Hearing impairment after asphyxia and neonatal encephalopathy: a Norwegian population-based study.

The purpose of this study is to evaluate the association between perinatal asphyxia, neonatal encephalopathy, and childhood hearing impairment. This is a population-based study including all Norwegian infants born ≥ 36 weeks gestation between 1999 and 2014 and alive at 2 years (n = 866,232). Data was linked from five national health registries with follow-up through 2019. Perinatal asphyxia was defined as need for neonatal intensive care unit (NICU) admission and an Apgar 5-min score of 4-6 (moderate) or 0-3 (severe). We coined infants with seizures and an Apgar 5-min score < 7 as neonatal encephalopathy with seizures. Infants who received therapeutic hypothermia were considered to have moderate-severe hypoxic-ischemic encephalopathy (HIE). The reference group for comparisons were non-admitted infants with Apgar 5-min score ≥ 7. We used logistic regression models and present data as adjusted odds ratios (aORs) with 95% confidence intervals (CI). The aOR for hearing impairment was increased in all infants admitted to NICU: moderate asphyxia aOR 2.2 (95% CI 1.7-2.9), severe asphyxia aOR 5.2 (95% CI 3.6-7.5), neonatal encephalopathy with seizures aOR 7.0 (95% CI 2.6-19.0), and moderate-severe HIE aOR 10.7 (95% CI 5.3-22.0). However, non-admitted infants with Apgar 5-min scores < 7 did not have increased OR of hearing impairment. The aOR for hearing impairment for individual Apgar 5-min scores in NICU infants increased with decreasing Apgar scores and was 13.6 (95% CI 5.9-31.3) when the score was 0.          Conclusions: An Apgar 5-min score < 7 in combination with NICU admission is an independent risk factor for hearing impairment. Children with moderate-severe HIE had the highest risk for hearing impairment. What is Known: • Perinatal asphyxia and neonatal encephalopathy are associated with an increased risk of hearing impairment. • The strength of the association, and how other co-morbidities affect the risk of hearing impairment, is poorly defined. What is New: • Among neonates admitted to a neonatal intensive care unit (NICU), decreased Apgar 5-min scores, and increased severity of neonatal encephalopathy, were associated with a gradual rise in risk of hearing impairment. • Neonates with an Apgar 5-min score 7, but without NICU admission, did not have an increased risk of hearing impairment.

Prevalence and predictors of self-reported hearing aid use and benefit in Norway: the HUNT study.

BACKGROUND: Knowledge on hearing aid use and benefit is important to ensure appropriate and effective treatment. We aimed to assess prevalence and predictors of hearing aid use and benefit in Norway, as well as possible birth cohort changes. METHODS: We analyzed two large cross-sectional, population-based hearing surveys of 63,182 adults in 1996-1998 and 2017-2019 (the HUNT study). We used multivariable regression models to examine independent predictors of hearing aid use and benefit, including demography, hearing-related variables, known risk factors for hearing loss and birth cohort. RESULTS: The nationally weighted hearing aid use in the adult population increased from 4.2% in 1997 to 5.8% in 2018. The use among individuals with disabling hearing loss (≥ 35 dB HL) increased from 46.3% to 64.4%. Most users reported some (47%) or great (48%) help from their hearing aids. In addition to the level of hearing loss and birth cohort, factors associated with hearing aid use included lower age, tinnitus, childhood-onset hearing loss, higher education, marriage, having children, being exposed to occupational noise or impulse noise, recurrent ear infections, and head injury. In addition to the level of hearing loss, factors related to hearing aid benefit included younger age, female gender, and higher income. Being bothered by tinnitus reduced the benefit. CONCLUSION: Our study shows an increase in self-reported hearing aid usage over time in Norway, with lower adoption rates and perceived benefits observed among the elderly. The results suggest that having a spouse and children positively influences the adoption of hearing aids. These findings emphasize the necessity of customized strategies to address demographic disparities and the need for innovative enhancements in hearing rehabilitation programs.

No accelerated 20-year hearing decline after occupational noise exposure has ceased: The HUNT study.

