Philip Newall

Hearing impairment and health-related quality of life : The blue mountains hearing study

Objectives: To assess the association between hearing impairment and health-related quality of life (HRQOL) in an older population, using the self-administered 36-item Short-Form Health Survey (SF-36). Design: Participants of the Blue Mountains Hearing Study (BMHS, N = 2956) attended a comprehensive interview and hearing examination in which both self-reported and measured hearing impairments were assessed. Hearing impairment was defined as the pure-tone average of air-conduction hearing thresholds >25 decibels hearing level (dB HL) for the four frequencies (0.5 to 4.0 kHz) in the better ear. Results: Of the 2431 participants with complete data (mean age, 67.0 yr), 1347 (55.4%) did not have measured hearing loss, whereas 324 (13.3%) had unilateral (285 mild, 22 moderate, 17 severe) and 760 (31.3%) had bilateral hearing impairment (478 mild, 207 moderate, 75 severe). After adjusting for demographic and medical confounders, bilateral hearing impairment was associated with poorer SF-36 scores in both physical and mental domains (fall in physical component score, PCS of 1.4 points, p = 0.025; fall in mental component score, MCS of 1.0 point, p = 0.13), with poorer scores associated with more severe levels of impairment (PCS ptrend = 0.04, MCS ptrend = 0.003). Participants with bilateral hearing impairment who habitually used hearing aids had a slightly better PCS (mean, 43.1; standard error [SE], 0.9) than those with the same impairment who did not have hearing aids or who only used them occasionally (mean, 41.2; SE 0.5), although this finding was not statistically significant (p = 0.055). Persons with self-reported hearing loss had significantly poorer HRQOL than corresponding persons without, but persons with unilateral or high-frequency hearing loss did not have significantly different HRQOL scores than their corresponding counterparts. Conclusions: This study quantifies the associated disease burden of age-related hearing impairment on health-related quality of life in a population-based cohort of older persons.

Sensory and Cognitive Association in Older Persons: Findings from an Older Australian Population

Background: Explanations for associations found between sensory and cognitive function remain unclear. Objective: To assess in an older Australian population: (1) the correlation between sensory and cognitive function across groups with a narrow age range; (2) any independent association between sensory and cognitive impairment. Methods: We examined 3,509 non-institutionalised residents aged 50+ years in the second cross-sectional survey of the Blue Mountains Eye Study (1997–2000). Visual impairment was defined for best-corrected visual acuity (VA) <6/12 in the better eye, moderate to severe hearing loss for hearing threshold >40 dB (better ear), and likely cognitive impairment for Mini-Mental State Examination (MMSE) <24 points. Results: We found likely cognitive impairment in 3.3%, vision impairment in 2.7% and moderate to severe hearing loss in 10.5% of this population. Correlation between VA or hearing threshold and MMSE score increased with age. After adjusting for age, weak but significant correlation was evident in the normal ageing sample between vision and MMSE (r = 0.12 with vision items included and r = 0.11 with vision items excluded, both p < 0.0001), and between hearing thresholds and MMSE (r = –0.12, p < 0.0001). After adjusting for age, sex, education and history of stroke, persons with vision impairment had a lower mean MMSE score than those with normal vision, regardless of whether vision-related items were included (27.1 vs. 28.6, p < 0.001) or excluded (19.8 vs. 21.0, p < 0.001). Similarly, persons with moderate to severe hearing loss had a lower mean MMSE score than those without hearing loss (28.1 vs. 28.7, p < 0.001). Persons with likely cognitive impairment also had lower mean VA and higher mean hearing threshold than those without, after adjustment. Conclusions: We have documented an age-related correlation between sensory and cognitive function in a normal ageing sample. The association between sensory impairment and likely cognitive impairment remained significant after excluding vision-related MMSE items and adjusting for confounding factors. Our data suggest that age-related decline and the effect of visual impairment on the measurement of cognition only partly explain the association between sensory and cognitive impairments in older persons.

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.

