Gregory A. Flamme

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.

Estimates of auditory risk from outdoor impulse noise. II: Civilian firearms.

Firearm impulses are common noise exposures in the United States. This study records, describes and analyzes impulses produced outdoors by civilian firearms with respect to the amount of auditory risk they pose to the unprotected listener under various listening conditions. Risk estimates were obtained using three contemporary damage risk criteria (DRC) including a waveform parameter-based approach (peak SPL and B-duration), an energy-based criterion (A-weighted SEL and equivalent continuous level) and a physiological model (AHAAH). Results from these DRC were converted into a number of maximum permissible unprotected exposures to facilitate interpretation. Acoustic characteristics of firearm impulses differed substantially across guns, ammunition, and microphone location. The type of gun, ammunition and the microphone location all significantly affected estimates of auditory risk from firearms. Vast differences in maximum permissible exposures were observed; the rank order of the differences varied with the source of the impulse. Unprotected exposure to firearm noise is not recommended, but people electing to fire a gun without hearing protection should be advised to minimize auditory risk through careful selection of ammunition and shooting environment. Small-caliber guns with long barrels and guns loaded with the least powerful ammunition tend to be associated with the least auditory risk.

Typical noise exposure in daily life

Abstract Objective: Identify the distribution of typical noise levels present in daily life and identify factors associated with average sound levels. Design: This was an observational study. Study sample: Participants (N = 286) were 20 to 68 year old men and women, drawn from the general population of Kalamazoo County, Michigan. A total of 73 000 person-hours of noise monitoring were conducted. Results: Median overall daily average levels were 79 and 77 dBLeqA,8,equiv , with average levels exceeding EPA recommended levels for 70% of participants. Median levels were similar between the hours of 9 a.m. and 9 p.m., and varied little across days of the week. Gender, occupational classification, and history of occupational noise exposure were related to average noise levels, but age, educational attainment, and non-occupational noise exposures were not. Conclusions: A large portion of the general population is exposed to noise levels that could result in long-term adverse effects on hearing. Gender and occupation were most strongly related to exposure, though most participants in this study had occupations that are not conventionally considered noisy.

Estimates of the auditory risk from outdoor impulse noise. I: Firecrackers.

Firecrackers are common impulse noise exposures in the United States. In this study, impulses produced outdoors by consumer firecrackers were recorded, described, and analyzed with respect to the amount of the auditory risk they pose to the unprotected listener under various listening conditions. Risk estimates were obtained using three contemporary damage risk criteria (DRC), including a waveform parameter-based approach (peak SPL and B duration), an energy-based criterion (A-weighted sound exposure level and equivalent continuous level), and a physiological model (the AHAAH model developed by Price and Kalb). Results from these DRC were converted into numbers of maximum permissible unprotected exposures to facilitate comparison. Acoustic characteristics of firecracker impulses varied with the distance, but only subtle differences were observed across firecrackers. Typical peak levels ranged between 171 dB SPL at 0.5 m and 142 dB SPL at 8 m. Estimates of the auditory risk did not differ significantly across firecrackers, but varied with the distance. Vast differences in maximum permissible exposures were observed, and the directions of the differences varied with the level of the impulse. Typical estimates of maximum permissible exposures ranged between 0 and 2 at 0.5 m and between 31 and 227,000 at 8 m. Unprotected exposures to firecracker impulses should be limited or avoided entirely if the firecrackers are ignited in batches within 8 m of the listener. Differences across DRC are inconsequential at 0.5 m, but have substantial implications at distances of 1 m and more.

Auditory risk estimates for youth target shooting

Abstract Objective: To characterize the impulse noise exposure and auditory risk for youth recreational firearm users engaged in outdoor target shooting events. The youth shooting positions are typically standing or sitting at a table, which places the firearm closer to the ground or reflective surface when compared to adult shooters. Design: Acoustic characteristics were examined and the auditory risk estimates were evaluated using contemporary damage-risk criteria for unprotected adult listeners and the 120-dB peak limit suggested by the World Health Organization (1999) for children. Study sample: Impulses were generated by 26 firearm/ammunition configurations representing rifles, shotguns, and pistols used by youth. Measurements were obtained relative to a youth shooters left ear. Results: All firearms generated peak levels that exceeded the 120 dB peak limit suggested by the WHO for children. In general, shooting from the seated position over a tabletop increases the peak levels, LAeq8 and reduces the unprotected maximum permissible exposures (MPEs) for both rifles and pistols. Pistols pose the greatest auditory risk when fired over a tabletop. Conclusion: Youth should utilize smaller caliber weapons, preferably from the standing position, and always wear hearing protection whenever engaging in shooting activities to reduce the risk for auditory damage.

