Demographic and Audiological Characteristics of Candidates for Over-the-Counter Hearing Aids in the United States.

OBJECTIVES: This report presents descriptive data on the demographic and audiological characteristics of US adults with perceived mild-to-moderate hearing loss, the primary candidates for over-the-counter (OTC) hearing aids. DESIGN: The analyses are descriptive and present population-weighted responses for various self-reported demographic and audiological variables for adults with mild or moderate perceived hearing trouble. Results of pure-tone audiometry and immittance measures are also presented. Nationally representative datasets from the National Health and Nutrition Examination Surveys (NHANES) for 2011 to 2012, 2015 to 2016, and 2017 to 2020, the three most recent NHANES datasets with audiological information, were used. RESULTS: The NHANES datasets indicated that there are 49.5 million adults in the United States with perceived mild-to-moderate hearing trouble. Results indicated that OTC hearing-aid candidates are most frequently 50 to 69 years of age, married, and identify as non-Hispanic White race/ethnicity. Most of these individuals graduated from high school, had several risk factors for hearing loss, had not had a hearing test in the past 5 years, and had never used hearing aids or assistive listening devices previously. The typical audiometric profile was a bilaterally symmetrical sloping hearing loss with slight to mild hearing loss above 2000 Hz. Group data showed normal immittance measures and absence of otoscopic abnormalities except for the presence of excessive (not impacted) cerumen in about 13% of the OTC hearing-aid candidates. CONCLUSIONS: Tens of millions of US adults have perceived mild-to-moderate hearing trouble but have not pursued assistance, either through obtaining a hearing test or acquiring prescription hearing aids.

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health.

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

Hearing thresholds for "otologically normal" adults from the National Health and Nutrition Examination Surveys 2011-12 and 2015-16.

Hearing threshold levels (HTLs) get worse with advancing age in adults. Publications of nationally representative data from U.S. adults have been confined to HTLs from unscreened individuals. ISO 7029:2017 provides equations for the hearing loss of adults of various ages. Equations were generated from a synthesis of international studies of HTLs for "otologically normal" or screened adults. No nationally representative data for screened U.S. adults were included in the ISO synthesis. This study investigated three different levels of screening rigor, referred to here as Screened, Screened+, and Screened++. Median HTLs are provided for Screened (N = 1545) and Screened++ (N = 795) groups from the National Health and Nutrition Examination Surveys for 2011-12 and 2015-16, the two most recent surveys of adults from 20 to 69 years of age with audiograms. Median HTLs from the Screened and Screened++ groups differed slightly between the sexes, were not affected by race/ethnicity, and increased substantially with age. For young adults, there were no differences in HTLs between screened (any level) and unscreened adults, but such differences in HTLs increased with advancing age, especially at higher frequencies. The default power-function model from ISO 7029:2017 did not provide a good description of the median age-associated HTLs from screened U.S. adults.

Predictive Sentence Context Reduces Listening Effort in Older Adults With and Without Hearing Loss and With High and Low Working Memory Capacity.

OBJECTIVES: Listening effort is needed to understand speech that is degraded by hearing loss, a noisy environment, or both. This in turn reduces cognitive spare capacity, the amount of cognitive resources available for allocation to concurrent tasks. Predictive sentence context enables older listeners to perceive speech more accurately, but how does contextual information affect older adults' listening effort? The current study examines the impacts of sentence context and cognitive (memory) load on sequential dual-task behavioral performance in older adults. To assess whether effects of context and memory load differ as a function of older listeners' hearing status, baseline working memory capacity, or both, effects were compared across separate groups of participants with and without hearing loss and with high and low working memory capacity. DESIGN: Participants were older adults (age 60-84 years; n = 63) who passed a screen for cognitive impairment. A median split classified participants into groups with high and low working memory capacity. On each trial, participants listened to spoken sentences in noise and reported sentence-final words that were either predictable or unpredictable based on sentence context, and also recalled short (low-load) or long (high-load) sequences of digits that were presented visually before each spoken sentence. Speech intelligibility was quantified as word identification accuracy, and measures of listening effort included digit recall accuracy, and response time to words and digits. Correlations of context benefit in each dependent measure with working memory and vocabulary were also examined. RESULTS: Across all participant groups, accuracy and response time for both word identification and digit recall were facilitated by predictive context, indicating that in addition to an improvement in intelligibility, listening effort was also reduced when sentence-final words were predictable. Effects of predictability on all listening effort measures were observed whether or not trials with an incorrect word identification response were excluded, indicating that the effects of predictability on listening effort did not depend on speech intelligibility. In addition, although cognitive load did not affect word identification accuracy, response time for word identification and digit recall, as well as accuracy for digit recall, were impaired under the high-load condition, indicating that cognitive load reduced the amount of cognitive resources available for speech processing. Context benefit in speech intelligibility was positively correlated with vocabulary. However, context benefit was not related to working memory capacity. CONCLUSIONS: Predictive sentence context reduces listening effort in cognitively healthy older adults resulting in greater cognitive spare capacity available for other mental tasks, irrespective of the presence or absence of hearing loss and baseline working memory capacity.