OBJECTIVES: It has been suggested that noise exposure can accelerate hearing decline after the noise exposure has ceased. We aimed to assess long-term hearing decline in persons with and without prior occupational noise exposure. METHODS: We conducted a population-based longitudinal study in Norway using the Trøndelag Health Study (HUNT) from 1996 to 1998 (baseline) and from 2017 to 2019 (follow-up). The sample included 1648 participants with baseline age ≥55 years (42% men, mean age 60 years) and <5 years occupational noise exposure after baseline. We analyzed the association between occupational noise exposure before baseline and mean hearing decline between 1998 and 2018 (20-year decline) at each frequency, adjusted for age, sex, education, and impulse noise exposure before baseline. RESULTS: Occupational noise exposure before baseline (N = 603) was associated with baseline hearing loss, but not with later accelerated 20-year decline, at any frequency. Noise-exposed persons had less subsequent 20-year decline at 3 kHz than did nonexposed. Restricting the noise-exposed group to persons who also had a baseline Coles notch (hearing thresholds at 3, 4, or 6 kHz of 10 dB or more compared with thresholds at 1 or 2 kHz and 6 or 8 kHz; N = 211), the exposed group showed less 20-year decline at both 3 and 4 kHz, as well as less accelerated 20-year decline at 8 kHz, compared with the nonexposed. CONCLUSION: Our large long-term longitudinal study shows no increased risk of continuing hearing decline after occupational noise exposure has ceased. The finding supports a conclusion that ear damage stops when the noise exposure is ended.

Retirement age and disability status as pathways to later-life cognitive impairment: Evidence from the Norwegian HUNT Study linked with Norwegian population registers.

BACKGROUND: Research shows that retirement age is associated with later-life cognition but has not sufficiently distinguished between retirement pathways. We examined how retirement age was associated with later-life dementia and mild cognitive impairment (MCI) for people who retired via the disability pathway (received a disability pension prior to old-age pension eligibility) and those who retired via the standard pathway. METHODS: The study sample comprised 7210 participants from the Norwegian Trøndelag Health Study (HUNT4 70+, 2017-2019) who had worked for at least one year in 1967-2019, worked until age 55+, and retired before HUNT4. Dementia and MCI were clinically assessed in HUNT4 70+ when participants were aged 69-85 years. Historical data on participants' retirement age and pathway were retrieved from population registers. We used multinomial regression to assess the dementia/MCI risk for women and men retiring via the disability pathway, or early (<67 years), on-time (age 67, old-age pension eligibility) or late (age 68+) via the standard pathway. RESULTS: In our study sample, 9.5% had dementia, 35.3% had MCI, and 28.1% retired via the disability pathway. The disability retirement group had an elevated risk of dementia compared to the on-time standard retirement group (relative risk ratio [RRR]: 1.64, 95% CI 1.14-2.37 for women, 1.70, 95% CI 1.17-2.48 for men). MCI risk was lower among men who retired late versus on-time (RRR, 0.76, 95% CI 0.61-0.95). CONCLUSION: Disability retirees should be monitored more closely, and preventive policies should be considered to minimize the dementia risk observed among this group of retirees.

Incidence rates of treated mental disorders before and during the COVID-19 pandemic-a nationwide study comparing trends in the period 2015 to 2021.

BACKGROUND: There is a concern that exposure to psychosocial stressors during the COVID-19 pandemic may have led to a higher incidence of mental disorders. Thus, this study aimed to compare trends in incidence rates of depressive disorder, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders in primary- and specialist health care before (2015-2019) and during the COVID-19 pandemic (2020-2021). METHODS: We used aggregated population registry data to calculate incidence rates of mental disorders from primary- (The Norwegian Control and Payment of Health Reimbursements Registry (KUHR)) and specialist (The Norwegian Patient Registry (NPR)) health care. The analyses included all Norwegian residents aged 18-65 during the study period. Incident cases were defined as having no previous registration with the same mental disorder in KUHR (from 2006) or NPR (from 2008). We used linear prediction models and mean models to compare incidence rates and test trends before and during the pandemic. RESULTS: During the pandemic, the incidence rates among women were higher or as predicted for OCD in specialist health care and for eating disorders in both primary- and specialist health care. These findings were strongest among women aged 18-24 years. Incidence rates for depression and phobia/OCD among both genders in primary health care and phobic anxiety disorders among both genders in specialist health care were lower or as predicted. CONCLUSION: The COVID-19 pandemic may have led to more women needing treatment for OCD and eating disorders in the Norwegian population. The decreased incidence rates for some disorders might indicate that some individuals either avoided seeking help or had improved mental health during the pandemic.

Cohort difference in the association between use of recreational firearms and hearing loss: findings from the HUNT study.

