Electrocochleographic frequency-following responses as a potential marker of age-related cochlear neural degeneration.

Auditory nerve (AN) fibers that innervate inner hair cells in the cochlea degenerate with advancing age. It has been proposed that age-related reductions in brainstem frequency-following responses (FFR) to the carrier of low-frequency, high-intensity pure tones may partially reflect this neural loss in the cochlea (Märcher-Rørsted et al., 2022). If the loss of AN fibers is the primary factor contributing to age-related changes in the brainstem FFR, then the FFR could serve as an indicator of cochlear neural degeneration. In this study, we employed electrocochleography (ECochG) to investigate the effects of age on frequency-following neurophonic potentials, i.e., neural responses phase-locked to the carrier frequency of the tone stimulus. We compared these findings to the brainstem-generated FFRs obtained simultaneously using the same stimulation. We conducted recordings in young and older individuals with normal hearing. Responses to pure tones (250 ms, 516 and 1086 Hz, 85 dB SPL) and clicks were recorded using both ECochG at the tympanic membrane and traditional scalp electroencephalographic (EEG) recordings of the FFR. Distortion product otoacoustic emissions (DPOAE) were also collected. In the ECochG recordings, sustained AN neurophonic (ANN) responses to tonal stimulation, as well as the click-evoked compound action potential (CAP) of the AN, were significantly reduced in the older listeners compared to young controls, despite normal audiometric thresholds. In the EEG recordings, brainstem FFRs to the same tone stimulation were also diminished in the older participants. Unlike the reduced AN CAP response, the transient-evoked wave-V remained unaffected. These findings could indicate that a decreased number of AN fibers contributes to the response in the older participants. The results suggest that the scalp-recorded FFR, as opposed to the clinical standard wave-V of the auditory brainstem response, may serve as a more reliable indicator of age-related cochlear neural degeneration.

Clinical Practice Guideline: Age-Related Hearing Loss Executive Summary.

OBJECTIVE: Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE: The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS: The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

Clinical Practice Guideline: Age-Related Hearing Loss.

OBJECTIVE: Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE: The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS: The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

A Longitudinal Framework to Describe the Relation Between Age-Related Hearing Loss and Social Isolation.

Many older adults live with some form of hearing loss and have difficulty understanding speech in the presence of background sound. Experiences resulting from such difficulties include increased listening effort and fatigue. Social interactions may become less appealing in the context of such experiences, and age-related hearing loss is associated with an increased risk of social isolation and associated negative psychosocial health outcomes. However, the precise relationship between age-related hearing loss and social isolation is not well described. Here, we review the literature and synthesize existing work from different domains to propose a framework with three conceptual anchor stages to describe the relation between hearing loss and social isolation: within-situation disengagement from listening, social withdrawal, and social isolation. We describe the distinct characteristics of each stage and suggest potential interventions to mitigate negative impacts of hearing loss on social lives and health. We close by outlining potential implications for researchers and clinicians.

Development and validation of the screening tool for age-related hearing loss in the community based on the information platform.

INTRODUCTION: Currently, age-related hearing loss has become prevalent, awareness and screening rates remain dismally low. Duing to several barriers, as time, personnel training and equipment costs, available hearing screening tools do not adequately meet the need for large-scale hearing detection in community-dwelling older adults. Therefore, an accurate, convenient, and inexpensive hearing screening tool is needed to detect hearing loss, intervene early and reduce the negative consequences and burden of untreated hearing loss on individuals, families and society. OBJECTIVES: The study harnessed "medical big data" and "intelligent medical management" to develop a multi-dimensional screening tool of age-related hearing loss based on WeChat platform. METHODS: The assessment of risk factors was carried out by cross-sectional survey, logistic regression model and receiver operating characteristic (ROC) curve analysis. Combining risk factor assessment, Hearing handicap inventory for the elderly screening version and analog audiometry, the screening software was been developed by JavaScript language and been evaluated and verified. RESULTS: A total of 401 older adults were included in the cross-sectional study. Logistic regression model (univariate, multivariate) and reference to literature mention rate of risk factors, 18 variables (male, overweight/obesity, living alone, widowed/divorced, history of noise, family history of deafness, non-light diet, no exercising habit, smoking, drinking, headset wearer habit, hypertension, diabetes, hyperlipidemia, cardiovascular and cerebrovascular diseases, hyperuricemia, hypothyroidism, history of ototoxic drug use) were defined as risk factors. The area under the ROC curve (AUC) of the cumulative score of risk factors for early prediction of age-related hearing loss was 0.777 [95% CI (0.721, 0.833)]. The cumulative score threshold of risk factors was defined as 4, to classify the older adults into low-risk (< 4) and high-risk (≥ 4) hearing loss groups. The sensitivity, specificity, positive predictive value, and negative predictive value of the screen tool were 100%, 65.5%, 71.8%, and 100.0%, respectively. The Kappa index was 0.6. CONCLUSIONS: The screening software enabled the closed loop management of real-time data transmission, early warning, management, whole process supervision of the hearing loss and improve self-health belief in it. The software has huge prospects for application as a screening approach for age-related hearing loss.