Estimation of all-cause noise exposure for U.S. adults from national survey data.

Millions of adults are at risk of hearing loss resulting from exposure to occupational and recreational noises. Data from the combined National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2015-2016 datasets were used to establish the prevalence of occupational and recreational noise exposures through self-report questions. For recreational noise exposures, NHANES asked about the use of firearms, including the use of hearing protection devices (HPDs) while shooting, and off-work exposures to very loud noise. For work exposures, NHANES asked about exposures to loud and very loud noise. For four of these five questions, graded responses on a 5- or 7-point scale were available. Receiver-operating-characteristic analyses were used to optimize the criterion response for identification of hearing loss for each question with graded responses using the unweighted data. Correlations among the graded responses supported reduction to two measures: (1) rounds fired combined with use of HPDs while shooting and (2) work exposure to loud and very loud noise combined. Logistic-regression analyses of various measures of pure-tone hearing loss were performed to examine the effects of recreational and occupational noise exposures on hearing loss. The odds of hearing loss were significantly greater for those who reported recreational and combined noise exposures.

Different Associations between Auditory Function and Cognition Depending on Type of Auditory Function and Type of Cognition.

OBJECTIVES: Previous studies strongly suggest that declines in auditory threshold can lead to impaired cognition. The aim of this study was to expand that picture by investigating how the relationships between age, auditory function, and cognitive function vary with the types of auditory and cognitive function considered. DESIGN: Three auditory constructs (threshold, temporal-order identification, and gap detection) were modeled to have an effect on four cognitive constructs (episodic long-term memory, semantic long-term memory, working memory, and cognitive processing speed) together with age that could have an effect on both cognitive and auditory constructs. The model was evaluated with structural equation modeling of the data from 213 adults ranging in age from 18 to 86 years. RESULTS: The model provided good a fit to the data. Regarding the auditory measures, temporal-order identification had the strongest effect on the cognitive functions, followed by weaker indirect effects for gap detection and nonsignificant effects for threshold. Regarding the cognitive measures, the association with audition was strongest for semantic long-term memory and working memory but weaker for episodic long-term memory and cognitive speed. Age had a very strong effect on threshold and cognitive speed, a moderate effect on temporal-order identification, episodic long-term memory, and working memory, a weak effect on gap detection, and nonsignificant, close to zero effect on semantic long-term memory. CONCLUSIONS: The result shows that auditory temporal-order function has the strongest effect on cognition, which has implications both for which auditory concepts to include in cognitive hearing science experiments and for practitioners. The fact that the total effect of age was different for different aspects of cognition and partly mediated via auditory concepts is also discussed.

Clinical Effectiveness of an At-Home Auditory Training Program: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effectiveness of an at-home frequent-word auditory training procedure for use with older adults with impaired hearing wearing their own hearing aids. DESIGN: Prospective, double-blind placebo-controlled randomized trial with three parallel branches: an intervention group who received the at-home auditory training; an active control group who listened to audiobooks using a similar platform at home (placebo intervention); and a passive control group who wore hearing aids and returned for outcomes, but received no intervention. Outcome measures were obtained after a 5-week period. A mixed research design was used with a between-subjects factor of group and a repeated-measures factor of time (pre- and post-treatment) to evaluate the effects of the at-home auditory training program. The intervention was completed in participants' own homes. Baseline and outcomes measures were assessed at a university research laboratory. The participants were adults, aged 54 to 80 years, with the mild-to-moderate hearing loss. Of the 51 identified eligible participants, 45 enrolled as a volunteer sample and 43 of these completed the study. Frequent-word auditory training regimen completed intervention at home over a period of 5 weeks. The active control group listened to audiobooks (placebo intervention) and the passive control group completed no intervention. The primary outcome measure is a Connected Speech test benefit. The secondary outcome measure is a 66-item self-report profile of hearing aid performance. RESULTS: Participants who received the at-home training intervention demonstrated significant improvements on aided recognition for trained materials, but no generalization of these benefits to nontrained materials was seen. This was despite reasonably good compliance with the at-home training regimen and careful verification of hearing aid function throughout the trial. Based on follow-up post-trial evaluation, the benefits observed for trained materials in the intervention group were sustained for a period of at least 8.5 months. No improvement was seen for supplemental outcome measures of hearing aid satisfaction, hearing handicap, or tolerance of background noise while listening to speech. CONCLUSIONS: The at-home auditory training procedure utilizing frequently occurring words was effective for the trained materials used in the procedure. No generalization was seen to nontrained materials or to perceived benefit from hearing aids.

