, with the E200K mutation. One presented with symptoms of polyneuropathy and the other with typical features. CONCLUSION: This case illustrates the phenotypic variability of presentation of CJD in a patient with hearing loss as the initial manifestation. In patients with subacute bilateral hypoacusis and signs of dementia, the differential diagnosis of CJD must be taken into consideration.

Hearing aid use among older U.S. adults; the national health and nutrition examination survey, 2005-2006 and 2009-2010.

OBJECTIVES: The authors estimated the proportion of older adults in the United States who report hearing aid use among those likely to benefit. To more fully understand what factors underlie the low proportion of hearing aid use, the authors examined a variety of socio-demographic correlates as well as measures of health care access and insurance status in relation to hearing aid use among potential hearing aid candidates. DESIGN: The study makes use of cross-sectional data collected during 2005-2006 and 2009-2010 as part of the National Health and Nutrition Examination Survey. The 1636 adults aged 70 years and older were selected by using a complex sampling design and comprise a nationally representative sample. In addition to self-reported hearing aid use, data on pure-tone thresholds, perceived hearing ability, place for routine health care, time since last hearing test, type of insurance coverage, and socio-demographic characteristics including age, sex, race/ethnicity, family size, and income-to-poverty ratio were collected. The analytical sample consisted of 601 adults who had a better-ear pure-tone average of ≥35 dB HL at 500, 1000, and 2000 Hz or who reported moderate or worse hearing ability. RESULTS: One third of the potential hearing aid candidates reported current use of hearing aids. The authors observed a 28 to 66% greater prevalence of hearing aid use among older adults in the upper four fifths of the income-to-poverty distribution compared with those in the bottom one fifth. Compared with people who had their hearing tested 5 to 9 years ago, those with more recent hearing tests were more than two to three times as likely to be a current hearing aid user. No differences were observed by age after adjusting for pure-tone average and no differences were observed by sex after adjusting for perceived hearing ability. No differences were observed by place of routine health care or by type of insurance coverage. CONCLUSIONS: Use of hearing aids is low among older adults who might benefit. Identifying and surmounting barriers to hearing aid use, especially among low-income adults, remains an important objective for hearing health care in the United States.

Communication outcomes in audiologic reporting.

BACKGROUND: Audiologists often work collaboratively with other health professionals-particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. PURPOSE: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. RESEARCH DESIGN: Retrospective chart review. STUDY SAMPLE: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. DATA COLLECTION AND ANALYSIS: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). RESULTS: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). CONCLUSIONS: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.