Clinical Utility of the Standardized Word Recognition Score.

OBJECTIVES: An unexpectedly low word recognition (WR) score may be taken as evidence of increased risk for retrocochlear tumor. We sought to develop evidence for or against using a standardized WR (sWR) score in detecting retrocochlear tumors. The sWR is a z score expressing the difference between an observed WR score and a Speech Intelligibility Index-based predicted WR score. We retrospectively compared the sensitivity and specificity of pure-tone asymmetry-based logistic regression models that incorporated either the sWR or the raw WR scores in detecting tumor cases. Two pure-tone asymmetry calculations were used: the 4-frequency pure-tone asymmetry (AAO) calculation of the American Academy of Otolaryngology-Head and Neck Surgery and a 6-frequency pure-tone asymmetry (6-FPTA) calculation previously optimized to detect retrocochlear tumors. We hypothesized that a regression model incorporating the 6-FPTA calculation and the sWR would more accurately detect retrocochlear tumors. DESIGN: Retrospective data from all patients seen in the audiology clinic at Mayo Clinic in Florida in 2016 were reviewed. Cases with retrocochlear tumors were compared with a reference group with noise- or age-related hearing loss or idiopathic sensorineural hearing loss. Two pure-tone-based logistic regression models were created (6-FPTA and AAO). Into these base models, WR variables (WR, sWR, WR asymmetry [WRΔ], and sWR asymmetry [sWRΔ]) were added. Tumor detection performance for each regression model was compared twice: first, using all qualifying cases (61 tumor cases; 2332 reference group cases), and second, using a data set filtered to exclude hearing asymmetries greater than would be expected from noise-related or age-related hearing loss (25 tumor cases; 2208 reference group cases). The area under the curve and the DeLong test for significant receiver operating curve differences were used as outcome measures. RESULTS: The 6-FPTA model significantly outperformed the AAO model-with or without the addition of WR or WRΔ variables. Including sWR into the AAO base regression model significantly improved disease detection performance. Including sWR into the 6-FPTA model significantly improved disease detection performance when large hearing asymmetries were excluded. In the data set that included large pure-tone asymmetries, area under the curve values for the 6-FPTA + sWR and AAO + sWR models were not significantly better than the base 6-FPTA model. CONCLUSIONS: The results favor the superiority of the sWR computational method in identifying reduced WR scores in retrocochlear cases. The utility would be greatest where undetected tumor cases are embedded in a population heavily representing age- or noise-related hearing loss. The results also demonstrate the superiority of the 6-FPTA model in identifying tumor cases. The 2 computational methods may be combined (ie, the 6-FPTA + sWR model) into an automated tool for detecting retrocochlear disease in audiology and community otolaryngology clinics. The 4-frequency AAO-based regression model was the weakest detection method considered. Including raw WR scores into the model did not improve performance, whereas including sWR into the model did improve tumor detection performance. This further supports the contribution of the sWR computational method for recognizing low WR scores in retrocochlear disease cases.

The Relative Contribution of Cochlear Synaptopathy and Reduced Inhibition to Age-Related Hearing Impairment for People With Normal Audiograms.

