Age-based disparities in hearing loss diagnosis and treatment in the United States population.

OBJECTIVE: To investigate age-related disparities in the diagnosis and treatment of borderline/mild hearing loss (HL) in the United States. STUDY DESIGN: A cross-sectional epidemiologic study. SETTING: The National Health and Nutrition Examination Survey (NHANES). METHODS: Multivariable logistic regressions controlling for hearing level were performed to investigate the association between: (1) age and recent hearing test; (2) age and hearing aid use. Age was grouped into quartiles (<25, 25-49, 50-74, ≥75 years). The first quartile of life was used as a reference group in all odds ratios, controlling for hearing level. RESULTS: Of 2115 participants with borderline/mild HL, 3 % (n = 53) were in age quartile Q1; 7 % (n = 147) were in Q2, 56 % (n = 1190) were in Q3, and 34 % (n = 725) were in Q4. Compared to Q1, those in Q2, Q3, and Q4 had 4.06 times (95 % CI = 2.11-8.02, p < 0.001), 4.51 times (2.56-8.19, p < 0.001), and 4.56 times (2.55-8.39, p < 0.001) lower odds of a hearing test within the past 4 years. Similar, although slightly larger, odds ratios were obtained when the outcome was hearing test within 1 year. Compared to Q1, those in Q2, Q3, and Q4 respectively had 4.38 times (1.47-13.5, p < 0.05), 5.41 times (2.27-11.8, p < 0.001), and 3.95 times (1.65-8.72, p < 0.05) lower odds of using a hearing aid. CONCLUSION: We have characterized a large, unaddressed, and modifiable disparity in the treatment of borderline/mild HL as individuals age out of the first quartile of life. Future studies are needed to explore factors, such as ageism, that may underlie these findings.

National Cohort Data Suggests an Association Between Serious Mental Illness and Audiometric Hearing Loss.

OBJECTIVE: To explore whether there is an association between serious mental illness (SMI) and hearing loss (HL) among US Hispanic adults. STUDY DESIGN AND SETTING: Cross-sectional epidemiological study (Hispanic Community Health Study), including multicentered US volunteers. METHODS: Multivariable linear regressions were conducted to study the association between SMI and HL. Adjustments were made for potential confounders including age, sex, education, vascular disease (hypertension or diabetes mellitus), and cognition. SMI was defined by (1) antipsychotic medication classification and (2) the use of at least 1 antipsychotic medication specifically used to treat SMI in clinical psychiatric practice. HL was measured by pure tone audiometry. RESULTS: A total of 7581 subjects had complete data. The mean age was 55.2 years (SD = 7.5 years) and the mean pure tone average in the better ear was 16.8 dB (SD = 10.7 dB). A total of 194 (2.6%) subjects were taking a HCHS-defined antipsychotic and 98 (1.3%) were taking at least 1 antipsychotic specifically used to treat SMI. On multivariable regression, use of HCHS's classified antipsychotics was associated with 3.75 dB worse hearing (95% confidence interval [CI] = 2.36-5.13, P < .001) and use of antipsychotics specific for SMI was associated with 4.49 dB worse hearing (95% CI = 2.56-6.43, P < .001) compared to those not using antipsychotics. CONCLUSION: SMI, as defined by either the use of HCHS-defined antipsychotics or the use of antipsychotic medication specific for SMI, is associated with worse hearing, controlling for potential confounders. Whether SMI contributes to HL, antipsychotic medication (through ototoxicity) contributes to HL, or whether HL contributes to SMI is unknown and warrants further investigation.

Cochlear Implantation after Stereotactic Radiosurgery for Vestibular Schwannoma: Initial Hearing Improvement and Longevity of Hearing Restoration.

OBJECTIVE: The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients? DATA SOURCES: PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched. STUDY SELECTION: Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study. DATA EXTRACTION: Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted. DATA SYNTHESIS: Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables. CONCLUSIONS: The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.

Etiology of Retinitis Pigmentosa.

Retinitis pigmentosa (RP) is a set of symptoms including tunnel vision, night blindness, and progressive vision loss, stemming from a very heterogeneous set of causes-it can result from a several different kinds of mutations (non-syndromic) in conjunction with other symptoms, as part of a larger syndrome (syndromic), or secondary to an organ system disease state (secondary RP). This chapter explores and elucidates these various causes of RP.

