Dane J. Genther

Hearing loss and depression in older adults

TO THE EDITOR Hearing loss (HL) is a common, but underappreciated health issue affecting older adults. The functional consequences of HL for older adults are now surfacing in epidemiological studies demonstrating that HL may be independently associated with depression1 and loneliness.2 Compared to other medical co-morbidities, HL is more strongly associated with the development of depression in older adults.1 Whether hearing rehabilitative treatment may mitigate the possible effects of HL on depression remains unclear. We investigated the association of HL and hearing aid use with major depressive disorder (MDD)in a nationally representative study of older patients.

Association of Hearing Loss With Hospitalization and Burden of Disease in Older Adults

To the Editor Hearing loss (HL) is a chronic condition that affects nearly 2 of every 3 adults aged 70 or older in the US.1 Hearing loss has broader implications for older adults, being independently associated with poorer cognitive2 and physical functioning.3 Currently, the association of HL with other health economic outcomes, such as healthcare utilization, is unstudied. We investigated the association of HL with hospitalization and burden of disease in a nationally representative study of adults aged 70 and older.

Association of Hearing Impairment and Mortality in Older Adults

BACKGROUND Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults. METHODS Prospective observational data from 1,958 adults ≥70 years of age from the Health, Aging, and Body Composition Study were analyzed using Cox proportional hazards regression. Participants were followed for 8 years after audiometric examination. Mortality was adjudicated by obtaining death certificates. Hearing was defined as the pure-tone average of hearing thresholds in decibels re: hearing level (dB HL) at frequencies from 0.5 to 4kHz. HI was defined as pure-tone average >25 dB HL in the better ear. RESULTS Of the 1,146 participants with HI, 492 (42.9%) died compared with 255 (31.4%) of the 812 with normal hearing (odds ratio = 1.64, 95% CI: 1.36-1.98). After adjustment for demographics and cardiovascular risk factors, HI was associated with a 20% increased mortality risk compared with normal hearing (hazard ratio = 1.20, 95% CI: 1.03-1.41). Confirmatory analyses treating HI as a continuous predictor yielded similar results, demonstrating a nonlinear increase in mortality risk with increasing HI (hazard ratio = 1.14, 95% CI: 1.00-1.29 per 10 dB of threshold elevation up to 35 dB HL). CONCLUSIONS HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.

Association between hearing impairment and lower levels of physical activity in older adults.

To determine whether hearing impairment, highly prevalent in older adults, is associated with activity levels.

Association Between Hearing Impairment and Self-Reported Difficulty in Physical Functioning

To determine whether hearing impairment, defined by using objective audiometry, is associated with multiple categories of self‐reported physical functioning in a cross‐sectional, nationally representative sample of older adults.

Factors associated with the accuracy of subjective assessments of hearing impairment

Objectives: Self-reported hearing impairment is often used to gauge objective hearing loss in both clinical settings and research studies. The aim of this study was to examine whether demographic factors affect the accuracy of subjective, self-reported hearing in older adults. Design: We examined 3557 participants aged 50 and older in the National Health and Nutrition Examination Survey cycles 1999–2006 and 2009–2010. We examined the relationship between objective and subjective hearing impairment using percent correct classification and misclassification bias in analyses stratified by gender, age group, race/ethnicity, and education. Results: We found that younger participants tended to overestimate and older participants underestimate their hearing impairment. Older women, blacks, and Hispanics were less accurate in self-reporting than their respective younger age groups. Conclusions: The association between subjective and objective hearing differs across gender, age, race/ethnicity, and education, and this observation should be considered by clinicians and researchers employing self-reported hearing.

The effect of alcohol abuse and alcohol withdrawal on short‐term outcomes and cost of care after head and neck cancer surgery

Alcohol abuse is associated with an increased incidence of postoperative complications in surgical patients and is a significant risk factor for the development of head and neck cancer (HNCA). We sought to determine the relationship between alcohol abuse and in‐hospital mortality, postoperative complications, length of stay, and costs in HNCA surgery.