The World Health Organization's hearing-impairment grading system: an evaluation for unaided communication in age-related hearing loss.

OBJECTIVE: This review evaluated the data from five datasets having pure-tone thresholds and functional measures of speech communication from relatively large groups of older adults to evaluate the validity of the proposed new World Health Organisation (WHO) hearing-impairment grading system, referred to here as WHO-proposed. DESIGN: This was a review of studies identified from the literature having both pure-tone audiometry and functional measures of speech communication from relatively large samples of older adults. STUDY SAMPLE: Three population or population-sample datasets and two clinical datasets were identified with access provided to de-identified data for five of these six studies. RESULTS: As the WHO-proposed hearing-impairment grade progressed from "normal" to "severe" (insufficient data from older adults were available for the "profound" category), each step in this progression led to a significant difference in functional communication relative to the preceding step. Cohen's d effect sizes were moderate to very large between each successive step on the WHO-proposed hearing-impairment grading scale, with some exceptions for the step from "normal" to "mild/slight" grades. CONCLUSIONS: The WHO-proposed hearing-impairment grading system, recently developed through expert opinion and adopted by WHO, is validated here with evidence from studies of functional communication in older adults.

Commentary on the regulatory implications of noise-induced cochlear neuropathy.

OBJECTIVE: A discussion on whether recent research on noise-induced cochlear neuropathy in rodents justifies changes in current regulation of occupational noise exposure. DESIGN: Informal literature review and commentary, relying on literature found in the authors' files. No formal literature search was performed. STUDY SAMPLE: Published literature on temporary threshold shift (TTS) and cochlear pathology, in humans and experimental animals, as well as the regulations of the US Occupational Safety and Health Administration (OSHA). RESULTS: Humans are less susceptible to TTS, and probably to cochlear neuropathy, than rodents. After correcting for inter-species audiometric differences (but not for differences in susceptibility), exposures that caused cochlear neuropathy in rodents already exceed OSHA limits. Those exposures also caused "pathological TTS" (requiring more than 24 h to recover), which does not appear to occur with human broadband noise exposure permissible under OSHA. CONCLUSION: It would be premature to conclude that noise exposures permissible under OSHA can cause cochlear neuropathy in humans.

Sensory-Cognitive Interactions in Older Adults.

The objective of this study was regarding sensory and cognitive interactions in older adults published since 2009, the approximate date of the most recent reviews on this topic. After an electronic database search of articles published in English since 2009 on measures of hearing and cognition or vision and cognition in older adults, a total of 437 articles were identified. Screening by title and abstract for appropriateness of topic and for articles presenting original research in peer-reviewed journals reduced the final number of articles reviewed to 34. These articles were qualitatively evaluated and synthesized with the existing knowledge base. Additional evidence has been obtained since 2009 associating declines in vision, hearing, or both with declines in cognition among older adults. The observed sensory-cognitive associations are generally stronger when more than one sensory domain is measured and when the sensory measures involve more than simple threshold sensitivity. Evidence continues to accumulate supporting a link between decline in sensory function and cognitive decline in older adults.

Text as a Supplement to Speech in Young and Older Adults.