OBJECTIVES: The risk of noise injury from recreational firearm use is well known. Despite preventive measures it is uncertain whether it has become less harmful. We assessed whether the association between recreational firearm use and hearing has changed during the last two decades. DESIGN: We used a repeated cross-sectional design and determined hearing thresholds by pure-tone audiometry. Frequency-specific associations between recreational firearm use and hearing thresholds were assessed by multivariate linear regression stratified by sex and adjusted for age and other covariates. STUDY SAMPLE: Two cross-sectional population-based cohorts 20 years apart (1998 and 2018) comprised 27,580 (53% women, mean age 53 years) and 26,606 individuals (56% women, mean age 54 years), respectively. RESULTS: Recreational firearm use was reported by 28% in 1998 and 30% in 2018. The proportion that reported wearing hearing protection increased. Exposure to recreational firearms was associated with elevated thresholds at 3-6 kHz in both cohorts. The association increased with the number of lifetime shots. The associations increased by age and were substantially smaller in the most recent cohort. CONCLUSIONS: Analyses of two cohorts revealed a reduction in the association between recreational firearm use and hearing over 20 years, coinciding with the introduction of hearing preservation measures.

Weaker association between hearing loss and non-employment in recent generations: the HUNT cohort study.

OBJECTIVES: To examine the prevalence of hearing loss (HL) among employed persons, the association between HL and non-employment, assessing whether this has changed over the last two decades. To identify susceptible groups for HL-related work problems and examine the association between HL and co-worker relations. DESIGN: Cross-sectional analyses of working-age participants (20-66 years). HL was defined as the pure-tone average threshold of 0.5-4 kHz in the better hearing ear: 20-34 dB (mild) or ≥35 dB (disabling). Associations were assessed with logistic regression. STUDY SAMPLE: Data from two waves of the Trøndelag Health Study (HUNT): HUNT2 1996-1998 (N = 38,603), HUNT4 2017-2019 (N = 19,614). RESULTS: The nationally weighted prevalence of HL among employees was 5.8%. HL was associated with non-employment, more strongly in HUNT2 (odds ratio (OR) 2.2, 95% confidence interval (CI) 2.0-2.4) than HUNT4 (OR 1.9, CI 1.7-2.1). HL was not associated with poorer co-worker relations. The association between HL and non-optimal work performance was stronger among white-collar workers than blue-collar workers. CONCLUSIONS: Our study shows that HL is common in the employed population. It also indicates a weakened association between HL and non-employment in recent generations. White-collar workers appear to be more vulnerable to HL-related work problems than blue-collar workers.

This paper evaluates employment and work performance among hearing impaired. We show a prevalence of hearing loss (HL) among employed persons of 5.8% and that HL is associated with higher odds of non-employment. Our study indicates that the association between HL and non-employment has weakened in recent generations.

Occupational noise exposure and tinnitus: the HUNT Study.

OBJECTIVE: We aimed to assess the association between occupational noise exposure and tinnitus. Further, to assess whether the association depends on hearing status. DESIGN: In this cross-sectional study, tinnitus (>1 h daily) was regressed on job exposure matrix (JEM)-based or self-reported occupational noise exposure, adjusted for confounders. STUDY SAMPLE: The 14,945 participants (42% men, 20-59 years) attended a population-based study in Norway (HUNT4, 2017-2019). RESULTS: JEM-based noise exposure, assessed as equivalent continuous sound level normalised to 8-h working days (LEX 8 h), over the working career or as minimum 5 years ≥85 dB) was not associated with tinnitus. Years of exposure ≥80 dB (minimum one) was not associated with tinnitus. Self-reported high noise exposure (>15 h weekly ≥5 years) was associated with tinnitus overall and among persons with elevated hearing thresholds (prevalence ratio (PR) 1.3, 1.0-1.7), however not statistically significantly among persons with normal thresholds (PR 1.1, 0.8-1.5). CONCLUSIONS: Our large study showed no association between JEM-based noise exposure and tinnitus. This may to some extent reflect successful use of hearing protection. High self-reported noise exposure was associated with tinnitus, but not among normal hearing persons. This supports that noise-induced tinnitus to a large extent depends on audiometric hearing loss.

Genome-wide association identifies the first risk loci for psychosis in Alzheimer disease.