Measurement of impulse peak insertion loss for four hearing protection devices in field conditions

Abstract Objective: In 2009, the U.S. Environmental Protection Agency (EPA) proposed an impulse noise reduction rating (NRR) for hearing protection devices based upon the impulse peak insertion loss (IPIL) methods in the ANSI S12.42-2010 standard. This study tests the ANSI S12.42 methods with a range of hearing protection devices measured in field conditions. Design: The method utilizes an acoustic test fixture and three ranges for impulse levels: 130–134, 148–152, and 166–170 dB peak SPL. For this study, four different models of hearing protectors were tested: Bilsom 707 Impact II electronic earmuff, E·A·R Pod Express, E·A·R Combat Arms version 4, and the Etymotic Research, Inc. Electronic BlastPLG™ EB1. Study sample: Five samples of each protector were fitted on the fixture or inserted in the fixtures ear canal five times for each impulse level. Impulses were generated by a 0.223 caliber rifle. Results: The average IPILs increased with peak pressure and ranged between 20 and 38 dB. For some protectors, significant differences were observed across protector examples of the same model, and across insertions. Conclusions: The EPAs proposed methods provide consistent and reproducible results. The proposed impulse NRR rating should utilize the minimum and maximum protection percentiles as determined by the ANSI S12.42-2010 methods.

Short-term variability of pure-tone thresholds obtained with TDH-39P earphones.

Abstract Objective: To estimate the short-term variability and correlates of variability in pure-tone thresholds obtained using audiometric equipment designed for occupational use, and to examine the justification for excluding 8 kHz as a mandatory threshold in occupational hearing conservation programs. Method: Pure-tone thresholds and other hearing-related tests (e.g. noise dosimetry, otoscopy, middle-ear assessment) were conducted with a group of 527 adults between 20 and 69 years of age. Five measurement visits were completed by participants within 14 days. Results: The 50% critical difference boundaries were − 5 and 0 dB at 4 kHz and below and − 5 and 5 dB at 6 and 8 kHz. The likelihood of spurious notches due to test-retest variability was substantially lower than the likelihood of failing to detect a notched configuration when present. Correlates of variability included stimulus frequency, baseline threshold, acoustic reflectance of the ear, average noise exposure during the previous eight hours, age, and the testers level of education in audiology. Conclusion: The short-term variability in 8-kHz pure-tone thresholds obtained with the TDH-39P earphone was slightly greater than at other frequencies, but this difference was not large enough to justify the disadvantages stemming from the inability to detect a 6-kHz notch.

Sports Officials’ Hearing Status: Whistle Use as a Factor Contributing to Hearing Trouble

The objectives of this study were to examine the prevalence of hearing loss in a sample of sports officials and estimate the duration of whistle use required to reach a permissible 8-hr 100% noise dose. We conducted an online survey of 321 sports officials regarding their exposure to whistle noise and symptoms of hearing loss and tinnitus, and we assessed the acoustic characteristics of commercially available whistles. Male sports officials registered in Michigan had a greater prevalence of self-reported hearing trouble and tinnitus than observed in the general population of the midwestern United States. Sound levels produced by whistles range between 104 and 116 dBA, which corresponds to maximum unprotected exposure times of 90 to 5 sec, respectively. These findings suggest that whistle use may contribute to hearing loss among sports officials.

Impulse noise generated by starter pistols

Abstract Objective: This study describes signals generated by .22 and .32 caliber starter pistols in the context of noise-induced hearing loss risk for sports officials and athletes. Design: Acoustic comparison of impulses generated from typical .22 and .32 caliber starter pistols firing blanks were made to impulses generated from comparable firearms firing both blanks and live rounds. Acoustic characteristics are described in terms of directionality and distance from the shooter in a simulated outdoor running track. Metrics include peak sound pressure levels (SPL), A-weighted equivalent 8-hour level (LeqA8), and maximum permissible number of individual shots, or maximum permissible exposures (MPE) for the unprotected ear. Results: Starter pistols produce peak SPLs above 140 dB. The numbers of MPEs are as few as five for the .22-caliber starter pistol, and somewhat higher (≤ 25) for the .32-caliber pistol. Conclusion: The impulsive sounds produced by starter pistols correspond to MPE numbers that are unacceptably small for unprotected officials and others in the immediate vicinity of the shooter. At the distances included in this study, the risk to athletes appears to be low (when referencing exposure criteria for adults), but the sound associated with the starter pistol will contribute to the athletes overall noise exposure.

Acquired Hearing Loss in Adolescents

Studies on prevalence of acquired hearing loss across the life span have shown a trend of increase in hearing loss with age. A parallel decline in age of recreational use of loud music and cigarette smoking suggests that these early listening and recreational habits may be major contributing factors to the chronic hearing disability seen in later years. In recognition of these new recreational patterns of adolescents and young adults, Healthy People 2010 has issued a list of objectives for prevention of noise-induced hearing loss and smoking in adolescents and young adults through early education and intervention. In this article, the authors describe the effects of noise- and music-induced and smoking-induced hearing loss and provide guidelines for early identification and hearing conservation. Such an early approach to identification and conservation should ultimately help reduce hearing loss prevalence rates in adults.