Electrophysiological and behavioral evidence of auditory processing deficits in children with reading disorder

OBJECTIVE The aim of the research was to investigate auditory processing abilities in children with reading disorders using electrophysiological and behavioral tasks. METHODS Differences in auditory processing between control, compensated (age appropriate reading skills with a history of reading disorder), and reading disordered groups were systematically investigated. RESULTS The reading disorder group had significantly lower results than control and compensated reader groups for most tests in the reading and auditory processing test battery. All children with a reading disorder did not pass at least one behavioral test of auditory processing, and hence would be diagnosed clinically as having an auditory processing disorder (APD). The reading disorder group also had significantly smaller /ga/-evoked mismatch negativity (MMN) area than the control group. Compensated and control groups had similar results for the electrophysiological and behavioral auditory processing tests. Correlation analyses showed that reading fluency and accuracy and nonword scores (measured using Castle and Colthearts word/nonword test) correlated significantly with most APD measures. CONCLUSIONS The general profile of auditory processing deficits in children with reading disorder was a combination of deficits on frequency patterns (i.e. frequency pattern test) and absent or small /ga/-evoked MMN. Significant results from the correlation analyses support the co-morbidity of reading and auditory processing disorders. SIGNIFICANCE Children with reading disorders are likely to have auditory processing disorders.

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.

Development and evaluation of Mandarin disyllabic materials for speech audiometry in China

The purpose of this study is to develop and evaluate disyllabic Mandarin speech test materials (MSTMs) in order to facilitate wider use of speech audiometry in Chinese audiology clinics. Phonologically balanced Mandarin disyllabic materials with high familiarity were designed based on the basic rules for developing speech materials and the particular characteristics of Mandarin, and recorded digitally. In order to establish the validity and reliability of these Mandarin disyllabic materials, equivalence of difficulty between the word lists was evaluated for a group of 60 subjects (age-range 18–25 years) with normal hearing. Subsequently, performance-intensity (PI) functions were measured in a group of 30 subjects with normal hearing (age-range 18–25 years), and a group of 35 subjects with sensineural hearing loss. The nine lists of Mandarin disyllabic materials were found to have sufficient reliability and validity to be used in clinical situations

Retinal microvascular abnormalities and age-related hearing loss: the Blue Mountains hearing study.

Objective: Microvascular disease may contribute to hearing loss. We tested this hypothesis by examining the relation of retinal microvascular abnormalities and hearing loss. Methods: This was a cross-sectional, population-based study. We performed retinal photography and pure-tone audiometry on 1511 older individuals (ages 54+ years) from the Blue Mountains Eye Study population. Examination of the retinal microvasculature provides a noninvasive means of assessing systemic microvascular changes associated with cardiovascular disease, especially since reliable methods of quantifying retinal microvascular abnormalities from retinal photographs have recently been developed. Trained graders masked to audiometry data assessed retinal photographs for signs of retinal microvascular damage, for example, focal arteriolar narrowing, arteriovenous nicking, and retinopathy (microaneurysms, retinal hemorrhages), and used a computer-assisted method to measure arteriolar and venular calibers. We defined moderate or profound hearing loss as pure-tone average air-conducted hearing thresholds in the better ear worse than 40 dB at 0.5, 1, 2, and 4 kHz. We used odds ratios (OR), 95% confidence intervals (CI), and probability values to present the associations between retinal microvascular abnormalities and hearing loss; an OR >1 indicates that persons with the microvascular abnormality are more likely to have hearing loss, a CI that includes 1.00 (e.g., 0.85 to 2.34) indicates no statistically significant association (i.e., the association may have occurred due to chance), whereas a value of p < 0.05 indicates that an association is unlikely to have occurred due to chance. Results: The proportion of women and men with moderate or profound hearing loss was 10.4% (90/862) and 15.4% (100/649), respectively. After adjustment for age, sex, blood pressure, and other risk factors for hearing loss, retinopathy in women was associated with hearing loss (adjusted OR, 2.10; 95% CI, 1.09 to 4.06, p = 0.002) but not in men. Associations were stronger for moderate or worse low-frequency (0.25 to 1.0 kHz) hearing loss in women (adjusted OR, 3.00; 95% CI, 1.25 to 7.19, p = 0.0005) but were absent for high-frequency hearing loss. In men, no retinal microvascular abnormalities were associated with hearing loss at either low or high frequencies. Conclusions: Retinopathy, a sign of retinal microvascular damage, was associated with hearing loss in women but not in men. Our results provide modest support to the hypothesis that microvascular disease may play a role in age-related hearing loss in women, particularly low-frequency losses.

