Theodore S. Tweed

Low Prevalence of Hearing Aid Use Among Older Adults with Hearing Loss: The Epidemiology of Hearing Loss Study

OBJECTIVES: To measure the prevalence of hearing aid use among older adults with hearing loss and to identify factors associated with those currently using hearing aids.

The prevalence of hearing impairment and associated risk factors: the Beaver Dam Offspring Study.

OBJECTIVEnTo estimate the prevalence of hearing impairment (HI) and evaluate the cross-sectional associations of environmental and cardiovascular disease risk factors and HI in middle-aged adults.nnnDESIGNnData were collected as part of the Beaver Dam Offspring Study, an epidemiological cohort study of aging. Hearing impairment was defined as a pure-tone average (0.5, 1.0, 2.0, and 4.0 kHz) greater than 25 db hearing level in either ear. Word recognition in competing message (WRCM) was measured using the Northwestern University No. 6 word list. Questionnaire information about behaviors, environmental factors, and medical history was also collected.nnnPARTICIPANTSnThe participants (N = 3285) were offspring of participants of the population-based Epidemiology of Hearing Loss Study and ranged in age from 21 to 84 years (mean age, 49 years).nnnRESULTSnThe prevalence of HI was 14.1%, and the mean (SD) WRCM score was 64% (15%). In a multivariate model, after age, sex, education, and occupational noise were controlled for, a history of ear surgery (odds ratio [OR], 4.11; 95% confidence interval [CI], 2.37-7.15), a larger central retinal venular equivalent (OR, 1.77; 95% CI, 1.20-2.60 [fourth quartile vs first quartile]), and a higher hematocrit percentage (OR, 0.77; 95% CI, 0.63-0.95 [per 5%]) were independently associated with HI. Factors associated with lower WRCM scores were similar but also included mean intima-media thickness (mean difference, -0.63%; 95% CI, -1.06% to -0.19%; P = .005 [per 0.1 mm]) and statin use (mean difference, -2.09%; 95% CI, -3.58% to -0.60%; P = .005).nnnCONCLUSIONSnHearing impairment is a common condition in middle-aged adults. Cardiovascular disease risk factors may be important correlates of age-related auditory dysfunction.

Generational Differences in the Prevalence of Hearing Impairment in Older Adults

There were significant changes in health and lifestyle throughout the 20th century which may have changed temporal patterns of hearing impairment in adults. In this study, the authors aimed to assess the effect of birth cohort on the prevalence of hearing impairment in an adult population aged 45-94 years, using data collected between 1993 and 2008 from 3 cycles of the Epidemiology of Hearing Loss Study (n = 3,753; ages 48-92 years at baseline) and a sample of participants from the Beaver Dam Offspring Study (n = 2,173; ages > or =45 years). Hearing impairment was defined as a pure-tone average of thresholds at 0.5, 1, 2, and 4 kHz greater than 25-dB HL [hearing level]. Descriptive analysis, generalized additive models, and alternating logistic regression models were used to examine the birth cohort effect. Controlling for age, with every 5-year increase in birth year, the odds of having hearing impairment were 13% lower in men (odds ratio = 0.87, 95% confidence interval: 0.83, 0.92) and 6% lower in women (odds ratio = 0.94, 95% confidence interval: 0.89, 0.98). These results suggest that 1) older adults may be retaining good hearing longer than previous generations and 2) modifiable factors contribute to hearing impairment in adults.

Moderate Alcohol Consumption and Hearing Loss: A Protective Effect

OBJECTIVE: To determine if moderate alcohol consumption is associated inversely with hearing loss in a large population based study of older adults.

Long-term Assessment of Systemic Inflammation and the Cumulative Incidence of Age-related Hearing Impairment in the Epidemiology of Hearing Loss Study

BACKGROUNDnAlthough research has linked systemic inflammation to various diseases of aging, few studies have examined the potential role it may play in the development of age-related hearing impairment.nnnMETHODSnAmong 1,073 participants free of hearing impairment (pure-tone average 0.5, 1, 2, 4kHz ≤ 25 dB HL) in the population-based Epidemiology of Hearing Loss Study (1998-2000), serum C-reactive protein, and interleukin-6 were measured at three time points (1988-1990, 1998-2000, and 2009-2010), and tumor necrosis factor-α was measured at one time point (1998-2000), whereas hearing impairment was measured again in 2003-2005 and 2009-2010 to determine the 10-year cumulative incidence.nnnRESULTSnInflammatory marker levels from a single time point (1998-2000) were not associated with an increased risk of developing hearing impairment. Associations between long-term serum C-reactive protein levels and incident hearing impairment differed by age (p = .031). Participants less than 60 years with consistently high (>3 mg/L) or increasing levels of serum C-reactive protein over 10 years were nearly two times (hazard ratio: 1.96, 95% confidence interval: 1.19, 3.23) as likely to develop hearing impairment over the subsequent 10-year period, an association not seen in participants more than or equal to 60 years. A statistically significant association (p-trend = .041) was also observed between number of markers in the highest group at baseline and incident hearing impairment in this younger age group.nnnCONCLUSIONSnAssociations between long-term serum C-reactive protein levels and incident hearing impairment were observed in the cohort as a whole, but differed significantly by age group, with statistically significant associations observed in adults less than 60 years, participants moving through the peak risk period for hearing impairment over the course of the study.

