Unmet hearing health care needs: the Beaver Dam offspring study.

OBJECTIVES: We evaluated the use of hearing health care services (hearing testing and hearing aids) by adults aged 21 to 84 years. METHODS: Hearing was tested and medical and hearing health histories were obtained as part of the Beaver Dam Offspring Study between 2005 and 2008 (n = 3285, mean age = 49 years). RESULTS: Of the cohort, 34% (55% of participants aged ≥ 70 years) had a hearing test in the past 5 years. In multivariate modeling, older age, male gender, occupation, occupational noise, and having talked with a doctor about a hearing problem were independently associated with having had a hearing test in the past 5 years. Hearing aid use was low among participants with a moderate to severe hearing impairment (22.5%) and among participants with a hearing handicap (8.6%), as determined by the Hearing Handicap Inventory. CONCLUSIONS: Data support the need for improvement in hearing health care. Hearing aids' effectiveness is limited if patients do not acquire them or do not use them once acquired. Future research should focus on developing effective strategies for moving patients from diagnosis to treatment.

Modifiable determinants of hearing impairment in adults.

OBJECTIVE: To identify factors contributing to the declining prevalence of hearing impairment in more recent generations. METHODS: We used data on hearing thresholds and potential risk factors of hearing impairment collected from studies in Beaver Dam, Wisconsin, the Epidemiology of Hearing Loss Study (1993-1995, n=3753; 1998-2000, n=2800 and 2003-2005, n=2395), the concurrent Beaver Dam Eye Study on the same cohort, and a subgroup (n=2173) of the Beaver Dam Offspring Study (2005-2008). RESULTS: Educational attainment significantly reduced the odds ratio (OR) of the birth cohort effect on hearing impairment from 0.90 to 0.93, while a history of ear infection had a reverse effect on the decreasing trend (significantly changing the OR from 0.93 to 0.94). Occupational noise exposure, smoking, and a history of cardiovascular disease, while associated with hearing impairment, did not attenuate the cohort effect. The cohort effect remained significant after known risk factors were adjusted (OR=0.93; 95% confidence interval, 0.89-0.97). CONCLUSION: These data provide strong evidence that environmental, lifestyle, or other modifiable factors contribute to the etiology of hearing impairment and add support to the idea that hearing impairment in adults may be prevented or delayed.

Generational differences in the prevalence of hearing impairment in older adults.

There were significant changes in health and lifestyle throughout the 20th century which may have changed temporal patterns of hearing impairment in adults. In this study, the authors aimed to assess the effect of birth cohort on the prevalence of hearing impairment in an adult population aged 45-94 years, using data collected between 1993 and 2008 from 3 cycles of the Epidemiology of Hearing Loss Study (n = 3,753; ages 48-92 years at baseline) and a sample of participants from the Beaver Dam Offspring Study (n = 2,173; ages > or =45 years). Hearing impairment was defined as a pure-tone average of thresholds at 0.5, 1, 2, and 4 kHz greater than 25-dB HL [hearing level]. Descriptive analysis, generalized additive models, and alternating logistic regression models were used to examine the birth cohort effect. Controlling for age, with every 5-year increase in birth year, the odds of having hearing impairment were 13% lower in men (odds ratio = 0.87, 95% confidence interval: 0.83, 0.92) and 6% lower in women (odds ratio = 0.94, 95% confidence interval: 0.89, 0.98). These results suggest that 1) older adults may be retaining good hearing longer than previous generations and 2) modifiable factors contribute to hearing impairment in adults.

Longitudinal Decline on the Dichotic Digits Test.

Purpose The dichotic digits test (DDT) is commonly administered in clinical and research settings, but it is not well understood how performance changes in aging. The purpose of this study is to determine the 5-year change on the free recall task and right ear advantage (REA) in a population-based cohort and factors associated with change. Method Participants in the population-based Epidemiology of Hearing Loss Study, who completed the DDT during the fourth (2009-2010) and fifth (2013-2016) examination periods were included (n = 865, M age = 72.8 years at baseline). Free recall DDT was administered using 25 sets of triple-digit pairs presented at 70 dB HL. The REA was calculated by subtracting the score in the left ear from the score in the right ear. Results In 5 years, most participants (62.4%) declined on free recall performance (mean decline = 3.0% [4.5 digits], p < .01). In age-sex-adjusted models, higher baseline scores, hearing impairment, and lower education were significantly associated with increased risk of decline. An REA at baseline (76.8%) and follow-up (77.9%) was common. Half of participants (50.6%) had a 5-year REA widening (M = 1.9% [1.4 digits], p = .01). Older age, but not hearing impairment, was associated with increased risk of REA widening. Conclusions The 5-year decline on free recall recognition performance was not associated with age but was associated with hearing impairment, whereas the 5-year widening of REA was associated with age but not hearing impairment. These results indicate that the REA may be a more sensitive measure of aging of the central auditory system than free recall performance.