Older people often show auditory temporal processing deficits and speech-in-noise intelligibility difficulties even when their audiogram is clinically normal. The causes of such problems remain unclear. Some studies have suggested that for people with normal audiograms, age-related hearing impairments may be due to a cognitive decline, while others have suggested that they may be caused by cochlear synaptopathy. Here, we explore an alternative hypothesis, namely that age-related hearing deficits are associated with decreased inhibition. For human adults (N = 30) selected to cover a reasonably wide age range (25-59 years), with normal audiograms and normal cognitive function, we measured speech reception thresholds in noise (SRTNs) for disyllabic words, gap detection thresholds (GDTs), and frequency modulation detection thresholds (FMDTs). We also measured the rate of growth (slope) of auditory brainstem response wave-I amplitude with increasing level as an indirect indicator of cochlear synaptopathy, and the interference inhibition score in the Stroop color and word test (SCWT) as a proxy for inhibition. As expected, performance in the auditory tasks worsened (SRTNs, GDTs, and FMDTs increased), and wave-I slope and SCWT inhibition scores decreased with ageing. Importantly, SRTNs, GDTs, and FMDTs were not related to wave-I slope but worsened with decreasing SCWT inhibition. Furthermore, after partialling out the effect of SCWT inhibition, age was no longer related to SRTNs or GDTs and became less strongly related to FMDTs. Altogether, results suggest that for people with normal audiograms, age-related deficits in auditory temporal processing and speech-in-noise intelligibility are mediated by decreased inhibition rather than cochlear synaptopathy.

Metabolic and Sensory Components of Age-Related Hearing Loss: Associations With Distortion- and Reflection-Based Otoacoustic Emissions.

Age-related hearing loss is difficult to study in humans because multiple genetic and environmental risk factors may contribute to pathology and cochlear function declines in older adults. These pathologies, including degeneration of the stria vascularis, are hypothesized to affect outer hair cells responsible for active cochlear amplification of low-level sounds. Otoacoustic emission (OAE) measures are used to quantify the energy added to the traveling wave in cochlear amplification, which typically weakens with increased pure-tone thresholds and for older individuals. Thus, the current study evaluated two OAE measures for individuals with different components of age-related hearing loss. We examined two retrospective adult lifespan datasets (18 to 89+ years of age) from independent sites (Medical University of South Carolina and Boys Town National Research Hospital), which included demographics, noise history questionnaires, distortion-product otoacoustic emissions (DPOAE), and cochlear reflectance (CR). Metabolic and sensory estimates of age-related hearing loss were derived from the audiograms in each dataset, and then tested for associations with DPOAE and CR. The results showed that metabolic estimates increased for older participants and were associated with lower overall DPOAE and CR magnitudes across frequency (i.e., lower fitted intercepts). Sensory estimates were significantly higher for males, who reported more positive noise histories compared to females and were associated with steeper negative across-frequency slopes for DPOAEs. Although significant associations were observed between OAE configurations, DPOAEs appeared uniquely sensitive to metabolic estimates. The current findings suggest that distortion-based measures may provide greater sensitivity than reflection-based measures to the components of age-related hearing loss.

Genetic analysis of potential biomarkers and therapeutic targets in age-related hearing loss.

Age-related hearing loss (ARHL) or presbycusis is the phenomenon of hearing loss due to the aging of auditory organs with age. It seriously affects the cognitive function and quality of life of the elderly. This study is based on comprehensive bioinformatic and machine learning methods to identify the critical genes of ARHL and explore its therapy targets and pathological mechanisms. The ARHL and normal samples were from GSE49543 datasets of the Gene Expression Omnibus (GEO) database. Weighted gene co-expression network analysis (WGCNA) was applied to obtain significant modules. The Limma R-package was used to identify differentially expressed genes (DEGs). The 15 common genes of the practical module and DEGs were screened. Functional enrichment analysis suggested that these genes were mainly associated with inflammation, immune response, and infection. Cytoscape software created the protein-protein interaction (PPI) layouts and cytoHubba, support vector machine-recursive feature elimination (SVM-RFE), and random forests (RF) algorithms screened hub genes. After validating the hub gene expressions in GSE6045 and GSE154833 datasets, Clec4n, Mpeg1, and Fcgr3 are highly expressed in ARHL and have higher diagnostic efficacy for ARHL, so they were identified as hub genes. In conclusion, Clec4n, Mpeg1, and Fcgr3 play essential roles in developing ARHL, and they might become vital targets in ARHL diagnosis and anti-inflammatory therapy.

Construction and Effect of the Three-Level and Two-Stage Screening Mode for Age-Related Hearing Loss: A Study Based on the Community in Shanghai, China.

