Ted S. Tweed

Education, occupation, noise exposure history and the 10-yr cumulative incidence of hearing impairment in older adults

The purpose of this study was to determine the 10-yr cumulative incidence of hearing impairment and associations of education, occupation and noise exposure history with the incidence of hearing impairment in a population-based cohort study of 3753 adults ages 48-92 yr at the baseline examinations during 1993-1995 in Beaver Dam, WI. Hearing thresholds were measured at baseline, 2.5 yr-, 5 yr-, and 10-yr follow-up examinations. Hearing impairment was defined as a pure-tone average (PTA)>25 dB HL at 500, 1000, 2000, and 4000 Hz. Demographic characteristics and occupational histories were obtained by questionnaire. The 10-yr cumulative incidence of hearing impairment was 37.2%. Age (5 yr; Hazard Ratio (HR)=1.81), sex (M vs W; HR=2.29), occupation based on longest held job (production/operations/farming vs others; HR=1.34), marital status (unmarried vs married; HR=1.29) and education (<16 vs 16+yr; HR=1.40) were associated with the 10 yr incidence. History of noisy jobs was not associated with the 10-yr incidence of hearing impairment. The risk of hearing impairment was high, with women experiencing a slightly later onset. Markers of socioeconomic status were associated with hearing impairment, suggesting that hearing impairment in older adults may be associated with modifiable lifestyle and environmental factors, and therefore, at least partially preventable.

Tinnitus and its risk factors in the Beaver Dam Offspring Study

Abstract Objective: To assess the prevalence of tinnitus along with factors potentially associated with having tinnitus. Design: Data were from the Beaver Dam Offspring Study, an epidemiological cohort study of aging. Study Sample: After a personal interview and audiometric examination, participants (n = 3267, ages 21–84 years) were classified as having tinnitus if in the past year they reported having tinnitus of at least moderate severity or that caused difficulty in falling asleep. Results: The prevalence of tinnitus was 10.6%. In a multivariable logistic regression model adjusting for age and sex, the following factors were associated with having tinnitus: hearing impairment (Odds Ratio (OR) = 3.20), currently having a loud job (OR = 1.90), history of head injury (OR = 1.84), depressive symptoms (OR = 1.82), history of ear infection (men, OR = 1.75), history of target shooting (OR = 1.56), arthritis (OR = 1.46), and use of NSAID medications (OR = 1.33). For women, ever drinking alcohol in the past year was associated with a decreased risk of having tinnitus (OR = 0.56). Conclusions: These results suggest that tinnitus is a common symptom in this cohort and may be associated with some modifiable risk factors. Sumario Objetivo: Evaluar la prevalencia del acúfeno junto con los factores potencialmente asociados para tenerlo. Diseño: Los datos fueron obtenidos del Estudio “Beaver Dam Offspring”, una cohorte epidemiológica para el estudio del envejecimiento. Muestra: Después de una entrevista personal y un examen audiométrico, los participantes (n = 3267, edades 21–84 años) fueron clasificados como portadores de acúfeno si en el pasado año habían reportado tener acúfeno al menos de severidad moderada o si éste les ocasionaba dificultad conciliar el sueño. Resultados: La prevalencia del acúfeno fue de 10.6%. En modelo de regresión logística multivariada ajustada para edad y sexo, los siguientes factores fueron asociados al acúfeno: hipoacusia (tasa de probabilidad (OR) = 3.20), tener un empleo ruidoso (OR = 1.90), historia de traumatismo cefálico (OR = 1.84), síntomas depresivos (OR = 1.82), historia de infección ótica (hombres, OR = 1.75), historia de tiro con arma de fuego (OR = 1.56), artritis (OR = 1.46), y uso de AINES (OR = 1.33). Para las mujeres, el no haber bebido alcohol en el pasado año fue asociado con un decremento en el riesgo de tener acúfeno (OR = 0.56). Conclusiones: Estos resultados sugieren que el acúfeno es un síntoma común en esta cohorte y que puede estar asociado con algunos de los factores de riesgo modificables.

