Maryanne Golding

Prevalence and characteristics of tinnitus in older adults: the Blue Mountains Hearing Study.

There have been few recent estimates of the prevalence of tinnitus from large population-based samples of older persons. Our study aimed to assess the prevalence and characteristics of prolonged tinnitus in a representative sample of 2015 adults aged 55–99 years, residing in the Blue Mountains, west of Sydney, Australia, during 1997–99. All participants underwent a detailed hearing examination by an audiologist, including comprehensive questions about hearing. After age adjustment, subjects reporting tinnitus had significantly worse hearing at both lower and higher frequencies (p < 0.001). This difference was more marked in younger than in older subjects (p < 0.05). Overall, 602 subjects (30.3%) reported having experienced tinnitus, with 48% reporting symptoms in both ears. Tinnitus had been present for at least 6 years in 50% of cases, and most (55%) reported a gradual onset. Despite tinnitus being described as mildly to extremely annoying by 67%, only 37% had sought professional help, and only 6% had received any treatment. Existen pocas estimaciones recientes sobre la prevalencia de acúfeno calculada en una población amplía en personas mayores. Nuestro estudio tiene como objetivo conocer la prevalencia y las características de acúfeno de larga evolución en una muestra representativa de 2015 adultos de 55 a 99 años, residentes de Blue Mountains, al oeste de Sydney, Australia, de 1997 a 1999. Todos los participantes se sometieron a un examen audiológico detallado realizado por un audiólogo, que incluyó preguntas sobre la audición. Después de un ajuste etáreo se observó que los sujetos que manifestaban acúfeno tenían peores umbrales tanto en altas como en bajas frecuencias (p < 0.001). Esta diferencia fue más marcada en sujetos jóvenes que en viejos (p < 0.05). Un total de 602 sujetos (30.3%) reportaron haber experimentado acúfeno; 48% de ellos en forma bilateral. En 50% de los casos, el acúfeno tenía al menos 6 años de evolución y el 55% reportó un inicio gradual. Aunque el acúfeno fue descrito como mediana a extremadamente molesto en el 67% de los casos, sólo el 37% había buscado ayuda profesional y sólo 6%) había recibido algún tipo de tratamiento.

Risk factors for tinnitus in a population of older adults: the blue mountains hearing study.

Objective To identify potential and modifiable risk factors for tinnitus in a population of older adults. Study Design Cross-sectional study. Detailed questionnaires were interviewer-administered in a representative sample of 2015 persons aged 55+ yr, living in an area west of Sydney, Australia. Air- and bone-conduction audiometric thresholds were measured from 250 to 8000 Hz and from 500 to 4000 Hz, respectively. TEOAE and SOAE were measured for both ears. Results After adjusting for multiple variables in a Cox proportional hazards model, factors that significantly increased the risk of tinnitus were poorer hearing and cochlear function, self-reported work-related noise exposure, and history of middle ear or sinus infections, severe neck injury or migraine. Conclusion Interventions aimed at reducing age-related hearing loss, particularly by reducing excessive work-related noise exposure, and the effective, timely treatment of ear-related infections, may all decrease the risk of tinnitus.

Use of hearing aids and assistive listening devices in an older Australian population

