Christa L. Themann

Hearing Impairment Associated With Depression in US Adults, National Health and Nutrition Examination Survey 2005-2010

IMPORTANCE Depression among hearing impaired US adults has not been studied previously. OBJECTIVE To estimate the prevalence of and risk factors for depression among adults with hearing loss. DESIGN, SETTING, AND PARTICIPANTS Adults aged 18 years or older (N = 18 318) who participated in the National Health and Nutrition Examination Survey (NHANES), 2005-2010, a nationally representative sample. INTERVENTIONS Multistage probability sampling of US population. MAIN OUTCOMES AND MEASURES Depression, assessed by the 9-item Patient Health Questionnaire (PHQ-9) scale, and hearing impairment (HI), assessed by self-report and audiometric examination for adults aged 70 years or older. RESULTS The prevalence of moderate to severe depression (PHQ-9 score, ≥10) was 4.9% for individuals reporting excellent hearing, 7.1% for those with good hearing, and 11.4% for participants who reported a little trouble or greater HI. Using excellent hearing as the reference, after adjusting for all covariates, multivariate odds ratios (ORs) for depression were 1.4 (95% CI, 1.1-1.8) for good hearing, 1.7 (1.3-2.2) for a little trouble, 2.4 (1.7-3.2) for moderate trouble, 1.5 (0.9-2.6) for a lot of trouble, and 0.6 (0.1-2.6) for deaf. Moderate HI (defined by better ear pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz within the range 35- to 49-dB hearing level) was significantly associated with depression among older women (OR, 3.9; 95% CI, 1.3-11.3), after adjusting for age, sex, race/ethnicity, lifestyle characteristics, and selected health conditions. CONCLUSIONS AND RELEVANCE After accounting for health conditions and other factors, including trouble seeing, self-reported HI and audiometrically determined HI were significantly associated with depression, particularly in women. Health care professionals should be aware of an increased risk for depression among adults with hearing loss.

Americans hear as well or better today compared with 40 years ago: Hearing threshold levels in the unscreened adult population of the United States, 1959-1962 and 1999-2004

Objectives: (1) To present hearing threshold data from a recent nationally representative survey in the United States (National Health and Nutrition Examination Survey, 1999–2004) in a distributional format that might be appropriate to replace Annex B in international (ISO-1999) and national (ANSI S3.44) standards and (2) to compare these recent data with older survey data (National Health Examination Survey I, 1959–1962) on which the current Annex B is based. Design: Better-ear threshold distributions (selected percentiles and their confidence intervals) were estimated using linear interpolation. The 95% confidence intervals for the medians for the two surveys were compared graphically for each of the four age groups and for both men and women. In addition, we calculated odds ratios comparing the prevalences of better-ear hearing impairment (thresholds > 25 dB HL) between the two surveys, for 500, 1000, 2000, and 4000 Hz, and for their four-frequency average. Results: Across age and sex groups, median thresholds were lower (better) in the 1999–2004 survey at 500, 3000, 4000, and 6000 Hz (8000 Hz was not tested in the 1959–1962 survey). For both men and women, the prevalence of hearing impairment was significantly lower in 1999–2004 at 500, 2000, and 4000 Hz, but not at 1000 Hz. Conclusions: For men and women of a specific age, high-frequency hearing thresholds were lower (better) in 1999–2004 than in 1959–1962. The prevalences of hearing impairment were also lower in the recent survey. Differences seen at 500 Hz may be attributable at least in part to changes in standards for ambient noise in audiometry. The National Health and Nutrition Examination Survey 1999–2004 distributions are offered as a possible replacement for Annex B in ISO-1999 and ANSI S3.44.

Working in Noise with a Hearing Loss: Perceptions from Workers, Supervisors, and Hearing Conservation Program Managers

Objective: Workers with hearing loss face special problems, especially when working in noise. However, conventional hearing conservation practices do not distinguish between workers with normal hearing versus impaired hearing. This study collected information from workers with self-reported noise exposure and hearing loss, supervisors of such workers, and hearing conservation program managers through focus groups and in-depth interviews to evaluate their perspectives on the impact of hearing loss on safety and job performance, the use of hearing protection, and information needed to appropriately manage hearing-impaired workers who work in noisy environments. Results: Concerns about working in noise with a hearing loss could be grouped into the following 10 categories: impact on job performance, impact on job safety, impaired ability to hear warning signals, impaired ability to monitor equipment, interference with communication, stress and/or fatigue, impaired communication caused by hearing protector use, reduced ability to monitor the environment as the result of hearing protector use, concerns about future quality of life, and concerns about future employability. Mostly, there was an agreement between the perceptions of workers, supervisors, and hearing conservation program managers regarding difficulties associated with hearing loss and consequent needs. These findings suggest that noise-exposed workers with hearing loss face many of the same problems reported in the literature by noise-exposed workers with normal hearing, with additional concerns primarily about job safety as the result of a reduced ability to hear environmental sounds, warning signals, and so forth. Conclusions: The study outlines potential challenges regarding job safety and hearing conservation practices for noise-exposed, hearing-impaired workers. Awareness of these issues is a necessary first step toward providing appropriate protective measures for noise-exposed, hearing-impaired workers.

Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years

Importance As the US population ages, effective health care planning requires understanding the changes in prevalence of hearing loss. Objective To determine if age- and sex-specific prevalence of adult hearing loss has changed during the past decade. Design, Setting, and Participants We analyzed audiometric data from adults aged 20 to 69 years from the 2011-2012 cycle of the US National Health and Nutrition Examination Survey, a cross-sectional, nationally representative interview and examination survey of the civilian, noninstitutionalized population, and compared them with data from the 1999-2004 cycles. Logistic regression was used to examine unadjusted, age- and sex-adjusted, and multivariable-adjusted associations with demographic, noise exposure, and cardiovascular risk factors. Data analysis was performed from April 28 to June 3, 2016. Interventions Audiometry and questionnaires. Main Outcomes and Measures Speech-frequency hearing impairment (HI) defined by pure-tone average of thresholds at 4 frequencies (0.5, 1, 2, and 4 kHz) greater than 25 decibels hearing level (HL), and high-frequency HI defined by pure-tone average of thresholds at 3 frequencies (3, 4, and 6 kHz) greater than 25 decibels HL. Results Based on 3831 participants with complete threshold measurements (1953 men and 1878 women; mean [SD] age, 43.6 [14.4] years), the 2011-2012 nationally weighted adult prevalence of unilateral and bilateral speech-frequency HI was 14.1% (27.7 million) compared with 15.9% (28.0 million) for the 1999-2004 cycles; after adjustment for age and sex, the difference was significant (odds ratio [OR], 0.70; 95% CI, 0.56-0.86). Men had nearly twice the prevalence of speech-frequency HI (18.6% [17.8 million]) as women (9.6% [9.7 million]). For individuals aged 60 to 69 years, speech-frequency HI prevalence was 39.3% (95% CI, 30.7%-48.7%). In adjusted multivariable analyses for bilateral speech-frequency HI, age was the major risk factor (60-69 years: OR, 39.5; 95% CI, 10.5-149.4); however, male sex (OR, 1.8; 95% CI, 1.1-3.0), non-Hispanic white (OR, 2.3; 95% CI, 1.3-3.9) and non-Hispanic Asian race/ethnicity (OR, 2.1; 95% CI, 1.1-4.2), lower educational level (less than high school: OR, 4.2; 95% CI, 2.1-8.5), and heavy use of firearms (≥1000 rounds fired: OR, 1.8; 95% CI, 1.1-3.0) were also significant risk factors. Additional associations for high-frequency HI were Mexican-American (OR, 2.0; 95% CI, 1.3-3.1) and other Hispanic race/ethnicity (OR, 2.4; 95% CI, 1.4-4.0) and the combination of loud and very loud noise exposure occupationally and outside of work (OR, 2.4; 95% CI, 1.4-4.2). Conclusions and Relevance Adult hearing loss is common and associated with age, other demographic factors (sex, race/ethnicity, and educational level), and noise exposure. Age- and sex-specific prevalence of HI continues to decline. Despite the benefit of delayed onset of HI, hearing health care needs will increase as the US population grows and ages.

Hearing threshold levels at age 70 years (65-74 years) in the unscreened older adult population of the United States, 1959-1962 and 1999-2006.

Objectives: To provide hearing threshold percentiles from unscreened older adults for creating new Annex B reference standards. Design: Percentiles are calculated, and 95% confidence intervals for medians from two U.S. surveys are compared graphically. Results: Median thresholds are lower (better) in the 1999–2006 National Health and Nutrition Examination Survey for men across all frequencies except 1 kHz. Results for women are similar; however, there is more overlap in confidence intervals across frequencies. Conclusions: The prevalence of hearing impairment in older adults, age 70 years (65–74 years), is lower in 1999–2006 compared with 1959–1962, consistent with our earlier findings for younger adults.

Hearing Impairment Among Noise-Exposed Workers — United States, 2003–2012

Hearing loss is the third most common chronic physical condition in the United States, and is more prevalent than diabetes or cancer (1). Occupational hearing loss, primarily caused by high noise exposure, is the most common U.S. work-related illness (2). Approximately 22 million U.S. workers are exposed to hazardous occupational noise (3). CDC compared the prevalence of hearing impairment within nine U.S. industry sectors using 1,413,789 noise-exposed worker audiograms from CDCs National Institute for Occupational Safety and Health (NIOSH) Occupational Hearing Loss Surveillance Project (4). CDC estimated the prevalence at six hearing impairment levels, measured in the better ear, and the impact on quality of life expressed as annual disability-adjusted life years (DALYs), as defined by the 2013 Global Burden of Disease (GBD) Study (5). The mining sector had the highest prevalence of workers with any hearing impairment, and with moderate or worse impairment, followed by the construction and manufacturing sectors. Hearing loss prevention, and early detection and intervention to avoid additional hearing loss, are critical to preserve worker quality of life.