Psychotic symptoms, defined as the occurrence of delusions or hallucinations, are frequent in Alzheimer disease (AD with psychosis, AD + P). AD + P affects ~50% of individuals with AD, identifies a subgroup with poor outcomes, and is associated with a greater degree of cognitive impairment and depressive symptoms, compared to subjects without psychosis (AD - P). Although the estimated heritability of AD + P is 61%, genetic sources of risk are unknown. We report a genome-wide meta-analysis of 12,317 AD subjects, 5445 AD + P. Results showed common genetic variation accounted for a significant portion of heritability. Two loci, one in ENPP6 (rs9994623, O.R. (95%CI) 1.16 (1.10, 1.22), p = 1.26 × 10-8) and one spanning the 3'-UTR of an alternatively spliced transcript of SUMF1 (rs201109606, O.R. 0.65 (0.56-0.76), p = 3.24 × 10-8), had genome-wide significant associations with AD + P. Gene-based analysis identified a significant association with APOE, due to the APOE risk haplotype ε4. AD + P demonstrated negative genetic correlations with cognitive and educational attainment and positive genetic correlation with depressive symptoms. We previously observed a negative genetic correlation with schizophrenia; instead, we now found a stronger negative correlation with the related phenotype of bipolar disorder. Analysis of polygenic risk scores supported this genetic correlation and documented a positive genetic correlation with risk variation for AD, beyond the effect of ε4. We also document a small set of SNPs likely to affect risk for AD + P and AD or schizophrenia. These findings provide the first unbiased identification of the association of psychosis in AD with common genetic variation and provide insights into its genetic architecture.

Hearing loss, sick leave, and disability pension: findings from the HUNT follow-up study.

BACKGROUND: Evidence on the association between hearing loss and sick leave or disability pension is to a great extent based on few cross-sectional studies and remains unclear. We aim to assess the associations in a long-term follow-up population study. METHODS: We used baseline data from a large population-based hearing study in Norway, the HUNT Hearing study (1996-1998). The sample included 21 754 adults (48.5% men, mean age at baseline 36.6 years). We used register data on sick leave and disability pension (1996-2011). Cox regression was used to assess the association between hearing loss at baseline (Pure tone average/PTA 0.5-4 kHz > 20 dB) and time to first physician-certified sick leave episode, as well as time to first disability pension payment. RESULTS: Hearing loss at baseline (yes/no) was weakly associated with time to first physician-certified sick leave episode: Hazard ratio (HR) 1.2 (95% confidence interval (CI) 1.1-1.3). Restricting the exposed group to people with both hearing loss and tinnitus, the HR was slightly increased: 1.3 (95% CI 1.1-1.6). Hearing loss in 1996-1998 was also associated with time to first received disability pension: HR 1.5 (95% CI 1.3-1.8). Stronger associations were found for disabling hearing loss (PTA > 35). Restricting the exposure to hearing loss and tinnitus, the HR was increased: 2.0 (95% CI 1.4-2.8). CONCLUSIONS: This large population-based cohort study indicates that hearing loss is associated with increased risk of receiving disability pension, especially among younger adults and low educated workers. Hearing loss was weakly associated with sick leave.

Quantitative levels of noise exposure and 20-year hearing decline: findings from a prospective cohort study (the HUNT Study).

OBJECTIVE: We aimed to assess the association between occupational noise exposure and long-term hearing decline. DESIGN: This prospective cohort study used linear regression to investigate the association between occupational noise exposure and 20-year hearing decline, adjusted for important confounders. STUDY SAMPLE: The Norwegian cohort (N = 4,448) participated in two population-based health studies with pure-tone audiometry; HUNT2 1996-1998 and HUNT4 2017-2019. Exposure assessments included a quantitative job exposure matrix (JEM) and questionnaires. RESULTS: The participants (40.2% men, 20-39 years at baseline) had a mean 20-year decline (3-6 kHz) of 11.3 ± 9.8 decibels (dB). There was a positive association between 20-year logarithmic average noise level (JEM-based, LEX,20y) and 20-year hearing decline among men. Compared with no exposure ≥80 dB during follow-up, minimum 5 years of exposure ≥85 dB (JEM-based) predicted 2.6 dB (95% CI: 0.2-5.0) larger 20-year decline for workers aged 30-39 years at baseline, and -0.2 dB (95% CI: -2.2 to 1.7) for workers aged 20-29 years. Combining JEM information with self-reported noise exposure data resulted in stronger associations. CONCLUSION: This large longitudinal study shows an association between JEM-based noise exposure level and increased 20-year hearing decline among men. Contrary to expectations, the associations were weaker among younger workers, which might reflect a latency period.