BACKGROUND Hearing loss is a common sensory impairment experienced by older persons. Evidence shows that the use of hearing aids and/or assistive listening devices (ALDs) can benefit those with a hearing loss but that historically the uptake and use of these technologies has remained relatively low compared with the number of people who report a hearing loss. PURPOSE The aim of this study was to determine the prevalence, usage, and factors associated with the use of hearing aids and ALDs in an older representative Australian population. RESEARCH DESIGN A population-based survey. STUDY SAMPLE A total of 2956 persons out of 3914 eligible people between the ages of 49 and 99 yr (mean age 67.4 yr), living in the Blue Mountains, west of Sydney, completed a hearing study conducted from 1997 to 2003. DATA COLLECTION AND ANALYSIS Hearing levels were assessed using pure tone audiometry, and subjects were administered a comprehensive hearing survey by audiologists, which included questions about hearing aid and ALD usage. Logistic regression analysis was used to identify factors associated with hearing aid and ALD usage. RESULTS Of the surveyed population, 33% had a hearing loss as measured in the better ear. 4.4% had used an ALD in the past 12 mo, and 11% owned a hearing aid. Of current hearing aid owners, 24% never used their aids. ALD and hearing aid usage were found to be associated with increasing age, hearing loss, and self-perceived hearing disability. CONCLUSIONS These results indicate that hearing aid ownership and ALD usage remains low in the older population. Given the significant proportion of older people who self-report and have a measured hearing loss, it is possible that more could be helped through the increased use of hearing aid and/or ALD technology. Greater efforts are needed to promote the benefits of these technologies and to support their use among older people with hearing loss.

The detection of adult cortical auditory evoked potentials (CAEPs) using an automated statistic and visual detection

Abstract The detection of adult cortical auditory evoked potentials (CAEPs) can be challenging when the stimulus is just audible. The effectiveness of a statistic compared with expert examiners in (1) detecting the presence of CAEPs when stimuli were present, and (2) reporting the absence of CAEPs when no stimuli were present, was investigated. CAEPs recorded from ten adults, using two speech-based stimuli, five stimulus presentation levels, and non-stimulus conditions, were given to four experienced examiners who were asked to determine if responses to auditory stimulation could be observed, and their degree of certainty in making their decision. These recordings were also converted to multiple dependent variables and Hotellings T2 was applied to calculate the probability that the mean value of any linear combination of these variables was significantly different from zero. Results showed that Hotellings T2 was equally sensitive to the best of individual experienced examiners in differentiating a CAEP from random noise. It is reasonable to assume that the difference in response detection for a novice examiner and Hotellings T2 would be even greater. Sumario La detección de los potenciales evocados auditivos corticales (CAEP) del adulto puede ser un desafío cuando el estímulo es apenas audible. Se investigó la efectividad de una comparación estadística con examinadores expertos para (1) detectar la presencia del CAEP cuando el estimulo estuvo presente, y (2) reportar la ausencia del CAEP cuando ningún estímulo estaba presente. Los CAEP registrados para diez adultos, usando dos estímulos con base en lenguaje, cinco niveles de presentación del estímulo, y condiciones sin estímulo, fueron presentados a cuatro examinadores con experiencia, a quienes se solicitó que determinaran si las respuestas a estímulos auditivos podían ser observadas y su grado de certeza en la toma de sus decisiones. Estos registros fueron también convertidos a múltiples variables dependientes y se aplicó el T2 de Hotelling para calcular la probabilidad de que el valor medio de una combinación lineal de estas variables fuera significativamente diferente de cero. Los resultados mostraron que el T2 de Hotelling era igualmente sensible que lo mejor de los examinadores experimentados individuales para diferenciar un CAEP de un ruido aleatorio. Es razonable asumir que la diferencia en detección de respuestas para un examinador novato y el T2 de Hotelling serían aún mayor.

Odds of demonstrating auditory processing abnormality in the average older adult: The blue mountains hearing study