Trends in Worker Hearing Loss by Industry Sector, 1981–2010

BACKGROUND The purpose of this study was to estimate the incidence and prevalence of hearing loss for noise-exposed U.S. workers by industry sector and 5-year time period, covering 30 years. METHODS Audiograms for 1.8 million workers from 1981-2010 were examined. Incidence and prevalence were estimated by industry sector and time period. The adjusted risk of incident hearing loss within each time period and industry sector as compared with a reference time period was also estimated. RESULTS The adjusted risk for incident hearing loss decreased over time when all industry sectors were combined. However, the risk remained high for workers in Healthcare and Social Assistance, and the prevalence was consistently high for Mining and Construction workers. CONCLUSIONS While progress has been made in reducing the risk of incident hearing loss within most industry sectors, additional efforts are needed within Mining, Construction and Healthcare and Social Assistance.

Real ear attenuation at threshold for three audiometric headphone devices : implications for maximum permissible ambient noise level standards

Attenuation measurements were made using the ANSI S12.6-1984 protocol on a standard Telephonics headset with TDH-50P earphones and Model 51 cushions, Amplivox Audiocups headphone enclosures, and Peltor AudioMate headphone enclosures. Each of the enclosures housed Telephonics TDH-50P earphones with Model 51 cushions. The mean attenuation values obtained were compared with those previously reported, and reasons for discrepancies were analyzed. Pure-tone threshold shifts in background noise complying with ANSI S3.1-1977 and Occupational Safety and Health Administration (1983) maximum permissible ambient noise level standards were estimated on the basis of the attenuation values for each headphone device, and the adequacy of these current standards for accurate pure-tone threshold assessment was considered. The results indicated that Model 51 cushions alone are insufficient to attenuate the ambient noise levels permitted under ANSI S3.1-1977, and even the utilization of noise-excluding headphone enclosures does not reduce the background noise levels permitted under the Occupational Safety and Health Administration (1983) to a sufficient degree to permit testing down to 0 dB HL.

Hearing difficulty and tinnitus among U.S. workers and non‐workers in 2007

BACKGROUND Hearing loss and tinnitus are two potentially debilitating physical conditions affecting many people in the United States. The purpose of this study was to estimate the prevalence of hearing difficulty, tinnitus, and their co-occurrence within U.S. METHODS Data from the 2007 National Health Interview Survey (NHIS) were examined. Weighted prevalence and adjusted prevalence ratios for self-reported hearing difficulty, tinnitus, and their co-occurrence were estimated and compared by demographic, among workers with and without occupational noise exposure, and across industries and occupations. RESULTS Seven percent of U.S. workers never exposed to occupational noise had hearing difficulty, 5% had tinnitus and 2% had both conditions. However, among workers who had ever been exposed to occupational noise, the prevalence was 23%, 15%, and 9%, respectively (P < 0.0001). CONCLUSIONS Hearing difficulty and tinnitus are prevalent in the U.S.; especially among noise-exposed workers. Improved strategies for hearing conservation or better implementation are needed.

Vital Signs: Noise-Induced Hearing Loss Among Adults — United States 2011–2012

Introduction The 2016 National Academies of Sciences report “Hearing Health Care for Adults: Priorities for Improving Access and Affordability” included a call to action for government agencies to strengthen efforts to collect, analyze, and disseminate population-based data on hearing loss in adults. Methods CDC analyzed the most recent available data collected both by questionnaire and audiometric tests of adult participants aged 20–69 years in the 2011–2012 National Health and Nutrition Examination Survey (NHANES) to determine the presence of audiometric notches indicative of noise-induced hearing loss. Prevalence of both unilateral and bilateral audiometric notches and their association with sociodemographics and self-reported exposure to loud noise were calculated. Results Nearly one in four adults (24%) had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who reported excellent or good hearing had audiometric notches (5.5% bilateral and 18.0% unilateral). Among participants who reported exposure to loud noise at work, almost one third had a notch. Conclusions and Implications for Public Health Practice Noise-induced hearing loss is a significant, often unrecognized health problem among U.S. adults. Discussions between patients and personal health care providers about hearing loss symptoms, tests, and ways to protect hearing might help with early diagnosis of hearing loss and provide opportunities to prevent harmful noise exposures. Avoiding prolonged exposure to loud environments and using personal hearing protection devices can prevent noise-induced hearing loss.