Accuracy of automated pure-tone audiometry in population-based samples of older adults.

OBJECTIVE: Automated pure-tone audiometry is frequently used in teleaudiology and hearing screening. Given the high prevalence of age-related hearing loss, older adults are an important target population. This study aimed to investigate the accuracy of automated audiometry in older adults, and to examine the influence of test frequency, age, sex, hearing and cognitive status. DESIGN AND STUDY SAMPLE: In a population-based study, two age-homogeneous samples of 70-year-olds (n = 238) and 85-year-olds (n = 114) were tested with automated audiometry in an office using circum-aural headphones and, around 4 weeks later, with manual audiometry conducted to clinical standards. The differences were analysed for individual frequencies (range: 0.25-8 kHz) and pure-tone averages. RESULTS: The mean difference varied across test frequencies and age groups, the overall figure being -0.7 dB (SD = 8.8, p < 0.001), and 68% to 94% of automated thresholds corresponded within ±10 dB of manual thresholds. The poorest accuracy was found at 8 kHz. Age, sex, hearing and cognitive status were not associated with the accuracy (ordinal regression analysis). CONCLUSIONS: Automated audiometry seems to produce accurate assessments of hearing sensitivity in the majority of older adults, but with larger error margins than in younger populations, and is not affected by relevant patient factors associated with old age.

Pathophysiological and Clinical Aspects of Hearing Loss Among 85-Year-Olds.

PURPOSE: This study aimed to identify the prevalence of conductive/mixed and sensorineural hearing loss, with an attempt to differentiate between sensory and neural components in 85-year-olds. METHOD: A comprehensive auditory test protocol, including pure-tone audiometry, speech audiometry, auditory brainstem response (ABR), and distortion product otoacoustic emission (DPOAE), was used to identify different types of hearing loss in 85-year-olds. This study comprised a subsample (n = 125) selected from an unscreened cohort of 85-year-olds born in 1930, within the Gothenburg H70 Birth Cohort Studies in Sweden. RESULTS: Test results were reported descriptively. Sensorineural hearing loss was present in one or both ears in almost all participants (98%), and the majority had absent DPOAEs. Only approximately 6% had additional conductive hearing loss, that is, mixed hearing loss. Approximately 20% of the participants with a pure-tone average at 0.5-4 kHz < 60 dB HL had worse word recognition scores compared with predicted scores by the Speech Intelligibility Index (SII), whereas only two participants were classified with neural dysfunction with the use of ABR. CONCLUSIONS: Sensorineural hearing loss, likely related to outer hair cell loss, was present in the vast majority of 85-year-olds. Conductive/mixed hearing loss appears to be relatively rare in advanced age. Poor word recognition scores in relation to SII-predicted scores were relatively common (20%) in 85-year-olds, whereas auditory neuropathy was only rarely identified (1.6%) by the use of ABR latencies. To explain abnormal word recognition and to identify the neural component of hearing loss among the older-old population, future research should consider factors such as listening effort and cognition among the older-old population.

Hearing Loss and Cognitive Function in Early Old Age: Comparing Subjective and Objective Hearing Measures.

INTRODUCTION: Population-based research has consistently shown that people with hearing loss are at greater risk of cognitive impairment. We aimed to explore the cross-sectional association of both subjective and objective hearing measures with global and domain-specific cognitive function. We also examined the influence of hearing aid use on the relationship. METHODS: A population-based sample (n = 1,105, 52% women) of 70-year-olds that were representative of the inhabitants of the city of Gothenburg, Sweden completed a detailed cognitive examination, pure-tone audiometry, and a questionnaire regarding perceived hearing problems. A subsample (n = 247, 52% women) also completed a test of speech-recognition-in-noise (SPRIN). Multiple linear regression analyses were conducted to explore the association of hearing with cognitive function, adjusting for sex, education, cardiovascular factors, and tinnitus. RESULTS: Global cognitive function was independently associated with the better ear pure-tone average across 0.5-4 kHz (PTA4, ß = -0.13, 95% CI, -0.18, -0.07), the better ear SPRIN score (ß = 0.30, 95% CI, 0.19, 0.40), but not with the self-reported hearing measure (ß = -0.02, 95% CI, -0.07, 0.03). Both verbally loaded and nonverbally loaded tasks, testing a variety of cognitive domains, contributed to the association. Hearing aid users had better global cognitive function than nonusers with equivalent hearing ability. The difference was only significant in the mild hearing loss category. DISCUSSION: In a population-based sample of 70-year-old persons without dementia, poorer hearing was associated with poorer global and domain-specific cognitive function, but only when hearing function was measured objectively and not when self-reported. The speech-in-noise measure showed the strongest association. This highlights the importance of including standardized hearing tests and controlling for hearing status in epidemiological geriatric research. More research is needed on the role that hearing aid use plays in relation to age-related cognitive declines.

Prevalence of hearing loss and need for aural rehabilitation in 85-year-olds: a birth cohort comparison, almost three decades apart.