Determinants of Hearing Aid Acquisition in Older Adults

OBJECTIVES We determined factors associated with hearing aid acquisition in older adults. METHODS We conducted a population-based, prospective study that used information from 3 examinations performed on study participants as part of the Epidemiology of Hearing Loss Study (1993-2005). We included participants (n = 718; mean age = 70.5 years) who exhibited hearing loss at baseline or the first follow-up and had no prior history of hearing aid use. We defined hearing loss as a pure tone threshold average (PTA) at 0.5, 1, 2, and 4 kilohertz in the better ear of greater than 25 decibels Hearing Level. RESULTS The 10-year cumulative incidence of hearing aid acquisition was 35.7%. Associated factors included education (college graduate vs all others: hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.5, 4.1), self-perception of hearing (poor vs good or better: HR = 2.5; 95% CI = 1.3, 5.0), score on a perceived hearing handicap inventory (+1 difference: HR = 1.1; 95% CI = 1.0, 1.1), and PTA (+ 5 dB difference: HR = 1.4; 95% CI = 1.2, 1.6). CONCLUSIONS The low rate of hearing aid ownership among older adults is a problem that still needs to be addressed.

The ten-year incidence of tinnitus among older adults.

Abstract As part of a population-based study in Beaver Dam, Wisconsin, we estimated the 10-year cumulative incidence of tinnitus and its risk factors. Participants (n = 2922, aged 48–92 years) not reporting tinnitus at baseline (1993–1995) were followed for up to ten years. In addition to audiometric testing and anthropometric measures, data on tinnitus, health, and other history were obtained via questionnaire. Potential risk factors were assessed with discrete-time proportional hazards models. The 10-year cumulative incidence of tinnitus was 12.7%. The risk of developing tinnitus was significantly associated with: history of arthritis (hazard ratio (HR = 1.37), history of head injury (HR = 1.76), history of ever smoking (HR = 1.40), and among women, hearing loss (HR = 2.59). Alcohol consumption (HR = 0.63 for ≥ 141 grams/week vs. <15 grams/week), age (among women, HR = 0.90 for each five-year increase in age), and among men, obesity (HR = 0.55), were associated with decreased risk. The risk of developing tinnitus was high for older adults, and associated with modifiable health and behavioral factors. Sumario Como parte de un estudio poblacional en Beaver Dam, Winsconsin, estimamos la incidencia acumulada en 10 años de acúfeno y de sus factores de riesgo. Los participantes (n=2922, edades 48 a 92 años) no reportaban acúfeno al inicio (1993–1995) y fueron seguidos hasta 10 años. Además de las pruebas audiométricas y las mediciones antropométricas, se obtuvieron datos sobre el acúfeno, la salud y otros datos por medio de un cuestionario. Se evaluaron factores de riesgo potenciales por medio de modelos proporcionales de discreción/tiempo. La incidencia acumulada de acúfeno fue de 12.7%. El riesgo de desarrollar acúfeno fue asociado significativamente con: historia de artritis (riesgo peligroso (HR = 1.37), historia de golpes en la cabeza (HR=1.76), historia de haber fumado (HR=1.40) y entre las mujeres, hipoacusia (HR=2.59). Consumo de alcohol (HR=0.63 con ≥141 gramos/semana vs <15 gramos/semana), edad (entre las mujeres HR = 0.90 por cada incremento de edad de cinco años) y entre los hombres (obesidad (HR=0.55), se asociaron con incremento en el riesgo. El riesgo de para desarrollar acúfeno fue alto para adultos mayores, y se asoció con factores de comportamiento y de salud modificables.

Association of Leisure-Time Noise Exposure and Hearing Loss:Asociación entre exposición a ruido durante el tiempo libre e hipoacusia

The purpose of this study was to investigate the association of noisy leisure activities with hearing loss. Participants (n=3571) were examined in a population-based study of age-related hearing loss conducted in Beaver Dam, Wisconsin. Hearing thresholds were determined by audiometry. Hearing loss was defined as the pure-tone average of the frequencies 500,1,000, 2,000, and 4,000 Hz greater than 25 dB HL in either ear. Information regarding exposure to leisure-time noise was obtained by interview. After adjusting for potential confounders, individuals who engaged in leisure activities with average sound levels greater than 90 dBA were significantly more likely to have a hearing loss than participants who did not engage in noisy leisure activities (OR=1.11, 95 per cent 0=1.01-1.22). Individuals who engaged in woodworking were 30 per cent more likely to have a hearing loss than those who had never done woodworking. There was a 6 per cent increased risk of hearing loss for each 5-year period of participation. Health care professionals should consider counseling their patients who engage in noisy leisure activities about the risk of noise-induced hearing loss.