Background: There is a high incidence rate of age-related hearing loss. Severe hearing loss may increase the prevalence of mental illness, cognitive impairment, and even the risk of all-cause death. Purpose: Construction of the three-level and two-stage screening mode for age-related hearing loss of the community and to evaluate its effectiveness. Materials and Methods: A total of 401 participants (aged 60 years or older) from five typical communities were enrolled in the study. The risk factors assessment of age-related hearing loss was completed by using a cross-sectional survey and receiver operating characteristic (ROC) curve. Multiple screening method was adopted and verified by serial and parallel tests, respectively. Based on research data, incorporate risk factors assessment, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-s) and pure tone audiometry (PTA) were used to construct the screening mode. Results: Multiple screening series testing and multiple screening parallel testing, including risk factors assessment, HHIE-s, and PTA, were used for verification: the sensitivity, specificity, and Kappa index were 70.5% and 9.2%, 95.0% and 71.6%, 0.26 and 0.63, respectively. Finally, the three-level and two-stage screening mode for age-related hearing loss was established. "Three-level" was defined as the risk factors assessment/HHIE-s (high-risk population), PTA (suspect population), and comprehensive hearing loss assessment (confirmed population). "Two-stage" was defined as the population screening by general practitioner in the community and target screening by otolaryngologist of the tertiary hospitals. Conclusion: The three-level and two-stage screening mode for age-related hearing loss consists of the following framework: from population screening to target screening, from suspicious diagnosis to accurate diagnosis, from primary health care to tertiary hospitals. The study objective is to structure a new secondary prevention and treatment mode for age-related hearing loss with primary health care as the core, so as to help the front-end management of healthy aging.

Cognitive control in age-related hearing loss: A narrative review.

Recent evidence suggests links between hearing loss and cognitive impairment in older adults with peripheral age-related hearing loss (ARHL). Earliest cognitive changes have been observed in cognitive control; however, a cohesive account of cognitive control alterations in older adults with peripheral ARHL is lacking. Cognitive control refers to cognitive processes that manage and regulate one's behavior to achieve desired goals. This review summarizes behavioral evidence on alterations in three cognitive control processes, including cognitive flexibility, inhibitory control, and working memory updating, in individuals with ARHL. Of the three processes, cognitive flexibility and working memory updating have been most extensively studied, with relatively fewer studies examining inhibitory control. Most consistent evidence is observed for long-term changes in cognitive flexibility, particularly in individuals with greater severity of ARHL. Equivocal evidence is seen for alterations in inhibitory control and working memory updating, with various factors contributing to inconsistencies across studies. Our review summarizes the emerging body of research on cognitive control in individuals with ARHL to guide future work in this area and considerations related to the management of cognitive issues in this population.

Plasticity After Hearing Rehabilitation in the Aging Brain.

Age-related hearing loss, presbycusis, is an unavoidable sensory degradation, often associated with the progressive decline of cognitive and social functions, and dementia. It is generally considered a natural consequence of the inner-ear deterioration. However, presbycusis arguably conflates a wide array of peripheral and central impairments. Although hearing rehabilitation maintains the integrity and activity of auditory networks and can prevent or revert maladaptive plasticity, the extent of such neural plastic changes in the aging brain is poorly appreciated. By reanalyzing a large-scale dataset of more than 2200 cochlear implant users (CI) and assessing the improvement in speech perception from 6 to 24 months of use, we show that, although rehabilitation improves speech understanding on average, age at implantation only minimally affects speech scores at 6 months but has a pejorative effect at 24 months post implantation. Furthermore, older subjects (>67 years old) were significantly more likely to degrade their performances after 2 years of CI use than the younger patients for each year increase in age. Secondary analysis reveals three possible plasticity trajectories after auditory rehabilitation to account for these disparities: Awakening, reversal of deafness-specific changes; Counteracting, stabilization of additional cognitive impairments; or Decline, independent pejorative processes that hearing rehabilitation cannot prevent. The role of complementary behavioral interventions needs to be considered to potentiate the (re)activation of auditory brain networks.

Sound energy absorbance changes in the elderly with presbycusis with normal outer and middle ear.

OBJECTIVE: This study aimed to investigate the wideband tympanometry (WBT) findings in the elderly with presbycusis who have normal outer and middle ears according to otoscopic examination and traditional tympanometry, and to determine whether there is a relationship between the middle ear wideband absorbance value and the pure tone air-bone gap (ABG) observed especially at mid-high frequencies in the elderly. METHODS: The study included 30 elderly with presbycusis (> 65 years old, presbycusis group) and 30 healthy individuals (control group) between the ages of 18 and 55. Pure tone air conduction and bone conduction thresholds of all participants were determined and WBT was applied to all participants. Resonance frequency (RF), absorbance ratios at peak pressure (PPAR) and ambient pressure (APAR) values were analyzed. RESULTS: The RF value of the presbycusis group was lower than the control group (p < 0.05). APAR and PPAR values at 2000 and 4000 Hz and mean absorbance values of the presbycusis group were lower than the control group (p < 0.05). APAR was higher at 500 Hz in males than females (p < 0.05), but there was no difference between genders in RFs (p > 0.05). A moderate negative correlation was observed between ABG and both PPAR and APAR at 4000 Hz in presbycusis group (p < 0.05). CONCLUSION: it was determined that there was a decrease in RF and absorbances at 2000 and 4000 Hz in the elderly with presbycusis. Aging affects not only the inner ear but also the conduction mechanism of the middle ear. Our findings may be effective in a more accurate and reliable interpretation of WBT in the elderly with presbycusis.