OBJECTIVE: Many individuals >80 years have difficulties with speech communication due to age-related hearing loss and would benefit from aural rehabilitation. As the proportion of older people increases, there is a need to investigate the prevalence of "disabling hearing loss" to calculate future rehabilitation need. The aims are to determine the prevalence of hearing loss in an unscreened birth cohort of 85-year olds, and to identify differences in audiometric results between two birth cohorts, born 28-29 years apart. DESIGN: This is a population-based, cross-sectional study that is part of the Gothenburg H70 Birth Cohort Studies. STUDY SAMPLE: Hearing thresholds were measured and compared between 85-year olds born in 1930 (n = 286) and 1901-1902 (n = 249). RESULTS: Based on the WHO criteria, the prevalence of "disabling hearing loss" was 45% for men and 43% for women in the latest birth cohort. Hearing thresholds (0.5-4 kHz) for men improved compared with the earlier birth cohort. No such difference was observed for women. CONCLUSION: The prevalence of age-related hearing loss over three decades has decreased among 85-year-old men, but has been retained in women. The improvement for men occurred predominantly in the low-mid frequencies. An increased need for aural rehabilitation is expected due to demographic changes.

Auditory function and prevalence of specific ear and hearing related pathologies in the general population at age 70.

Objective: To describe the auditory function in early old age in detail based on both psychoacoustic and physiological measures, and to investigate the prevalence of specific audiological and otological pathologies.Design: An unscreened subsample from a population-based geriatric investigation was examined with otoscopy; tympanometry; pure-tone audiometry; word-recognition-in-noise test; distortion-product otoacoustic emissions; and auditory-evoked brainstem responses. Audiometric subtypes and diagnoses were established based on set criteria. The association between word scores and ABR was examined with linear regression analysis.Study Sample: 251 persons aged 70 (113 men, 138 women, born in 1944) that were representative of the inhabitants of the city of Gothenburg.Results: The prevalence of conductive pathology was 2% versus 49% for cochlear and 2% for auditory-neural pathology. Four percent had indeterminate type. Cochlear dysfunction was present in the majority of ears and around 20% performed worse-than-expected on speech testing. Poor performance on the speech in noise test was associated with prolonged interpeak latency interval of ABR waves I-V.Conclusion: Specific otological and audiological pathologies, other than cochlear hearing loss, are rare in the general population at age 70. Additionally, there is subtle evidence of age-related decline of the auditory nerve. Longitudinal follow-up would be of great interest.

Cross-sectional assessment of hearing acuity of an unscreened 85-year-old cohort - Including a 10-year longitudinal study of a sub-sample.

As the proportion of older people increases, it is important to investigate hearing acuity in older individuals and to calculate hearing decline for older ages, using standardised test protocols. The main aim of this study was to determine pure-tone hearing thresholds in an unscreened birth cohort of 85-year-olds born in 1930, living in an industrial Swedish city. A further aim was to describe hearing decline in men and women from 75 to 85 years of age with the aid of longitudinal data. The study was part of the Gothenburg H70 Birth Cohort Studies in Sweden. Hearing thresholds (0.25-8 kHz) were measured using automated pure-tone audiometry for 286 85-year-old participants. A subsample (n = 182) was hearing examined at 75 years of age and studied longitudinally from 75 to 85 years. At age 85 years, men had better hearing at low frequencies but poorer hearing at high frequencies than women. The longitudinal study showed a considerable decline between 75 and 85 years at mid-high frequencies (>1 kHz) and the amount of decline was similar between sexes. The results contribute to the estimation of the future need for hearing health services.

VEMP using a new low-frequency bone conduction transducer.

OBJECTIVE: A new prototype bone conduction (BC) transducer B250, with an emphasized low-frequency response, is evaluated in vestibular evoked myogenic potential (VEMP) investigations. The aim was to compare cervical (cVEMP) and ocular (oVEMP) responses using tone bursts at 250 and 500 Hz with BC stimulation using the B250 and the conventional B81 transducer and by using air conduction (AC) stimulation. METHODS: Three normal subjects were investigated in a pilot study. BC stimulation was applied to the mastoids in cVEMP, and both mastoid and forehead in oVEMP investigations. RESULTS: BC stimulation was found to reach VEMP thresholds at considerably lower hearing levels than in AC stimulation (30-40 dB lower oVEMP threshold at 250 Hz). Three or more cVEMP and oVEMP responses at consecutive 5 dB increasing mastoid stimulation levels were only obtained in all subjects using the B250 transducer at 250 Hz. Similar BC thresholds were obtained for both ipsilateral and contralateral mastoid stimulation. Forehead stimulation, if needed, may require a more powerful vibration output. CONCLUSION: Viable VEMP responses can be obtained at a considerably lower hearing level with BC stimulation than by AC stimulation. The cVEMP and oVEMP responses were similar when measured on one side and with the B250 attached to both ipsilateral and contralateral mastoids.

Improved hearing in Swedish 70-year olds-a cohort comparison over more than four decades (1971-2014).