Objective: To determine, for the average older adult, the odds of demonstrating an auditory processing abnormality for each of seven speech-based measures of auditory processing and how these odds vary based on a number of independent subject variables. Design: Using a cross-sectional design, 1576 adults aged 55 years and older were assessed with speech measures of central auditory processing and questionnaires pertaining to health status, cognitive and perceived auditory function. The speech-based measures from which abnormal/normal outcomes were derived were (a) right ear Macquarie Synthetic Sentence Identification (MSSI) test maximum performance score (Rt MSSImax), (b) left ear MSSI test maximum performance score (Lt MSSImax), (c) right ear Macquarie Dichotic Sentence Identification (MDSI) test score (Rt MDSI), (d) left ear MDSI test score (Lt MDSI), (e) difference score for the right and left ear MDSI test (MDSI Diff score), (f) right ear MSSI test maximum performance score subtracted from the maximum performance score for monosyllabic word list materials in the same ear (Rt PB-MSSImax), and (g) left ear MSSI test maximum performance score subtracted from the maximum performance score for monosyllabic word list materials in the same ear (Lt PB-MSSImax). Results: The odds of demonstrating auditory processing abnormality for average older participants, increased by 4 to 9% per year of age. Men were approximately twice as likely as women to demonstrate this abnormality, but the gender difference was only evident with dichotic measures. With increasing hearing handicap, the odds of demonstrating auditory processing abnormality increased, but this was only evident for speech-in-noise measures. With subtle cognitive decline, the odds of demonstrating auditory processing abnormality also increased. Conclusions: This population-based study provides evidence of a link between perceived hearing handicap and outcomes on speech-in-noise measures as well as evidence of a gender difference that became apparent using dichotic tests. The contribution of central auditory processing abnormality to hearing health should therefore not be overlooked in the provision of auditory rehabilitation programs to older adults.

Tinnitus in older people: It is a widespread problem

There is much evidence that tinnitus is far more common than most people realize. A number of years ago, a research group in Sydney, Australia, advertised for volunteers to help test out a device that might offer relief for tinnitus sufferers. The response was so overwhelming that the number of phone calls caused severe problems for the researchers. Some callers seemed to be truly distressed and anxious to seek treatment. It was clear that the incidence of serious tinnitus in the general population was much higher than had been expected by those organizing the study.

Development of Telscreen: a telephone-based speech-in-noise hearing screening test with a novel masking noise and scoring procedure

Abstract Objective: In 2006 the National Acoustic Laboratories was commissioned to create a telephone-based hearing screening test. Design: NAL developed ‘Telscreen’, a speech-in-noise test modelled on the Dutch and UK telephone tests. The first version, Telscreen I, had several novel features: individual scoring of digits; individual equalization of digit intelligibility; and accuracy-determined test termination. Evaluation of Telscreen I revealed that it did not discriminate satisfactorily between those with and without hearing impairment. Subsequently Telscreen II, which included a novel sensitized masking noise, was developed. Study sample: Telscreen I was evaluated by 105 participants (22–86 years), 37% with normal hearing (all thresholds <20 dB HL in the test ear), 63% with hearing impairment (all thresholds >20 dB HL in the test ear). Telscreen II was evaluated by 75 participants (25–86 years), 33% with normal hearing, 67% with hearing impairment. Results: Correlations between Telscreen I results and hearing thresholds, r = 0.57, and hearing disability scores, r = 0.51 were highly significant, but lower than expected. Correlations for Telscreen II were higher: r = 0.77 and 0.65, respectively. Telscreen II was found to have high sensitivity: 90%; and specificity: 90.2%. Conclusions: Telscreen II is an efficient, reliable, and innovative hearing screening test that provides a solid foundation for future tests delivered via mobile and internet technologies.

An audiological profile of elderly Australians reporting speech affecting stroke

This study examined the audiological profile and hearing rehabilitation of 73 people who reported having had speech-affecting strokes. Participants were drawn from the Blue Mountains Hearing Study (BMHS), a population survey of age-related hearing loss in 2956 members of a representative elderly Australian community. While speech-affecting stroke did not seem to cause greater levels of hearing impairment or handicap than for other participants matched for age and gender, this may be due to a low prevalence of participants with severe effects on speech or language as a result of their stroke. Although 52% of participants self-reported a hearing loss, fewer than 23% had ever worn a hearing aid with only 15% wearing hearing aids for more than 1 hour per day. Pure tone audiometry identified 64% of participants with thresholds considered appropriate for hearing aid fitting when previously established criteria were applied. Questions concerning use of hearing aid/s and self reported hearing loss were not reliable in determining which participants with a speech affecting stroke met these audiometric criteria. The risks of uncorrected hearing loss compromising speech and language assessment and rehabilitation following stroke are discussed.