Smoking, Central Adiposity, and Poor Glycemic Control Increase Risk of Hearing Impairment

To determine associations between smoking, adiposity, diabetes mellitus, and other risk factors for cardiovascular disease (CVD) and the 15‐year incidence of hearing impairment (HI).

Generational Differences in the Reporting of Tinnitus

Objectives: Recent research suggests that hearing impairment is declining among older adults compared with earlier generations of the same age. Tinnitus is often associated with hearing impairment, so one might hypothesize that the prevalence of tinnitus is declining in a similar manner. The purpose of this study was to use multigenerational data with repeated measures to determine whether the prevalence of tinnitus is declining among more recent generations. Design: Using data from the Epidemiology of Hearing Loss Study (1993–1995, 1998–2000, 2003–2005, and 2009–2010) and the Beaver Dam Offspring Study (2005–2008), the authors examined birth cohort patterns in the report of tinnitus for adults aged 45 years and older (n =12,689 observations from 5764 participants). Participants were classified as having tinnitus if they reported tinnitus in the past year of at least moderate severity or that caused difficulty falling asleep. A low-frequency (500, 1000, and 2000 Hz) and high-frequency (3000, 4000, 6000, and 8000 Hz) pure tone average from the worse ear was used to summarize hearing status. Other potential risk factors for tinnitus were also explored to determine if changes in the prevalence of these factors over time could explain any observed birth cohort differences in the prevalence of tinnitus. These included the following: education, history of head injury, history of doctor-diagnosed ear infections, history of cardiovascular disease (myocardial infarction, stroke, or angina), current noisy job, longest-held job, target shooting in the past year, number of concerts ever attended, alcohol use in the past year, doctor diagnosis of arthritis, current aspirin use, regular exercise, and consulting with a physician in the past year about any hearing/ear problem. Birth cohort effects were modeled with alternating logistic regression models which use generalized estimating equations to adjust for correlation among repeated measurements over time that are nested within families. Results: The report of tinnitus tended to increase with more recent birth cohorts compared with earlier birth cohorts. For example, at ages 55 to 59 years, 7.6% of participants born between 1935 and 1939 reported tinnitus, compared with 11.0% of those born in 1940 to 1944, 13.6% of those born between 1945 and 1949, and 17.5% of those born between 1950 and 1954. Similarly, at ages 65 to 69 years, 7.9% of participants born between 1925 and 1929 reported tinnitus, compared with 10.0% of those born between 1930 and 1934, 11.9% of those born between 1935 and 1939, and 13.7% of those born between 1940 and 1944. Final alternating logistic regression model results indicated that, on average, after adjusting for age and other factors, participants in a given generation were significantly more likely to report tinnitus than participants from a generation 20 years earlier (odds ratio = 1.78, 95% confidence interval = 1.44, 2.21). Conclusions: Increased reports of tinnitus may reflect increased prevalence of symptoms, increased awareness of symptoms, or higher health expectations among more recent generations of adults. Regardless of the reasons, the increasing prevalence of tinnitus suggests that health care providers may see an increased number of patients bothered by this common but little understood symptom.

Notched Audiograms and Noise Exposure History in Older Adults

Objective: Using data from a population-based cohort study, we compared four published algorithms for identifying notched audiograms and compared their resulting classifications with noise exposure history. Design: Four algorithms: (1) Coles et al. (2000), (2) McBride and Williams (2001), (3) Dobie and Rabinowitz (2002), and (4) Hoffman et al. (2006) were used to identify notched audiograms. Audiometric evaluations were collected as a part of the 10-yr follow-up examinations of the Epidemiology of Hearing Loss Study, in Beaver Dam, WI (2003–2005, N = 2395). Detailed noise exposure histories were collected by interview at the baseline examination (1993–1995) and updated at subsequent visits. An extensive history of occupational noise exposure, participation in noisy hobbies, and firearm usage was used to evaluate consistency of the notch classifications with the history of noise exposure. Results: The prevalence of notched audiograms varied greatly by definition (31.7, 25.9, 47.2, and 11.7% for methods 1, 2, 3, and 4, respectively). In this cohort, a history of noise exposure was common (56.2% for occupational noise, 71.7% for noisy hobbies, 13.4% for firearms, and 81.2% for any of these three sources). Among participants with a notched audiogram, almost one-third did not have a history of occupational noise exposure (31.4, 33.0, 32.5, and 28.1% for methods 1, 2, 3, and 4, respectively), and approximately 11% did not have a history of exposure to any of the three sources of noise (11.5, 13.6, 10.3, and 7.6%). Discordance was greater in women than in men. Conclusions: These results suggest that there is a poor agreement across existing algorithms for audiometric notches. In addition, notches can occur in the absence of a positive noise history. In the absence of an objective consensus definition of a notched audiogram and in light of the degree of discordance in women between noise history and notches by each of these algorithms, researchers should be cautious about classifying noise-induced hearing loss by notched audiograms.