The electrophysiological masking level difference: effects of age and mediation of hearing and cognition.

OBJECTIVE: Evaluate the conceptual framework that age effects on the electrophysiological binaural masking level difference (MLD) are partially mediated by age-related hearing loss and/or global cognitive function via mediation analysis. DESIGN: Participants underwent a series of audiometric tests. The MLD was measured via cortical auditory evoked potentials using a speech stimulus (/ɑ/) in speech-weighted background noise. We used mediation analyses to determine the total effect, natural direct effects, and natural indirect effects, which are displayed as regression coefficients ([95% CI]; p value). STUDY SAMPLE: Twenty-eight individuals aged 19-87 years (mean [SD]: 53.3 [25.2]), recruited from the community. RESULTS: Older age had a significant total effect on the MLD (-0.69 [95% CI: -0.96, -0.45]; p < 0.01). Neither pure tone average (-0.11 [95% CI: -0.43, 0.24; p = 0.54] nor global cognitive function (-0.02 [95% CI: -0.13, 0.02]; p = 0.55) mediated the relationship of age and the MLD and effect sizes were small. Results were insensitive to use of alternative hearing measures or inclusion of interaction terms. CONCLUSIONS: The electrophysiological MLD may be an age-sensitive measure of binaural temporal processing that is minimally affected by age-related hearing loss and global cognitive function.

Benefits of amplification for unaided speech discrimination in age-related hearing loss with flat type audiogram.

OBJECTIVE: The present study aimed to investigate whether hearing aid use can induce improvement as acclimatization effect in unaided speech perception in patients with age-related hearing loss. METHODS: Fifty ears in 41 patients (age range: 65-91 years) diagnosed as age-related hearing loss were enrolled in this study. They used hearing aids for more than 8 hours per day. Unaided speech audiometry using 67-S Japanese monosyllabic word list was performed one or two years after the commencement of hearing aid use. The changes in the unaided speech discrimination score before and after the commencement of hearing aid use were analyzed. To investigate factors for improvement, the patients' backgrounds in terms of age, sex, pure tone average, unaided maximum speech discrimination score, fitting period (one year/two years), fitting ear (bilateral/unilateral), audiogram type (flat-type/other-type), and the level of amplification were also analyzed. RESULTS: Significant improvement in the unaided speech discrimination score after hearing aid use was seen only in the flat-type audiogram group. More than half of older patients in the flat-type audiogram group improved their unaided maximum speech discrimination score 10 % or more. The analysis of aided hearing thresholds revealed that the flat-type audiogram group had significantly lower thresholds of 3kHz and 4kHz than the other-type audiogram group. The age, sex, pure tone average, fitting period, fitting ear, functional gain were not influential factors for improvement. On the other hand, unaided maximum speech discrimination score before using hearing aid and aided hearing threshold at 4kHz had a negative correlation with improvement. CONCLUSION: The findings suggested that older patients with age-related hearing loss whose audiogram is a flat type can benefit from amplification as means of improving their unaided speech perception since flat-type audiogram can be more easily adjusted to sufficiently amplify speech sound at high frequencies. It should be considered that the potential for experience-dependent plasticity is retained even in older adults.

Cognitive, physical, and mental profiles of older adults with misplaced self-evaluation of hearing loss.

