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.

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.

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.

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.

U.S. Population Data on Hearing Loss, Trouble Hearing, and Hearing-Device Use in Adults: National Health and Nutrition Examination Survey, 2011-12, 2015-16, and 2017-20.

The National Health and Nutrition Examination Survey (NHANES) data on audiometric hearing loss, self-reported trouble hearing, and the use of hearing aids and assistive listening devices (ALDs) for the three most recent surveys (2011-12, 2015-16, and 2017-20) were analyzed for adults ranging in age from 20 to 80-plus years. Complete audiograms were available for a total of 8,795 adults. The prevalence of hearing loss, measured audiometrically and self-reported, is provided for males and females by age decade. Logistic-regression analyses identified variables affecting the odds of having an audiometrically defined hearing loss or self-reported trouble hearing. As in previous reports, males were more likely than females to have audiometric hearing loss and the prevalence of hearing loss increased steadily with advancing age. The same trends were observed for self-reported hearing difficulty, although the effects of age and sex were smaller for self-reported trouble hearing compared to audiometric hearing loss. The agreement between the audiometric classification of hearing loss severity and the amount of trouble reported on the self-report measure was moderate (r = 0.61). The prevalence of hearing-aid and ALD use differed for males and females of the same age, females generally using these devices less frequently than males, but both showing increased prevalence of device use with advancing age. Unmet hearing-healthcare need, defined as the percentage of those with identified hearing loss or trouble hearing who were not current hearing-aid users or had never tried hearing aids or ALDs, was about 85%.

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.

Hearing Thresholds for Unscreened U.S. Adults: Data From the National Health and Nutrition Examination Survey, 2011-2012, 2015-2016, and 2017-2020.

Hearing threshold levels (HTLs) at 500-8,000 Hz from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2015-2016, and 2017-2020 were analyzed for males and females ranging in age from 20 to 80-plus years (N = 8,795). HTLs for the 10th, 25th, 50th, 75th, and 90th percentiles are provided for males and females. Equations were generated to describe median HTLs as a function of age at each frequency. The medians generated for this unscreened dataset of U.S. adults were compared to those in Table B.3 of ISO 1999 (2013), which came from analyses of the NHANES 1999-2006 datasets. The ISO 1999 values were found to be slightly higher (worse) at several frequencies. The ISO 1999 (2013) median HTLs were 2 to 5 dB worse at 500 Hz for males and females and 2 to 8 dB worse at 4,000 and 6,000 Hz for males than the updated NHANES estimates. As in prior analyses of NHANES data, HTLs worsened with age, were better for females than males, and were better for Non-Hispanic Blacks than for Non-Hispanic Whites. The latter difference was observed for both males and females, was confined to frequencies above 2,000 Hz, and widened with increasing age.

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.

Modification of a Method for Diagnosing Noise-Induced Hearing Loss Sustained During Military Service.

Moore (2020) proposed a method for diagnosing noise-induced hearing loss (NIHL) sustained during military service, based on an analysis of the shapes of the audiograms of military personnel. The method, denoted M-NIHL, was estimated to have high sensitivity but low-to-moderate specificity. Here, a revised version of the method, denoted rM-NIHL, was developed that gave a better balance between sensitivity and specificity. A database of 285 audiograms of military noise-exposed men was created by merging two previously used databases with a new database, randomly shuffling, and then splitting into two, one for development of the revised method and one for evaluation. Two comparable databases of audiograms of 185 non-exposed men were also created, again one for development and one for evaluation. Based on the evaluation databases, the rM-NIHL method has slightly lower sensitivity than the M-NIHL method, but the specificity is markedly higher. The two methods have similar overall diagnostic performance. If an individual is classified as having NIHL based on a positive diagnosis for either ear, the rM-NIHL method has a sensitivity of 0.98 and a specificity of 0.63. Based on a positive diagnosis for both ears, the rM-NIHL method has a sensitivity of 0.76 and a specificity of 0.95.

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.

Differences in Auditory Perception Between Young and Older Adults When Controlling for Differences in Hearing Loss and Cognition.

This study was designed to examine age effects on various auditory perceptual skills using a large group of listeners (155 adults, 121 aged 60-88 years and 34 aged 18-30 years), while controlling for the factors of hearing loss and working memory (WM). All subjects completed 3 measures of WM, 7 psychoacoustic tasks (24 conditions) and a hearing assessment. Psychophysical measures were selected to tap phenomena thought to be mediated by higher-level auditory function and included modulation detection, modulation detection interference, informational masking (IM), masking level difference (MLD), anisochrony detection, harmonic mistuning, and stream segregation. Principal-components analysis (PCA) was applied to each psychoacoustic test. For 6 of the 7 tasks, a single component represented performance across the multiple stimulus conditions well, whereas the modulation-detection interference (MDI) task required two components to do so. The effect of age was analyzed using a general linear model applied to each psychoacoustic component. Once hearing loss and WM were accounted for as covariates in the analyses, estimated marginal mean thresholds were lower for older adults on tasks based on temporal processing. When evaluated separately, hearing loss led to poorer performance on roughly 1/2 the tasks and declines in WM accounted for poorer performance on 6 of the 8 psychoacoustic components. These results make clear the need to interpret age-group differences in performance on psychoacoustic tasks in light of cognitive declines commonly associated with aging, and point to hearing loss and cognitive declines as negatively influencing auditory perceptual skills.