Prevalence of Subclinical Hearing Loss in the United States.

OBJECTIVE: Current definitions of hearing loss (HL) may be insufficiently strict, as subclinical hearing loss (SCHL; >0 and ≤25 dB hearing level) has been associated with deleterious age-related conditions. SCHL prevalence and mean age of HL onset in the United States has not been characterized. STUDY DESIGN: A cross-sectional epidemiologic prevalence study. SETTING: US Community. METHODS: We analyzed cross-sectional audiometric data in the US National Health and Nutrition Examination Survey (2005-2012, 2015-2018, n = 15,649). Results were scaled to the current population using weighting. RESULTS: 79.6% of participants (227.32 million Americans) had SCHL. The mean age of HL onset at thresholds of 25, 20, and 15 dB was 74, 66, and 55 years, respectively, for the 4-frequency pure-tone average, and 48, 44, and 35 years for the high-frequency pure-tone average. CONCLUSION: We present SCHL prevalence and define HL onset by various sensitive definitions. These results inform ongoing public health efforts to increase hearing aid utilization, particularly given the arrival of over-the-counter hearing aids.

Hearing Loss Is Associated With Worse Socialization in the U.S. Hispanic Adult Population.

OBJECTIVE: The association between hearing loss and socialization has been characterized in limited detail and primarily among non-Hispanic Caucasians. We aimed to study this relationship using more detailed socialization measures than previously used and focusing on Hispanics. STUDY DESIGN: Cross-sectional epidemiologic study (Hispanic Community Health Study). SETTING: Multicentered, four U.S. communities. PARTICIPANTS: U.S. Hispanics ages 18 to 76 years. MAIN MEASURES: Multivariable linear regression controlling for confounders (age, sex, education) was conducted to analyze the association between hearing loss (four-frequency pure tone average) and socialization. Socialization was assessed with three independent surveys: a modified Cohen Interpersonal Support Evaluation List (ISEL), the Cohen Social Network Index (SNI), and a modified Moos Family Environment Scale. RESULTS: Average age was 46.7 years (standard deviation [SD], 13.6 yr; range, 18-75 yr). Average ISEL composite score was 25.9 (SD, 6.66; n = 4,330). Controlling for confounders, for every 10 dB worsening in hearing, the ISEL score decreased by 0.31 (95% confidence interval [CI], 0.08-0.52; p < 0.01). Average SNI network diversity score was 6.89 (SD, 1.81; n = 3,117) and average SNI network size was 15.4 individuals (SD, 8.11). Controlling for confounders, for every 10 dB worsening in hearing, the SNI network diversity decreased by 0.22 (95% CI, 0.15-0.29; p < 0.001), and SNI size decreased by 0.25 (95% CI, 0.07-0.62; p < 0.05). Average family cohesion score on the Moos Family Environment Scale was 12.9 (SD, 2.77; n = 4,234). Controlling for age, sex, and education, for every 10 dB worsening in hearing, family cohesion decreased by 0.14 (95% CI, 0.04-0.23; p < 0.01). CONCLUSION: Hearing loss is associated with less social support, smaller/less diverse social networks, and less family cohesion in U.S. Hispanics.

Patient-Reported Postoperative Pain and Numbness: Applications for Endoscopic vs. Microscopic Ear Surgery.

Background: Transcanal endoscopic ear surgery (TEES) avoids a postauricular incision, which has been shown to minimize pain and numbness. Our objective is to assess how much patients value minimizing pain and numbness relative to other postoperative otologic outcomes. Methods: Cross-sectional anonymous surveys were distributed to otolaryngology clinic patients in a tertiary care center. Patients were instructed to rate how much they value various outcomes when undergoing hypothetical ear surgery on a scale of 0 (not important) to 10 (very important). Results: 102 patients responded. Ten percent of survey respondents were Spanish-speaking. Outcomes of the highest importance included hearing (mean 9.3; SD 1.9), staff friendliness (8.9; 1.8), numbness (8.3; 2.4), and pain (8.1; 2.5). Outcomes of moderate importance included time spent under anesthesia (7.0; 3.2), scar visibility (6.3; 3.5), incision size (5.5; 3.4), incision hidden in the ear canal (5.4, 3.9), and surgery cost to the hospital (5.1; 3.9). In linear regression analysis, increasing age was associated with decreased value placed on incision size (p < 0.001) and scar visibility (p < 0.001). Conclusion: Patients placed a high value on minimizing pain and numbness after ear surgery, nearly as much as a good hearing outcome. These patient-centric outcomes are important in justifying the minimally invasive approach of TEES.