Objective: the world population is ageing rapidly. In light of these demographic changes, it is of interest to generate current data regarding the prevalence and characteristics of age-related hearing loss. The purpose of this study was to investigate hearing acuity and the prevalence of hearing loss in a contemporary age-homogenous cohort of old adults, and to assess secular trends in hearing function during the last half-century (1971-2014). Methods: we performed a prospective population-based cohort comparison study of unscreened populations. As part of a geriatric population-based study (H70), a new cohort of 70-year olds (n = 1,135) born in 1944 was tested with computerised automated pure-tone audiometry. The hearing thresholds were compared to three earlier born cohorts of 70-year olds, born in 1901-02 (n = 376), 1906-07 (n = 297) and 1922 (n = 226), respectively. Results: significant improvements in median pure-tone thresholds were seen at several frequencies in both men (range: 5-20 dB, P < 0.01) and women (range: 5-10 dB, P < 0.01). When investigating the effect of birth cohort on hearing in a linear regression, significant trends were found. Men's hearing improved more than women's. The prevalence of hearing loss declined in the study period (1971-2014) from 53 to 28% for men and 37 to 23% for women (P < 0.01). Conclusions: these results indicate that the hearing acuity in Swedish 70-year olds has improved significantly over more than four decades. The largest improvements were seen at 4-6 kHz in men, possibly reflecting a decrease in occupational noise exposure. Further studies are required to pinpoint the reasons for improved hearing-health among older people.

Electro-acoustic performance of the new bone vibrator Radioear B81: a comparison with the conventional Radioear B71.

OBJECTIVE: The objective is to evaluate the electro-acoustic performance of a new audiometric bone vibrator, the B81 from Radioear Corporation, USA. Comparison will be made with the widely used B71 which has well-known limitations at low frequencies. DESIGN: The B81 is based on the balanced electromagnetic separation transducer (BEST) principle where static forces are counterbalanced so that nonlinear distortion forces are reduced and maximum hearing levels can be increased. STUDY SAMPLE: Maximum hearing level, total harmonic distortion (THD), frequency response, and electrical impedance were measured for six devices of each bone vibrator type on an artificial mastoid. RESULTS: It was found that B81 reaches 10.7-22.0 dB higher maximum (@ THD = 6% or Vin = 6 VRMS) hearing levels than B71 for frequencies below 1500 Hz, and had significantly lower THD up to 1000 Hz. There was no statistically significant difference between their frequency response, except a deviation at the mid frequencies (α = 0.01) where B81 was more efficient and the electrical impedances were practically the same. CONCLUSIONS: In general, B81 had an improved electro-acoustic performance compared to B71 and is compatible with same audiometers. In particular, B81 allows for sensorineural hearing loss to be measured at considerably higher hearing levels than with B71 below 1500 Hz.

Transmission of bone conducted sound - correlation between hearing perception and cochlear vibration.

The vibration velocity of the lateral semicircular canal and the cochlear promontory was measured on 16 subjects with a unilateral middle ear common cavity, using a laser Doppler vibrometer, when the stimulation was by bone conduction (BC). Four stimulation positions were used: three ipsilateral positions and one contralateral position. Masked BC pure tone thresholds were measured with the stimulation at the same four positions. Valid vibration data were obtained at frequencies between 0.3 and 5.0 kHz. Large intersubject variation of the results was found with both methods. The difference in cochlear velocity with BC stimulation at the four positions varied as a function of frequency while the tone thresholds showed a tendency of lower thresholds with stimulation at positions close to the cochlea. The correlation between the vibration velocities of the two measuring sites of the otic capsule was high. Also, relative median data showed similar trends for both vibration and threshold measurements. However, due to the high variability for both vibration and perceptual data, low correlation between the two methods was found at the individual level. The results from this study indicated that human hearing perception from BC sound can be estimated from the measure of cochlear vibrations of the otic capsule. It also showed that vibration measurements of the cochlea in cadaver heads are similar to that measured in live humans.

Speech recognition in noise using bilateral open-fit hearing aids: the limited benefit of directional microphones and noise reduction.

OBJECTIVE: To investigate speech recognition performance in noise with bilateral open-fit hearing aids and as reference also with closed earmolds, in omnidirectional mode, directional mode, and directional mode in conjunction with noise reduction. DESIGN: A within-subject design with repeated measures across conditions was used. Speech recognition thresholds in noise were obtained for the different conditions. STUDY SAMPLE: Twenty adults without prior experience with hearing aids. All had symmetric sensorineural mild hearing loss in the lower frequencies and moderate to severe hearing loss in the higher frequencies. RESULTS: Speech recognition performance in noise was not significantly better with an omnidirectional microphone compared to unaided, whereas performance was significantly better with a directional microphone (1.6 dB with open fitting and 4.4 dB with closed earmold) compared to unaided. With open fitting, no significant additional advantage was obtained by combining the directional microphone with a noise reduction algorithm, but with closed earmolds a significant additional advantage of 0.8 dB was obtained. CONCLUSIONS: The significant, though limited, advantage of directional microphones and the absence of additional significant improvement by a noise reduction algorithm should be considered when fitting open-fit hearing aids.