Better Hearing in Norway: A Comparison of Two HUNT Cohorts 20 Years Apart.

OBJECTIVE: To obtain updated robust data on a age-specific prevalence of hearing loss in Norway and determine whether more recent birth cohorts have better hearing compared with earlier birth cohorts. DESIGN: Cross-sectional analyzes of Norwegian representative demographic and audiometric data from the Nord-Trøndelag Health Study (HUNT)-HUNT2 Hearing (1996-1998) and HUNT4 Hearing (2017-2019), with the following distribution: HUNT2 Hearing (N=50,277, 53% women, aged 20 to 101 years, mean = 50.1, standard deviation = 16.9); HUNT4 Hearing (N=28,339, 56% women, aged 19 to 100 years, mean = 53.2, standard deviation = 16.9). Pure-tone hearing thresholds were estimated using linear and quantile regressions with age and cohort as explanatory variables. Prevalences were estimated using logistic regression models for different severities of hearing loss averaged over 0.5, 1, 2, and 4 kHz in the better ear (BE PTA4). We also estimated prevalences at the population-level of Norway in 1997 and 2018. RESULTS: Disabling hearing loss (BE PTA4 ≥ 35 dB) was less prevalent in the more recent born cohort at all ages in both men and women (p < 0.0001), with the largest absolute decrease at age 75 in men and at age 85 in women. The age- and sex-adjusted prevalence of disabling hearing loss was 7.7% (95% confidence interval [CI] 7.5 to 7.9) and 5.3% (95% CI 5.0 to 5.5) in HUNT2 and HUNT4, respectively. Hearing thresholds were better in the more recent born cohorts at all frequencies for both men and women (p < 0.0001), with the largest improvement at high frequencies in more recent born 60- to 70-year old men (10 to 11 dB at 3 to 4 kHz), and at low frequencies among the oldest. CONCLUSIONS: The age- and sex-specific prevalence of hearing impairment has decreased in Norway from 1996-1998 to 2017-2019.

Explaining better hearing in Norway: a comparison of two cohorts 20 years apart - the HUNT study.

BACKGROUND: The hearing function at a given age seems to have improved in more recent born cohorts in industrialized countries. But the reasons for the improvement have not yet been explained. METHODS: We investigated the extent to which better hearing in Norway is attributed to modifiable risk factors by using representative demographic and audiometric data from two cohorts of the Trøndelag Health Study, HUNT2 (1996-1998) and HUNT4 (2017-2019). We estimated natural indirect effects using causal inference methods in order to assess whether cohort improvement in hearing thresholds (HTs) was mediated by occupational noise exposure, recurrent ear infections, smoking and education. RESULTS: The improvement in HTs from HUNT2 to HUNT4 was 2.8 and 3.0 dB at low respectively high frequencies. Together all risk factors mediated this improvement by 0.8 dB (95% CI 0.7-0.9) and 0.8 dB (95% CI 0.7-0.9) respectively, corresponding to mediated proportions of 27 and 28%. Substantial mediation was specifically found for occupational noise in men and recurrent ear infections in women (mediated proportions of 11 and 17% at high frequencies, respectively). CONCLUSIONS: Increased education, less occupational noise exposure, ear infections and smoking contributed considerably to better hearing in Norway the last two decades.

Otitis Media in Childhood and Disease in Adulthood: A 40-Year Follow-Up Study.

OBJECTIVES: The pathogenesis of chronic suppurative otitis media (CSOM) includes complex interactions between microbial, immunologic, and genetic factors. To our knowledge, no study has focused on the association between childhood otitis media, immune regulation, inflammatory conditions, and chronic disease in adulthood. The present study aims to assess whether CSOM in childhood predicts immune-related inflammatory disorders or cardiovascular disease in adulthood. Another aim is to assess the association with oto-vestibular diseases in adulthood. DESIGN: Population cohort study in Norway comprised 51,626 participants (mean age 52 years) who underwent a hearing investigation at 7 to 13 years of age where 189 were diagnosed with CSOM (otorhinolaryngologist diagnose) and 51,437 had normal hearing thresholds (controls). Data on adult disease were obtained from the Norwegian Patient Registry (ICD-10 codes from the specialist health services). We estimated associations with logistic regression analyses. RESULTS: The associations between CSOM in childhood and disease in adulthood were as follows: chronic sinusitis (odds ratio 3.13, 95% confidence interval 1.15 to 8.52); cardiovascular disease (1.38, 1.01 to 1.88); hearing loss (5.58, 3.78 to 8.22); tinnitus (2.62, 1.07 to 6.41). The adult hearing loss among cases with childhood CSOM was most frequently registered as sensorineural. There was no statistically significant increased risk of later asthma (1.84 [0.98 to 3.48]), inflammatory bowel disease, inflammatory joint disease, systemic tissue disease, or vestibulopathy. The estimates were adjusted for age, sex, socio-economic status, and smoking. CONCLUSION: Our large cohort study, which is the first to focus on the link between otitis media in childhood and immune-related inflammatory disorders later in life, does not confer a clear association. CSOM in childhood was strongly related to adult tinnitus and hearing loss, which was most frequently registered as sensorineural.