Long-term assessment of systemic inflammation and the cumulative incidence of age-related hearing impairment in the epidemiology of hearing loss study.

BACKGROUND: Although research has linked systemic inflammation to various diseases of aging, few studies have examined the potential role it may play in the development of age-related hearing impairment. METHODS: Among 1,073 participants free of hearing impairment (pure-tone average 0.5, 1, 2, 4kHz ≤ 25 dB HL) in the population-based Epidemiology of Hearing Loss Study (1998-2000), serum C-reactive protein, and interleukin-6 were measured at three time points (1988-1990, 1998-2000, and 2009-2010), and tumor necrosis factor-α was measured at one time point (1998-2000), whereas hearing impairment was measured again in 2003-2005 and 2009-2010 to determine the 10-year cumulative incidence. RESULTS: Inflammatory marker levels from a single time point (1998-2000) were not associated with an increased risk of developing hearing impairment. Associations between long-term serum C-reactive protein levels and incident hearing impairment differed by age (p = .031). Participants less than 60 years with consistently high (>3 mg/L) or increasing levels of serum C-reactive protein over 10 years were nearly two times (hazard ratio: 1.96, 95% confidence interval: 1.19, 3.23) as likely to develop hearing impairment over the subsequent 10-year period, an association not seen in participants more than or equal to 60 years. A statistically significant association (p-trend = .041) was also observed between number of markers in the highest group at baseline and incident hearing impairment in this younger age group. CONCLUSIONS: Associations between long-term serum C-reactive protein levels and incident hearing impairment were observed in the cohort as a whole, but differed significantly by age group, with statistically significant associations observed in adults less than 60 years, participants moving through the peak risk period for hearing impairment over the course of the study.

The prevalence of hearing impairment and associated risk factors: the Beaver Dam Offspring Study.

OBJECTIVE: To estimate the prevalence of hearing impairment (HI) and evaluate the cross-sectional associations of environmental and cardiovascular disease risk factors and HI in middle-aged adults. DESIGN: Data were collected as part of the Beaver Dam Offspring Study, an epidemiological cohort study of aging. Hearing impairment was defined as a pure-tone average (0.5, 1.0, 2.0, and 4.0 kHz) greater than 25 db hearing level in either ear. Word recognition in competing message (WRCM) was measured using the Northwestern University No. 6 word list. Questionnaire information about behaviors, environmental factors, and medical history was also collected. PARTICIPANTS: The participants (N = 3285) were offspring of participants of the population-based Epidemiology of Hearing Loss Study and ranged in age from 21 to 84 years (mean age, 49 years). RESULTS: The prevalence of HI was 14.1%, and the mean (SD) WRCM score was 64% (15%). In a multivariate model, after age, sex, education, and occupational noise were controlled for, a history of ear surgery (odds ratio [OR], 4.11; 95% confidence interval [CI], 2.37-7.15), a larger central retinal venular equivalent (OR, 1.77; 95% CI, 1.20-2.60 [fourth quartile vs first quartile]), and a higher hematocrit percentage (OR, 0.77; 95% CI, 0.63-0.95 [per 5%]) were independently associated with HI. Factors associated with lower WRCM scores were similar but also included mean intima-media thickness (mean difference, -0.63%; 95% CI, -1.06% to -0.19%; P = .005 [per 0.1 mm]) and statin use (mean difference, -2.09%; 95% CI, -3.58% to -0.60%; P = .005). CONCLUSIONS: Hearing impairment is a common condition in middle-aged adults. Cardiovascular disease risk factors may be important correlates of age-related auditory dysfunction.