OBJECTIVE: The purpose of this experiment was to quantify the contribution of visual text to auditory speech recognition in background noise. Specifically, the authors tested the hypothesis that partially accurate visual text from an automatic speech recognizer could be used successfully to supplement speech understanding in difficult listening conditions in older adults, with normal or impaired hearing. The working hypotheses were based on what is known regarding audiovisual speech perception in the elderly from speechreading literature. We hypothesized that (1) combining auditory and visual text information will result in improved recognition accuracy compared with auditory or visual text information alone, (2) benefit from supplementing speech with visual text (auditory and visual enhancement) in young adults will be greater than that in older adults, and (3) individual differences in performance on perceptual measures would be associated with cognitive abilities. DESIGN: Fifteen young adults with normal hearing, 15 older adults with normal hearing, and 15 older adults with hearing loss participated in this study. All participants completed sentence recognition tasks in auditory-only, text-only, and combined auditory-text conditions. The auditory sentence stimuli were spectrally shaped to restore audibility for the older participants with impaired hearing. All participants also completed various cognitive measures, including measures of working memory, processing speed, verbal comprehension, perceptual and cognitive speed, processing efficiency, inhibition, and the ability to form wholes from parts. Group effects were examined for each of the perceptual and cognitive measures. Audiovisual benefit was calculated relative to performance on auditory- and visual-text only conditions. Finally, the relationship between perceptual measures and other independent measures were examined using principal-component factor analyses, followed by regression analyses. RESULTS: Both young and older adults performed similarly on 9 out of 10 perceptual measures (auditory, visual, and combined measures). Combining degraded speech with partially correct text from an automatic speech recognizer improved the understanding of speech in both young and older adults, relative to both auditory- and text-only performance. In all subjects, cognition emerged as a key predictor for a general speech-text integration ability. CONCLUSIONS: These results suggest that neither age nor hearing loss affected the ability of subjects to benefit from text when used to support speech, after ensuring audibility through spectral shaping. These results also suggest that the benefit obtained by supplementing auditory input with partially accurate text is modulated by cognitive ability, specifically lexical and verbal skills.

Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL).

The Fifth Eriksholm Workshop on "Hearing Impairment and Cognitive Energy" was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman's seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener's motivation to expend mental effort in the challenging situations of everyday life.

Speech recognition for multiple bands: Implications for the Speech Intelligibility Index.

The Speech Intelligibility Index (SII) assumes additivity of the importance of acoustically independent bands of speech. To further evaluate this assumption, open-set speech recognition was measured for words and sentences, in quiet and in noise, when the speech stimuli were presented to the listener in selected frequency bands. The filter passbands were constructed from various combinations of 20 bands having equivalent (0.05) importance in the SII framework. This permitted the construction of a variety of equal-SII band patterns that were then evaluated by nine different groups of young adults with normal hearing. For monosyllabic words, a similar dependence on band pattern was observed for SII values of 0.4, 0.5, and 0.6 in both quiet and noise conditions. Specifically, band patterns concentrated toward the lower and upper frequency range tended to yield significantly lower scores than those more evenly sampling a broader frequency range. For all stimuli and test conditions, equal SII values did not yield equal performance. Because the spectral distortions of speech evaluated here may not commonly occur in everyday listening conditions, this finding does not necessarily represent a serious deficit for the application of the SII. These findings, however, challenge the band-independence assumption of the theory underlying the SII.

Task-Related Vigilance During Word Recognition in Noise for Older Adults with Hearing Loss.

BACKGROUND/STUDY CONTEXT: Vigilance refers to the ability to sustain and adapt attentional focus in response to changing task demands. For older adults with hearing loss, vigilant listening may be particularly effortful and variable across individuals. This study examined the extent to which neural responses to sudden, unexpected changes in task structure (e.g., from rest to word recognition epochs) were related to pupillometry measures of listening effort. METHODS: Individual differences in the task-evoked pupil response during word recognition were used to predict functional magnetic resonance imaging (MRI) estimates of neural responses to salient transitions between quiet rest, noisy rest, and word recognition in unintelligible, fluctuating background noise. Participants included 29 older adults (M = 70.2 years old) with hearing loss (pure tone average across all frequencies = 36.1 dB HL [hearing level], SD = 6.7). RESULTS: Individuals with a greater average pupil response exhibited a more vigilant pattern of responding on a standardized continuous performance test (response time variability across varying interstimulus intervals r(27) = .38, p = .04). Across participants there was widespread engagement of attention- and sensory-related cortices in response to transitions between blocks of rest and word recognition conditions. Individuals who exhibited larger task-evoked pupil dilation also showed even greater activity in the right primary auditory cortex in response to changes in task structure. CONCLUSION: Pupillometric estimates of word recognition effort predicted variation in activity within cortical regions that were responsive to salient changes in the environment for older adults with hearing loss. The results of the current study suggest that vigilant attention is increased amongst older adults who exert greater listening effort.

The effects of dosage and duration of auditory training for older adults with hearing impairment.

This study explored a range of training dosages and durations for a word-based auditory-training procedure for older adults with hearing impairment. Three groups received a different "dose": 2x/week; 3x/week; no training. Fifteen training sessions comprised a "cycle" which was repeated three times for each dosage. Groups that completed training performed significantly better than controls for speech-in-noise materials included in the training regimen, with no significant difference observed between the 2x or 3x/week training groups. Based on these results, as well as prior literature on learning theory, training 2x or 3x/week for 5-15 weeks appears to be sufficient to yield training benefits with this training regimen.