Olfactory Impairment in Adults The Beaver Dam Experience

Olfactory function may be important for environmental and nutritional safety and enjoyment. Population‐based epidemiological studies of olfaction are needed to understand the magnitude of the health burden, identify modifiable risk factors, and develop and test prevention and treatment strategies for olfactory impairment. However, measuring olfaction in large studies is challenging, requiring repeatable, efficient methods that can measure change over time. Two large cohort studies, the Epidemiology of Hearing Loss Study (EHLS) and the Beaver Dam Offspring Study (BOSS), included olfactory testing. In both studies, the San Diego Odor Identification Test (SDOIT) was used to measure olfaction. Subjects were asked to identify eight common household odors (such as coffee and chocolate). Olfactory impairment was defined as correctly identifying fewer than six out of eight odorants after two trials. The EHLS participants were age 53–95 years at the time of the first measurement (1998–2000), and participants in the BOSS were age 21–84 years. The prevalence of olfactory impairment in the EHLS was 25% overall, more common in men than women, and increased with age. Five years later olfaction was measured a second time and the majority (84%) of the EHLS participants were classified the same. Among those with impairment at the base line nearly one‐third (31%) improved to unimpaired. This heterogeneity in olfactory impairment has unique implications for data analyses and predicting outcomes and associations. Preliminary data from the BOSS suggest the prevalence of olfactory impairment may be lower in younger generations. All these factors point to a continuing need for epidemiological studies of olfaction.

Self-Reported Hearing Difficulties Among Adults With Normal Audiograms: The Beaver Dam Offspring Study.

Objective: Clinicians encounter patients who report experiencing hearing difficulty (HD) even when audiometric thresholds fall within normal limits. When there is no evidence of audiometric hearing loss, it generates debate over possible biomedical and psychosocial etiologies. It is possible that self-reported HDs relate to variables within and/or outside the scope of audiology. The purpose of this study is to identify how often, on a population basis, people with normal audiometric thresholds self-report HD and to identify factors associated with such HDs. Design: This was a cross-sectional investigation of participants in the Beaver Dam Offspring Study. HD was defined as a self-reported HD on a four-item scale despite having pure-tone audiometric thresholds within normal limits (<20 dB HL0.5, 1, 2, 3, 4, 6, 8 kHz bilaterally, at each frequency). Distortion product otoacoustic emissions and word-recognition performance in quiet and with competing messages were also analyzed. In addition to hearing assessments, relevant factors such as sociodemographic and lifestyle factors, environmental exposures, medical history, health-related quality of life, and symptoms of neurological disorders were also examined as possible risk factors. The Center for Epidemiological Studies-Depression was used to probe symptoms associated with depression, and the Medical Outcomes Study Short-Form 36 mental score was used to quantify psychological stress and social and role disability due to emotional problems. The Visual Function Questionnaire-25 and contrast sensitivity test were used to query vision difficulties. Results: Of the 2783 participants, 686 participants had normal audiometric thresholds. An additional grouping variable was created based on the available scores of HD (four self-report questions), which reduced the total dataset to n = 682 (age range, 21–67 years). The percentage of individuals with normal audiometric thresholds who self-reported HD was 12.0% (82 of 682). The prevalence in the entire cohort was therefore 2.9% (82 of 2783). Performance on audiological tests (distortion product otoacoustic emissions and word-recognition tests) did not differ between the group self-reporting HD and the group reporting no HD. A multivariable model controlling for age and sex identified the following risk factors for HD: lower incomes (odds ratio [OR]