BACKGROUND: Although inconsistency between objective and subjective hearing loss among older adults has been suggested, a systematic examination of the cognitive and physical functioning among such older adults is lacking. Our objective was to assess the cognitive, physical, and mental profiles associated with the discrepancy. METHODS: The auditory acuity of 696 community-dwelling older adults was evaluated using a pure-tone average of hearing thresholds at 1.0 and 4.0 kHz in the better-hearing ear. Participants were then stratified as follows: normal hearing ≤ 25 dB, mild loss >25 dB and ≤40 dB, and moderate loss >40 dB and ≤70 dB. Global cognition, gait speed, and depressive symptoms were also assessed. RESULTS: Among older adults, 63.5% of those with mild hearing loss and 22.2% of those with moderate hearing loss did not recognize hearing difficulties. Significantly lower cognition and gait performance were observed in those with moderate hearing loss without subjective hearing loss (i.e., overestimation of hearing acuity) than in those with subjective hearing loss. Furthermore, older adults with subjective hearing loss showed a higher tendency toward depression than those without subjective hearing loss, irrespective of objective hearing loss. CONCLUSIONS: Our results suggest that failure to recognize a high level of age-related hearing loss may be related to impaired cognition and gait performance among older adults. Subjective hearing loss may indicate a tendency toward depression.

Application and prospect of quasi-targeted metabolomics in age-related hearing loss.

Age-related hearing loss (ARHL) is a common sensory deficit in the elderly, which seriously affects physical and mental health. Therefore, understanding its underlying molecular mechanisms and taking interventions to treat ARHL are urgently needed. In our study, cochlea of 4-week-old C57BL/6 mice as the Youth group (n = 6) and 48-week-old cochlea as the Old group (n = 6) were subjected to quasi-targeted metabolomics analysis by Ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). In total, 208 differential metabolites were identified in 12 cochlea samples, which highlighted the following discriminant compounds: tryptophan, piperidine, methionine, L-arginine, histamine, serotonin, acetylcholine, and 4-aminobutyric acid. Differentially expressed metabolites were identified which were involved in KEGG pathways related to the digestion and absorption of oxidative stress associated amino acids, Synaptic vesicle cycle of serotonin, Pantothenate and CoA Biosynthesis. These findings are a first step toward elucidating the pathophysiological pathways involved in the etiology of ARHL and provide the possibility to further explore the mechanisms of ARHL using metabolomic analysis.

Evaluation of age-related changes in middle-ear structures by wideband tympanometry.

BACKGROUND: Presbycusis is bilateral sensorineural hearing loss associated with the progressive degeneration of cochlear and central auditory pathways with aging. AIMS/OBJECTIVES: We aimed to reveal age-related changes in middle ear function by using wideband tympanometry (WBT). MATERIALS AND METHODS: Fifty-eight patients diagnosed with presbycusis were compared to 52 audiologically healthy participants. WBT measurement was performed on both ears via wideband click stimulus with a tympanometer device using probe tone frequencies of 226-8000 Hz. RESULTS: There were no statistically significant differences detected among the resonance frequencies or maximum absorbance ratios measured in both ears between groups (p > .05). The mean absorbance of the right and left ears at 4000 and 8000 Hz was statistically higher in the patient group than in the healthy controls (r = 0.038, 0.030; l = 0.015, 0.012). Moreover, mean compliance values were found to be significantly lower in the patient group than in the control group (r = 0.030 and l = 0.040). CONCLUSION: The significant differences detected in compliance and absorbance values for high frequencies in presbycusis patients were remarkable. Thus, it has been shown that WBT yields an advantage compared to traditional tympanometry in the diagnosis and treatment of middle ear diseases.

Changes in the peripheral and central auditory performance in the elderly-A cross-sectional study.

Age-related hearing loss (ARHL, formerly presbycusis) is due to a variety of lifetime damages to the auditory system and is characterized by bilateral sensorineural hearing loss, impaired speech understanding in noise and central sound processing deficits. Despite its commonness, the pathogenesis has not been completely clarified yet; especially the existence of an independent central ARHL component still remains controversial. We present the results of a cross-sectional topodiagnostic test battery study which aimed at separating aging- and hearing loss-related effects on all parts of the auditory system by current test procedures. Three groups of 30 participants each underwent extensive topodiagnostic test procedures (otoscopy, tympanometry, questionnaires, pure-tone audiometry, DPOAE threshold measurements, auditory brainstem response, central auditory discrimination tests, and speech-in-noise test). By comparing the results of the normally hearing young (18-26 years) and healthy control group, the normally hearing elderly group (60-80 years) and the hearing-impaired elderly group (60-80 years), we deduced aging and hearing loss-related effects on auditory performance. All measurements indicated a significant deterioration of auditory performance in the elderly, partly associated with aging and partly with age-related hearing loss. Our study thereby contributes to a multifocal concept of ARHL. All parts of the auditory system are impaired by aging, age-related hearing loss, or a combination of both. Further evidence for an independent central ARHL component, not attributable to peripheral hearing loss, is provided by the results of the central auditory discrimination test.