Wiley Tl

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.

Comment on tinnitus in older adults from the Blue Mountains Study by Sindhusake et al and comparison with tinnitus data from the Epidemiology of Hearing Loss Study.

We were pleased to see the article by Sindhusake et al on ‘Prevalence and characteristics of tinnitus in older adults: the Blue Mountains Hearing Study’, published in a recent issue of the International Journal of Audiology (Sindhusake et al, 2003). As the authors point out, there have been few recent populationbased estimates of the prevalence of tinnitus, and their article is a welcome addition to the literature. In their discussion, the authors expressed a desire to compare their results with those from the Epidemiology of Hearing Loss Study (EHLS) (Cruickshanks et al, 1998). At the time when Sindhusake et al were writing their manuscript, however, these data were not yet available. The EHLS results have since been published in the Journal of the American Academy of Audiology (2002) (Nondahl et al, 2002). The EHLS is an ongoing population-based study of hearing loss conducted in Beaver Dam, Wisconsin. The baseline examinations were conducted between 1993 and 1995, and 3753 adults aged 48–92 years participated. In our report on tinnitus, we focused on ‘significant tinnitus’, defined as buzzing, ringing or noise in the ears in the past year of at least moderate severity, tinnitus that caused difficulty in falling asleep, or both. During the baseline study, 8.2% reported significant tinnitus (Nondahl et al, 2002). We chose to focus on significant tinnitus because of the inherent variability in the assessment of tinnitus by selfreport. As we discussed in our paper, the same tinnitus symptoms could be considered to be of moderate severity by one person but mild or severe by another person. In addition, one’s awareness of tinnitus may vary over time. Finally, the tinnitus status of participants with mild tinnitus at the EHLS baseline examination was more variable 5 years later than that of participants with moderate-to-severe tinnitus at baseline, supporting our decision to exclude mild cases from our definition. The 5year incidence of tinnitus among those without tinnitus at baseline was 5.7%. Age, gender, hearing loss, history of cardiovascular disease and history of head injury were associated with prevalent tinnitus. Hearing loss, total cholesterol, history of head injury and otosclerosis were associated with the 5-year incidence of tinnitus. In the Blue Mountains Hearing Study (BMHS; n=2015; age range 55–99 years), tinnitus was defined as ‘any prolonged ringing, buzzing, or other sounds in your ears or head within the past year... that is, lasting for five minutes or longer.’ Based on this definition, the BMHS group reported a prevalence of 30.3% (Sindhusake et al, 2003), considerably higher than that for the EHLS. A question on duration was included for the 5-year follow-up examination of the EHLS (1998–2000; n=2800; age range 53–97 years), which allows us to create a tinnitus endpoint with a similar definition as that used in the BMHS. Defining tinnitus as ‘buzzing, ringing or noise in your ears in the past year that usually lasts longer than five minutes’, we find a prevalence of 17.9% (unpublished data), still lower than that reported from the BMHS. Sindhusake et al correctly point out that comparing studies of tinnitus prevalence can be problematic, due to variations in tinnitus definition, question wording, the context in which questions about tinnitus are asked, and demographic differences in populations. Although the two studies are remarkably similar in the distribution of age, gender, marital status and pure-tone average, other factors such as ethnicity, occupational history, cardiovascular profile, or history of head injury may contribute to the observed differences in tinnitus prevalence. Thank you for allowing us this opportunity to inform your readers about results from the EHLS and highlight some comparisons with results reported by Sindhusake et al. We are pleased to see continuing population-based research on this common and often perplexing condition.