Occupational noise exposure and asymmetric hearing loss: Results from the HUNT population study in Norway.

BACKGROUND: A large population study with adequate data on confounders is required to determine whether asymmetric hearing loss (AHL) is associated with occupational noise exposure. METHODS: We performed a cross-sectional population study in Norway (the Health Investigation in Nord-Trøndelag: HUNT) with 24 183 participants, using pure-tone audiometry and questionnaires. AHL was defined as a difference in hearing threshold between the right and left ears of greater than or equal to 15 dB for the pure-tone average of 0.5 to 2 or 3 to 6 kHz. RESULTS: The mean age of the participants was 53 years (range, 19-99); 53% were women. The prevalence of AHL in this general Norwegian population was 6% for the 0.5 to 2 kHz range and 15% for 3 to 6 kHz. In unadjusted regression models, subjects reporting prolonged occupational noise exposure to high-level noise sources (N = 1652) had a higher risk of AHL at 3 to 6 kHz than those reporting no prior exposure (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.75-2.25). After adjustment for age and sex, OR was 1.08; (95% CI, 0.95-1.24). After additional adjustment for head trauma, ear infections, blasting or shooting (all associated with AHL), smoking, and diabetes, OR was 1.00 (95% CI, 0.87-1.16). No association between occupational noise and right-ear hearing threshold advantage (left-right ear difference) was observed after adjustment for confounders. CONCLUSION: Our study suggests that AHL is relatively common in the general population, especially at the high-frequency range in men and elderly subjects. Our study showed no relation between occupational noise exposure and AHL after confounder adjustment.

Marriage and cohabiting rates among people with childhood sensorineural hearing loss in a large Norwegian cohort: results from the SHINT and the HUNT study.

Objective: To investigate the association between childhood sensorineural hearing loss (SNHL) and cohabiting/marriage rates in a large Norwegian cohort.Design: This study is based on data from the School Hearing Investigation in Nord-Trøndelag (SHINT), data from the Nord-Trøndelag Health Study (HUNT), and registry data on marital status from Statistics Norway. Marital status is measured yearly from 1975-2015 (marriage) and 1987-2014 (cohabitation). The association between SNHL and marital status was tested using multinomial logistic regression models estimating odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex, and education.Study sample: The total sample comprised 50,022 participants born between 1940 and 1980. SNHL in SHINT of 41 dB or more was defined as moderate-profound (N = 216), 26-40 dB as mild (N = 294) and 16-25 dB as slight (N = 246).Results: There was a significant association between any SNHL and cohabitation (OR = .56, 95% CI = 0.43-0.72) and marriage (OR = .50, 95% CI = 0.40-0.62), between mild SNHL and cohabitation (OR = .58, 95% CI = 0.40-0.86) and marriage (OR = .40, 95% CI = 0.29-0.56), and between moderate-profound SNHL and cohabitation (OR = .43, 95% CI = 0.26-0.71) and marriage (OR = .45, 95% CI = 0.31-0.66).Conclusions: Childhood SNHL reduces the likelihood of cohabitation and marriage.

Childhood Sensorineural Hearing Loss and Educational Attainment in Adulthood: Results From the HUNT Study.