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.

A Comparison of the Perceived Hearing Difficulties of Community and Clinical Samples of Older Adults.

Purpose This study aimed to compare the perceived hearing difficulties of a community sample of older adults to two clinical samples of older adults, one with no hearing aid experience and the other with hearing aid experience. Method Scale scores from the Communication Profile for the Hearing Impaired (CPHI) were analyzed for a community sample of older adults (N = 243) and compared to scores from two clinical samples, one without (N = 342) and one with prior hearing-aid experience (N = 179). General linear model (GLM) analyses were performed to examine the effects of data sample type and other factors on CPHI scale scores. Scores for the Hearing Handicap Inventory for the Elderly (HHIE) were also available for most participants and were analyzed. Results GLM analyses of each of the 20 CPHI scale scores showed significant effects of sample type with hearing-loss severity and age most frequently showing significant effects as well. GLM analyses controlling for hearing-loss severity and age across sample types found significant differences on most CPHI scales between the community sample and each of the two clinical samples. Significant differences between the two clinical samples were also found on several CPHI scales and on the HHIE. Conclusions Older adults from the community who did not seek help for hearing difficulties self-reported less difficulty and a greater denial or lack of awareness of communication problems than those who sought assistance at an audiology clinic. For those presumed to have sought a hearing evaluation, those acquiring hearing aids perceived greater communication difficulties in all environments, had greater awareness of communication difficulties, were more accepting of their hearing loss, but tended to allocate more responsibility for their difficulties to others, compared to those who sought clinical assistance but did not acquire hearing aids.

Factors Underlying Individual Differences in Speech-Recognition Threshold (SRT) in Noise Among Older Adults.

Many older adults have difficulty understanding speech in noisy backgrounds. In this study, we examined peripheral auditory, higher-level auditory, and cognitive factors that may contribute to such difficulties. A convenience sample of 137 volunteer older adults, 90 women, and 47 men, ranging in age from 47 to 94 years (M = 69.2 and SD = 10.1 years) completed a large battery of tests. Auditory tests included measures of pure-tone threshold, clinical and psychophysical, as well as two measures of gap-detection threshold and four measures of temporal-order identification. The latter included two monaural and two dichotic listening conditions. In addition, cognition was assessed using the complete Wechsler Adult Intelligence Scale-3rd Edition (WAIS-III). Two monaural measures of speech-recognition threshold (SRT) in noise, the QuickSIN, and the WIN, were obtained from each ear at relatively high presentation levels of 93 or 103 dB SPL to minimize audibility concerns. Group data, both aggregate and by age decade, were evaluated initially to allow comparison to data in the literature. Next, following the application of principal-components factor analysis for data reduction, individual differences in speech-recognition-in-noise performance were examined using multiple-linear-regression analyses. Excellent fits were obtained, accounting for 60-77% of the total variance, with most accounted for by the audibility of the speech and noise stimuli and the severity of hearing loss with the balance primarily associated with cognitive function.

Development of the SWB-HL: A Scale of the Subjective Well-Being of Older Adults With Hearing Loss.

The objective of this research was to develop and evaluate a self-report measure of subjective well-being (SWB) for use with older adults with hearing loss (HL). A convenience sample of 173 local volunteers between the ages of 60 and 88 years (M = 74.4; SD = 7.2 years) participated in this study. The initial 18-item version of the scale was constructed, response characteristics examined, and then subjected to factor analysis, as well as evaluation of the scales' reliability and validity. The analysis of response characteristics and subsequent factor analysis resulted in the elimination of eight of the 18 test items. The SWB-HL Total score was derived from the 10 remaining items. It was shown that the SWB-HL tapped three underlying domains interpreted as: Life Satisfaction (three items); Acceptance of Hearing Loss (Accept HL; four items); and Social Support (three items). Psychometric analysis showed very good reliability and good criterion validity was established for the 10-item SWB-HL Total score. In addition, significant differences were observed between aided and unaided SWB-HL Total scores following 4-6 weeks of hearing aid use. The SWB-HL is a 10-item self-report measure of SWB that shows good reliability and validity when used by older adults with hearing loss and reveals improved SWB following the use of hearing aids.