The Contribution of Family History to Hearing Loss in an Older Population

Objectives: Although it has been well established that the prevalence of and severity of hearing loss increase with age, the contribution of familial factors to age-related hearing loss cannot be quantified. This is largely because hearing loss in older people has both genetic and environmental contributions. As environmental factors play an increasing role with age, it is difficult to delineate the separate contribution of genetic factors to age-related hearing loss. In a population-based survey of hearing loss in a representative older Australian community, we attempted to overcome this using logistic regression analysis, accounting for known factors associated with hearing loss including age, sex, noise exposure at work, diabetes, and current smoking. Design: We tested hearing thresholds using pure tone audiometry and used a forced choice questionnaire to determine the nature of family history in a population of individuals aged 50 yrs or older in a defined region, west of Sydney, Australia (N = 2669). We compared the characteristics of participants with and without family history of hearing loss. Of those reporting a positive family history, we compared subgroups for age, gender and severity of hearing loss, and trends by the severity of hearing loss. Logistic regression was used to obtain odds ratios (ORs) with 95% confidence intervals (CIs) that compared the chances of having hearing loss in participants with and without family history, after adjusting for other factors known associated with hearing loss. Results: Our findings indicate that family history was most strongly associated with moderate to severe age-related hearing loss. We found a strong association between maternal family history of hearing loss and moderate to severe hearing loss in women (adjusted OR 3.0; 95% CI 1.6-5.6 in women with without a maternal history). Paternal family history of hearing loss was also significantly, though less strongly, associated with moderate-severe hearing loss in men (adjusted OR 2.0; CI 1.01-3.9 in men with than without a paternal history). Conclusions: Findings from this study are important in the identification of individuals whose auditory system may be genetically susceptible to aging and environmental insult. Genetic counseling may assist in ameliorating the effects of hearing loss.

The Listening in Spatialized Noise test: Normative data for children

The Listening in Spatialized Noise test (LISN®) produces a three-dimensional auditory environment under headphones, using only a PC and an audiometer, and was designed to provide an ecologically valid assessment of auditory figure-ground skills in children. The listener is required to indicate the intelligibility level of a story presented at 0° azimuth, in the presence of distracter sentences simultaneously presented at either 0° or ±90° azimuth. Various measures assess the extent to which either spatial, vocal, or spatial and vocal cues combined, increase a listeners ability to comprehend the story, without being affected by differences between participants in variables such as linguistic skills. There was a trend of improved performance with increasing age for 48 normally hearing seven-, eight-, and nine-year-olds, and sixteen adults. Whereas some significant differences were found between adults and children, there were no significant differences in performance between the seven-, eight-, and nine-year-olds on any measure, and no significant gender or practice effects were observed. Future studies on children with suspected auditory processing disorder were considered warranted. Sumario La prueba de audición en ruido espacializado (LISN®) produce un ambiente auditivo tridimensional con audífonos, por medio de una PC y un audiómetro. Se diseñó para proporcionar una evaluación ecológicamente válida de las habilidades figura/fondo en niños. Se le pide al sujeto que escucha que indique el nivel de inteligibilidad de una historia presentada a 0° azimut en presencia de oraciones simultáneas como distractor ya sea a 0° o a ±90° azimut. Hay varias mediciones que evalúan el grado en que las claves vocales, espaciales o vocales y espaciales combinadas, aumentan la habilidad del sujeto para comprender la historia, sin que se vean afectadas por las diferencias entre participantes, tales como las habilidades lingüísticas. Hubo una tendencia a mejorar el desempeño con el incremento de la edad en 48 sujetos normoyentes de 7,8 y 9 años y en 16 adultos. Mientras que algunas diferencias significativas se encontraron entre niños y adultos, no hubo diferencias significativas en el desempeño entre los niños de 7,8 y 9 años en ninguna medición, ni tampoco se observó ninguna diferencia entre géneros o por efecto de la práctica. Se consideran necesarios más estudios en niños con sospecha de alteraciones en el procesamiento auditivo.