OBJECTIVES: Although the educational achievement gap between people without hearing loss and people with hearing loss is well-documented, few studies are based on large, nonclinical samples. The present study aims to investigate the educational attainment among Norwegian adults diagnosed with sensorineural hearing loss as children, compared with a matched control group of people without hearing loss. DESIGN: A prospective cohort design was applied. Between 1954 and 1986, the children in the first, fourth, and/or seventh grade in all primary schools in Nord-Trøndelag County participated in the School Hearing Investigation in Nord-Trøndelag, in which they underwent audiometric screening. Those with positive results had their hearing further tested by means of pure tone audiometry at 0.25, 0.5, 1, 2, 4, and 8 kHz with air- and bone-conduction thresholds, as well as a full examination by an ear, nose, and throat (ENT) specialist. In the present study, 216 persons were classified with moderate-severe hearing loss (41 to 100 dB HL), 293 with mild hearing loss (26 to 40 dB HL), and 240 with slight hearing loss (16 to 25 dB HL). Age-matched controls were recruited from the Norwegian Health Study, which was conducted in the same county. A total of 48,606 people participated in the present study. Data on educational attainment up to 2014 was provided by Statistics Norway. Control variables comprised sex, age, mothers', and fathers' education. The relation between childhood sensorineural hearing loss and educational attainment was tested by means of multinomial logistic regression models; first for the total sample (born between 1941 and 1979), and then for two different birth cohorts born between 1941 and 1959 and between 1960 and 1979. RESULTS: Percentwise, the educational attainment level in general has increased, both among people without hearing loss and people with hearing loss, and especially for women. However, 27.5% of people without hearing loss obtained higher education, whereas the corresponding numbers for those with mild or moderate-severe hearing loss were 18.8%, and 21.3%, respectively. The results from the regression analyses showed that in the total sample, compared with having primary education, people with moderate-severe or mild hearing loss were about half as likely to achieve higher education as people without hearing loss (odds ratio (OR) = 0.63 and 0.49, respectively). An interaction term between sensorineural hearing loss and sex was specified but it was not significant. In the older cohort, we found a significant association between mild hearing loss and higher education (OR = 0.40), and between moderate-severe hearing loss and secondary education (OR = 0.65). In the younger cohort, there was a significant association between mild hearing loss and higher education (OR = 0.56) and between slight hearing loss and secondary education (OR = 0.61). CONCLUSIONS: The results from this study indicate that the achievement gap between people without hearing loss and those with hearing loss remains. Future studies should try to pinpoint what might be hindering people with slight, mild, moderate, or severe hearing loss in pursuing higher education. Parents, health personnel, institutions for higher education, and policy makers alike should take this into consideration when making plans and policies.

Childhood sensorineural hearing loss and adult mental health up to 43 years later: results from the HUNT study.

BACKGROUND: Hearing loss is a global public health problem putting millions of people at risk of experiencing impediments in communication and potentially impaired mental health. Many studies in this field are based on small, cross sectional samples using self-report measures. The present study aims to investigate the association between childhood sensorineural hearing loss and mental health in adult men and women longitudinally in a large cohort with a matched control group, and hearing is measured by pure-tone audiometry. Studies of this kind are virtually non-existing. METHODS: The present study combines data from two large studies; the School Hearing Investigation in Nord-Trøndelag (SHINT) carried out yearly from 1954 to 1986, and the second wave of the Nord-Trøndelag Health Study (HUNT 2) conducted from 1995 to 1997. The participants were 7, 10 or 13 years during the SHINT, and between 20 and 56 years old during HUNT 2. The total sample consisted of 32,456 participants (of which 32,104 in the reference group). Participants with a sensorineural hearing loss in SHINT of 41 dB or more were classified with moderate-severe hearing loss (N = 66), 26-40 dB as mild (N = 66) and 16-25 dB as slight (N = 220). Mental health in adulthood was measured in HUNT 2 by symptoms of anxiety and depression, subjective well-being, and self-esteem. The association between childhood sensorineural hearing loss and adult mental health was tested by means of ANOVA. RESULTS: There was a significant relation between slight childhood sensorineural hearing loss and lowered subjective well-being in women (B = -.25, p = 0.038). Further investigation of the results revealed a significant association between slight hearing loss and symptoms of anxiety and depression (B = .30, p = 0.054) and between mild hearing loss and lowered self-esteem (B = .63, p = 0.024) among women aged 20-39 years. There were no significant relations between childhood sensorineural hearing loss and any of the three mental health outcomes among men. CONCLUSIONS: This study suggests that women with slight or mild sensorineural hearing loss from childhood experience elevated levels of symptoms of anxiety and depression, lowered subjective well-being and lowered self-esteem. However, the results should be interpreted with caution due to a lack of power in some analyses.