Differences Between Older Adults Who Do and Do Not Try Hearing Aids and Between Those Who Keep and Return the Devices.

The focus of this study was on the differences between older adults who complied with a clinical recommendation for hearing-aid acquisition (adherents; N = 105) and those who did not (nonadherents; N = 34) among a group of research volunteers from the community. All participants were first-time hearing-aid users. Differences between adherents and nonadherents were examined across several domains, including demographic variables, audiometric measures, measures of affect and personality, cognitive variables, hearing-aid expectations, and the perceived hearing difficulties of the older adults and their adjustments to those difficulties. It was found that the adherents differed significantly (p < .05) from the nonadherents primarily in their perceived difficulties and reactions to them as well as their expectations for hearing aids. Importantly, the pattern of differences between the adherents and nonadherents was primarily confined to measures that could potentially be shaped by appropriate counseling and education of the older adult. In a secondary analysis, among the 105 adherents, a small group (N = 21) returned their hearing aids for credit with 15 of them completing the outcome measures at the end of a 1-month trial period. When comparisons were made between the adherents who kept their hearing aids (N = 84) and those who returned them, the primary differences between these two groups of adherents were in the poorer aided outcomes obtained by those who returned their devices.

Further Evaluation and Application of the Wisconsin Age-Related Hearing Impairment Classification System.

Purpose The primary purpose of this report is to further evaluate the Wisconsin Age-Related Hearing Impairment Classification System (WARHICS) scheme for the classification of audiograms obtained from older adults, ages 50-89 years. Method This was a retrospective analysis of data from 11,729 older adults included in two population, one community, and two clinical data sets. To aid in the interpretation of the audiogram classifications, the functional significance of audiogram categories was evaluated using Hearing Handicap Inventory-Screen scores available for 10,330 of these same individuals. Results A WARHICS level could be obtained successfully for 99.5% of the 11,729 audiograms included in these analyses. It was applied successfully to population, community, and clinical samples. WARHICS Level 8 audiograms, corresponding to a broad profound hearing impairment (pure-tone thresholds from 500 to 8000 Hz, all > 80 dB HL), were very rare (.1% prevalence). WARHICS subtypes, designed to identify those with high-frequency notched audiograms or flat audiograms, occurred only 3%-6% of the time, depending on the data set. When compared to the current hearing-impairment grading system of the World Health Organization (WHO), several WARHICS levels fell within a given WHO hearing-impairment grade suggesting a finer grained categorization by the WARHICS. The Hearing Handicap Inventory-Screen scores provided justification for the fine-grained categorization according to the WARHICS. It is also demonstrated that the WARHICS levels could be extended to the classification of audiograms from all adults, regardless of age. Finally, a WARHICS-WHO hybrid classification scheme is proposed for future evaluation. Conclusions Although the WARHICS was developed from a population data set, it was demonstrated here to be applicable to population, community, and clinical data sets for adults aged 50-89 years. The applicability of the WARHICS or a WARHICS-WHO hybrid to population data sets that included younger adults suggests that this classification system has the potential to be applied even more broadly than just to age-related hearing loss.

Longitudinal Changes in Auditory and Cognitive Function in Middle-Aged and Older Adults.

Purpose This article aimed to document longitudinal changes in auditory function, including measures of temporal processing, and to examine the associations between observed changes in auditory and cognitive function in middle-aged and older adults. Method This was a prospective longitudinal study of 98 adults (66 women) with baseline ages ranging from 40 to 85 years. The mean interval between T1 baseline and T2 follow-up measurements was 8.8 years with a range of 7-11 years. Measures of hearing threshold, gap detection, and auditory temporal-order identification were completed at T1 and T2. Cognitive measures completed at T1 and T2 were the 13 scales of the Wechsler Adult Intelligence Scale-Third Edition. Three approaches were taken to analyze these data: (a) examination of changes over time in group performance, (b) correlations and slopes between auditory and cognitive measures to examine concomitant rates of decline over the 9-year T1-to-T2 period, and (c) regression analyses examining associations between auditory performance at T1 and cognitive performance 9 years later at T2. Results For the group data, there were significant declines in hearing loss, gap-detection thresholds at one frequency, and process-type measures of cognitive function from T1 to T2 matching the trends in the baseline cross-sectional data. Regression analyses of the longitudinal data revealed the strongest connection between auditory temporal-order processing and cognitive processing typically explaining 10%-15% of the variance. Conclusions A significant amount of variance in rates of cognitive decline, T1 to T2, and subsequent cognitive performance (T2) was explained by measures of auditory function. Although hearing loss occasionally emerged as a significant factor, auditory temporal-order identification emerged much more frequently as the auditory measure most strongly associated with cognitive function.