Otoscopic Abnormalities for the U.S. Population Aged 6-80+ Years: Prevalence and Consequences for Hearing.

PURPOSE: U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. METHOD: Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. RESULTS: Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logistic-regression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non-Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. CONCLUSION: Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity.

Easy as 1-2-3: Development and Evaluation of a Simple yet Valid Audiogram-Classification System.

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.

Reconstructing wholes from parts: effects of modality, age, and hearing loss on word recognition.

OBJECTIVE: In this study, the effects of age, hearing loss, and modality on the ability to integrate partial information in degraded stimuli, either speech or text, were examined using isolated words. It was hypothesized that the ability to make use of partial information in speech diminishes with age. It was also hypothesized that additional contributions of cochlear pathology underlying hearing loss would be manifest as a further decrement in performance for older adults with hearing loss, relative to older adults with normal hearing. Furthermore, it was hypothesized that, if the ability to integrate partial information in speech is amodal, then recognition performance for degraded speech would be associated with recognition performance for parallel measures of degraded text. Last, it was hypothesized that, if the nature of the amodal ability to integrate partial information is cognitive, then the performance on auditory and visual measures of word recognition would be correlated with performance on measures of working memory. DESIGN: Twenty-five young adults with normal hearing, 20 older adults with normal hearing, and 21 older adults with hearing loss participated in this study. All participants completed three auditory and two parallel visual tasks consisting of listening to or reading degraded words or text. Older participants also completed a working-memory test battery. Group effects were examined for each of the auditory and visual measures. Performance of older participants on cognitive measures was compared with available data from a younger group participating in a different study in our laboratory (with similar protocol). Correlations between auditory and visual measures of speech recognition were examined for all participants. In addition, correlations between perceptual and cognitive measures were computed for the older participants. Finally, the relationship between dependent auditory measures and other independent measures in older adults were further examined using stepwise linear regression analyses. RESULTS: Of the 10 possible comparisons between the young and the two older groups for the five primary dependent measures, the young performed significantly better than the elderly did, 8 of the 10 times. The two older groups performed similarly for most tasks. In young adults, performance among the auditory tasks and between the two visual tasks was significantly and moderately to strongly correlated. In addition, performance on one of the visual tasks was weakly to moderately significantly correlated with performance on each of the three auditory tasks. Similar moderate to strong correlations were found within the auditory and visual modalities in older adults. However, none of the between-modality correlations were significant in the elderly. CONCLUSIONS: In summary, the results of this study suggest that the ability to integrate partial information in degraded words diminishes with age. Once audibility is accounted for, this ability does not seem to diminish with cochlear pathology. In young adults, both modality-specific factors and amodal cognitive factors seem to contribute to this ability. In older adults, although modality-specific factors continue to be important, it seems that the perceptual mechanisms that underlie the processing of degraded speech and text are separate, at least for isolated words. Our results suggest that, when peripheral factors are accounted for, some higher-level, yet-to-be identified, age-related factors contribute to speech-communication difficulties in the elderly.

U.S. Population Data on Self-Reported Trouble Hearing and Hearing-Aid Use in Adults: National Health Interview Survey, 2007-2018.

The National Health Interview Survey (NHIS) data on self-reported trouble hearing and the use of hearing aids were examined for the 12 recent surveys from 2007 to 2018 for adults from 18 to 85+ years of age. The aggregate dataset for all years included data from 357,714 adult respondents. Sample size for annual data ranged from 22,058 (2008) to 36,798 (2014). The prevalence of self-reported trouble hearing and hearing aid use, both current use and ever-using hearing aids, are reported for males and females for each age decade. Measures of unmet hearing healthcare (HHC) need were derived from estimates of the prevalence of hearing aid use among those with self-reported trouble hearing. Logistic-regression analyses identified variables affecting the odds of having self-reported trouble hearing, of using or rejecting hearing aids, and of having unmet HHC needs. The results largely corroborate and extend the findings of recent analyses of data from the National Health and Nutrition Examination Survey (NHANES) for a similar period (2011-2020). Overall, for males, 18.5% (95% CI [18.2%-18.8%]) had self-reported trouble hearing and 76.6% [76.0%-77.2%] of these individuals had never used hearing aids and, for females 13.1% [12.9%-13.4%] had trouble hearing and 79.5% [78.9%-80.1%] of these individuals had never used hearing aids. Unmet HHC needs are highly prevalent in the United States and have been so for many years.