Measuring Taste Impairment in Epidemiologic Studies The Beaver Dam Offspring Study

Taste or gustatory function may play an important role in determining diet and nutritional status and therefore indirectly impact health. Yet there have been few attempts to study the spectrum of taste function and dysfunction in human populations. Epidemiologic studies are needed to understand the impact of taste function and dysfunction on public health, to identify modifiable risk factors, and to develop and test strategies to prevent clinically significant dysfunction. However, measuring taste function in epidemiologic studies is challenging and requires repeatable, efficient methods that can measure change over time. Insights gained from translating laboratory‐based methods to a population‐based study, the Beaver Dam Offspring Study (BOSS) will be shared. In this study, a generalized labeled magnitude scale (gLMS) method was used to measure taste intensity of filter paper disks saturated with salt, sucrose, citric acid, quinine, or 6‐n‐propylthiouracil, and a gLMS measure of taste preferences was administered. In addition, a portable, inexpensive camera system to capture digital images of fungiform papillae and a masked grading system to measure the density of fungiform papillae were developed. Adult children of participants in the population‐based Epidemiology of Hearing Loss Study in Beaver Dam, Wisconsin, are eligible for this ongoing study. The parents were residents of Beaver Dam and 43–84 years of age in 1987–1988; offspring ranged in age from 21–84 years in 2005–2008. Methods will be described in detail and preliminary results about the distributions of taste function in the BOSS cohort will be presented.

Modifiable determinants of hearing impairment in adults

OBJECTIVEnTo identify factors contributing to the declining prevalence of hearing impairment in more recent generations.nnnMETHODSnWe used data on hearing thresholds and potential risk factors of hearing impairment collected from studies in Beaver Dam, Wisconsin, the Epidemiology of Hearing Loss Study (1993-1995, n=3753; 1998-2000, n=2800 and 2003-2005, n=2395), the concurrent Beaver Dam Eye Study on the same cohort, and a subgroup (n=2173) of the Beaver Dam Offspring Study (2005-2008).nnnRESULTSnEducational attainment significantly reduced the odds ratio (OR) of the birth cohort effect on hearing impairment from 0.90 to 0.93, while a history of ear infection had a reverse effect on the decreasing trend (significantly changing the OR from 0.93 to 0.94). Occupational noise exposure, smoking, and a history of cardiovascular disease, while associated with hearing impairment, did not attenuate the cohort effect. The cohort effect remained significant after known risk factors were adjusted (OR=0.93; 95% confidence interval, 0.89-0.97).nnnCONCLUSIONnThese data provide strong evidence that environmental, lifestyle, or other modifiable factors contribute to the etiology of hearing impairment and add support to the idea that hearing impairment in adults may be prevented or delayed.

Unmet Hearing Health Care Needs: The Beaver Dam Offspring Study

OBJECTIVESnWe evaluated the use of hearing health care services (hearing testing and hearing aids) by adults aged 21 to 84 years.nnnMETHODSnHearing was tested and medical and hearing health histories were obtained as part of the Beaver Dam Offspring Study between 2005 and 2008 (n = 3285, mean age = 49 years).nnnRESULTSnOf the cohort, 34% (55% of participants aged ≥ 70 years) had a hearing test in the past 5 years. In multivariate modeling, older age, male gender, occupation, occupational noise, and having talked with a doctor about a hearing problem were independently associated with having had a hearing test in the past 5 years. Hearing aid use was low among participants with a moderate to severe hearing impairment (22.5%) and among participants with a hearing handicap (8.6%), as determined by the Hearing Handicap Inventory.nnnCONCLUSIONSnData support the need for improvement in hearing health care. Hearing aids effectiveness is limited if patients do not acquire them or do not use them once acquired. Future research should focus on developing effective strategies for moving patients from diagnosis to treatment.

The use of hearing protection devices by older adults during recreational noise exposure

A population-based study to assess the use of hearing protection devices by older adults during noisy recreational activities was performed. The population-based Epidemiology of Hearing Loss Study was designed to measure the prevalence of hearing loss in adults residing in Beaver Dam, Wisconsin. The use of hearing protection devices during noisy recreational activities was assessed by performing three examinations over a period of 10 years (1993-1995, no. of participants (n)=3753, aged 48-92 years; 1998-2000, n=2800, aged 53-97 years; 2003-2005, n=2395, aged 58-100 years). The recreational activities included hunting, target shooting, woodworking/carpentry, metalworking, driving loud recreational vehicles, and performing yard work using either power tools or a chain saw. The prevalence of using hearing protection devices during any of these activities increased with time (9.5%, 15.0%, and 19.9% at baseline, 5 years, and 10 years, respectively). However, the use of hearing protection devices remained low for most activities. Those under the age of 65 were twice as likely to use hearing protection devices during noisy activities than were older adults. Men, those with a hearing handicap, and those with significant tinnitus were more likely to use hearing protection devices. Smokers and the less educated were less likely to use hearing protection devices. The results demonstrated that many adults expose themselves to potentially damaging recreational noise, leaving them at risk for hearing loss.