The Effect of Hospital Safety-Net Burden Status on Short-term Outcomes and Cost of Care After Head and Neck Cancer Surgery

OBJECTIVE To determine the association between safety-net hospital care and short-term outcomes after head and neck cancer surgery. DESIGN Cross-sectional analysis. Safety-net burden was calculated as the percentage of patients with head and neck cancer with Medicaid or no insurance. SETTING Nationwide Inpatient Sample database. PATIENTS Adults who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 through 2008. MAIN OUTCOME MEASURES Associations between hospital safety-net burden and short-term morality, medical and surgical complications, length of hospitalization, and costs. RESULTS Overall, 123 662 patients underwent surgery in 2001 through 2008. Patients treated at high-safety-net burden hospitals were significantly more likely to be admitted urgently or emergently (odds ratio [OR], 1.54; 95% CI, 1.06-1.15 [P = .03]), undergo major surgical procedures (OR, 1.24; 95% CI, 1.09-1.39 [P = .001]), have advanced comorbidity (OR, 1.35; 95% CI, 1.06-1.72 [P = .02]), and be black (OR, 1.70; 95% CI, 1.29-2.23 [P < .001]), but less likely to be elderly (OR, 0.66; 95% CI, 0.53-0.82 [P < .001]). High safety-net burden hospitals were significantly more likely to be teaching hospitals (OR, 2.04; 95% CI, 1.26-3.29 [P = .004]) and less likely to be located in the West (OR, 0.18; 95% CI, 0.07-0.44 [P < .001]). Safety-net burden was not associated with in-hospital mortality, acute medical complications, surgical complications, or hospital-related costs after controlling for all other variables including hospital volume status, but was associated with a mean increase in length of hospitalization of 24 hours (P < .001). CONCLUSIONS These data suggest that safety-net hospitals provide valuable specialty care to a vulnerable population without an increase in complications or costs. Health care reform must address the economic challenges that threaten the viability of these institutions at the same time that demand for their services increases.

Effect of comorbidity on short-term outcomes and cost of care after head and neck cancer surgery in the elderly

With increased life expectancy, there is growing awareness of the effect of comorbidity on physiologic reserves in elderly patients. Data in the area of head and neck cancer surgery is lacking.

Correlation of Final Evoked Potential Amplitudes on Intraoperative Electromyography of the Recurrent Laryngeal Nerve With Immediate Postoperative Vocal Fold Function After Thyroid and Parathyroid Surgery

IMPORTANCE Thyroid and parathyroid surgery are among the most common operations in the United States. Recurrent laryngeal nerve (RLN) injury is an infrequent but potentially detrimental complication. OBJECTIVE To correlate the final evoked potential amplitudes on intraoperative electromyography (EMG) after stimulation of the RLN with immediate postoperative vocal fold function after thyroid and parathyroid surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study at a tertiary academic medical center. We included 674 patients (with 1000 nerves at risk) undergoing thyroid or parathyroid surgery from July 1, 2008, through June 30, 2012. INTERVENTIONS Thyroid and parathyroid surgery. MAIN OUTCOMES AND MEASURES The association of final evoked potential amplitudes on EMG after thyroid and parathyroid surgery with vocal fold function as determined by postoperative fiberoptic laryngoscopy. RESULTS Three patients experienced permanent vocal fold paresis (VFP) secondary to intraoperative RLN transection. Of the remaining 997 RLNs at risk, 22 (2.2%) in 20 patients exhibited temporary VFP on fiberoptic laryngoscopy after extubation. Eighteen patients experienced unilateral temporary VFP, and 2 experienced bilateral VFP without the need for tracheostomy or reintubation. Of the 22 RLNs, postdissection EMG amplitudes were less than 200 µV (true-positive findings) in 21 and at least 200 µV (false-negative finding) in 1. Of the 975 RLNs (97.5%) with normal function, postdissection EMG amplitudes were at least 200 µV (true-negative findings) in 967 and less than 200 µV (false-positive findings) in 8. In regard to immediate postoperative VFP, sensitivity, specificity, positive and negative predictive values, and accuracy of postdissection EMG amplitudes of less than 200 µV were 95.5%, 99.2%, 72.4%, 99.9%, and 99.1%, respectively. CONCLUSIONS AND RELEVANCE Intraoperative nerve monitoring of the RLN with EMG provides real-time information regarding neurophysiologic function of the RLN and can predict immediate postoperative VFP reliably when a cutoff of 200 µV is used. The high negative predictive value means that the surgeon can presume with confidence that the RLN has not been injured in the presence of a potential of at least 200 µV. This information would be useful in patients for whom bilateral thyroid surgery is being considered.