Hearing Aid Usage and Reported Hearing Difficulty in Americans With Subclinical Hearing Loss.

OBJECTIVE: Subclinical hearing loss (SCHL) (previously defined by our group as a four-frequency pure tone average [PTA4] >0 to ≤25 dB) has recently been associated with depressive symptoms and cognitive decline. This suggests that the common 25 dB adult cutpoint in the United States for normal hearing may not be sensitive enough. We aim to characterize real-world hearing difficulties, as measured by hearing aid use and self-reported hearing difficulty, among individuals with SCHL. STUDY DESIGN: Analysis of biennial cross-sectional epidemiologic survey (National Health and Nutrition Examination Survey, 1999-2012, 2015-2016). SETTING: Community, multicentered, national. SUBJECTS: Noninstitutionalized US citizens ≥12 years old, n = 19,246. MEASURES: PTA4 (500, 1,000, 2,000, 4,000 Hz), high-frequency pure tone average (PTAhf) (6,000, 8,000 Hz), reported hearing aid use, subjective difficulty hearing. RESULTS: There were 806,705 Americans with SCHL who wore hearing aids (or 0.35% of the 227,324,096 Americans with SCHL; 95% confidence interval = 0.23%-0.54%). Among those with SCHL, 14.6% (33.1 million Americans) perceived a little trouble hearing and 2.29% (5.21 million Americans) perceived moderate/a lot of trouble hearing. When restricted to the borderline subcategory (>20 to ≤25 dB), 42.43% (6.64 million Americans) had at least a little trouble hearing. Among those with SCHL who wore hearing aids, 81% had a PTAhf >25 dB. CONCLUSION: Despite hearing loss traditionally being defined by PTA4 ≤ 25 dB in the United States, nearly 1 million adults and adolescents with SCHL wore hearing aids, and nearly half with borderline HL had subjective difficulty hearing. To better reflect real-world difficulties, stricter definitions of hearing loss should be explored, including a lower cutpoint for the PTA4 or by using the more sensitive PTAhf.

Tracheostomy Outcomes in Patients With COVID-19 at a New York City Hospital.

Objective: Tracheostomies have been performed in patients with prolonged intubation due to COVID-19. Understanding outcomes in different populations is crucial to tackle future epidemics. Study Design: Prospective cohort study. Setting: Tertiary academic medical center in New York City. Methods: A prospectively collected database of patients with COVID-19 undergoing open tracheostomy between March 2020 and April 2020 was reviewed. Primary endpoints were weaning from the ventilator and from sedation and time to decannulation. Results: Sixty-six patients underwent tracheostomy. There were 42 males (64%) with an average age of 62 years (range, 23-91). Patients were intubated for a median time of 26 days prior to tracheostomy (interquartile range [IQR], 23-30). The median time to weaning from ventilatory support after tracheostomy was 18 days (IQR, 10-29). Of those sedated at the time of tracheostomy, the median time to discontinuation of sedation was 5 days (IQR, 3-9). Of patients who survived, 39 (69%) were decannulated. Of those decannulated before discharge (n = 39), the median time to decannulation was 36 days (IQR, 27-49) following tracheostomy. The median time from ventilator liberation to decannulation was 14 days (IQR, 8-22). Thirteen patients (20.0%) had minor bleeding requiring packing. Two patients (3%) had bleeding requiring neck exploration. The all-cause mortality rate was 10.6%. No patients died of procedural causes, and no surgeons acquired COVID-19. Conclusion: Open tracheostomies were successfully and safely performed at our institution in the peak of the COVID-19 pandemic. The majority of patients were successfully weaned from the ventilator and sedation. Approximately 60% of patients were decannulated prior to hospital discharge.

Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas.

Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient's individual tumor characteristics, risk, symptoms, and therapeutic goals.