Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

Country Differences in Older Men's Hearing Difficulty Disadvantage

Objectives: Hearing difficulty is prevalent in older adulthood and projected to increase via global aging, particularly among men. Currently, there is limited research on how this gender disparity might vary by country. Methods: Using 2018 data (n = 29,480) from the Health and Retirement Study (HRS) international family of studies, we investigate gender disparities in hearing difficulty among respondents ages 55-89 from the United States (n = 12,566), Mexico (n = 10,762), and Korea (n = 6152) with country-specific ordinal logistic regression models that progressively adjust for demographic, social, and health indicators. Results: In the United States, men's hearing difficulty disadvantage was consistently observed. In Mexico, men's hearing difficulty disadvantage was explained by the interactive effect of gender and age group but resurfaced after adjusting for comorbidities. In Korea, there was consistently no gender difference in hearing difficulty. Discussion: Our results highlight the heterogeneity in older men's hearing difficulty disadvantage among a diverse group of aging countries.

The Associations of Sensory Impairment With 10-Year Risk of Dementia and Alzheimer's Disease: The Health and Retirement Study, 2010-2020

BACKGROUND

Studies have examined the association between dual sensory impairment and late-life cognitive outcomes in the U.S with inconsistent findings.

OBJECTIVE

To examine the associations between sensory impairment and 10-year risk of dementia or Alzheimer's disease among U.S. adults aged ≥ 50.

METHODS

A prospective cohort study based on the Health and Retirement Study from 2010 to 2020. Individuals aged ≥ 50 years without self-reported dementia and Alzheimer's disease in 2010 were included in the analysis. Self-reported visual and hearing impairments were measures in 2010. Main failure events included self-reported incident dementia and Alzheimer's disease over a 10-year follow-up period. Participants were categorized as having no visual or hearing impairment, visual impairment only, hearing impairment only, and dual sensory impairment. Fine-Gray competing risk regression model was applied to estimate the associations of sensory impairment with incident dementia and Alzheimer's disease, adjusted for demographic characteristics, health behaviors, and health conditions at baseline.

RESULTS

Of 20,248 identified individuals, 14.6% had visual impairment only, 11.2% had hearing impairment only, and 9.1% had dual impairment at baseline. After adjusting for all covariates, dual sensory impairment was associated with higher risk of dementia (HR = 1.46, 95% CI: 1.23-1.73) and Alzheimer's disease (HR = 1.35, 95% CI: 1.03-1.76). Visual impairment only was also associated with incident dementia and Alzheimer's disease among individuals <65 years.

CONCLUSION

Older adults in the U.S. with visual and hearing impairments simultaneously had a particularly greater risk of dementia and Alzheimer's disease, indicating the needs of targeted screening for timely treatment and further prevention of dementia and Alzheimer's disease.

Hearing Screening in Older Adults in Primary Care Clinics: How the Effects of Setting and Provider Encouragement Differ by Patient Sex and Race

OBJECTIVES

Few studies have examined how patient sex or race influence hearing healthcare, which was our study purpose.

DESIGN

We performed a secondary analysis using data from a pragmatic clinical trial that examined the effect of provider encouragement (yes/no) or setting (at-home/clinic) for older adults to follow through with routine hearing screening in primary care and the hearing healthcare pathway. Three protocols were compared: at-home screening without provider encouragement, at-home screening with provider encouragement, and in-clinic screening with provider encouragement.

RESULTS

Poisson regression (n = 627) showed few differences by patient sex but showed that Black patients in the at-home protocols were less likely to schedule or complete a formal diagnostic evaluation after a failed screening compared with Black patients in the clinic setting and White patients in all groups. Black patients, regardless of provider encouragement, were less likely to schedule or complete a diagnostic evaluation compared with White patients.

CONCLUSIONS

Results suggest that in-clinic screenings may increase the use of hearing healthcare for Black patients.

Exploring N400 Predictability Effects During Sustained Speech Comprehension: From Listening-Related Fatigue to Speech Enhancement Evaluation

OBJECTIVES

This study investigated the predictability effect on the N400 as an objective measure of listening-related fatigue during speech comprehension by: (1) examining how its characteristics (amplitude, latency, and topographic distribution) changed over time under clear versus noisy conditions to assess its utility as a marker for listening-related fatigue, and (2) evaluating whether these N400 parameters could assess the effectiveness of speech enhancement (SE) systems.

DESIGN

Two event-related potential experiments were conducted on 140 young adults (aged 20 to 30) assigned to four age-matched groups. Using a between-subjects design for listening conditions, participants comprehended spoken sentences ending in high- or low-predictability words while their brain activity was recorded using electroencephalography. Experiment 1 compared the predictability effect on the N400 in clear and noise-masked conditions, while experiment 2 examined this effect under two enhanced conditions (denoised using the transformer- and minimum mean square error-based SE models). Electroencephalography data were divided into two blocks to analyze the changes in the predictability effect on the N400 over time, including amplitude, latency, and topographic distributions.

RESULTS

Experiment 1 compared N400 effects across blocks under different clarity conditions. Clear speech in block 2 elicited a more anteriorly distributed N400 effect without reduction or delay compared with block 1. Noisy speech in block 2 showed a reduced, delayed, and posteriorly distributed effect compared with block 1. Experiment 2 examined N400 effects during enhanced speech processing. Transformer-enhanced speech in block 1 demonstrated significantly increased N400 effect amplitude compared to noisy speech. However, both enhancement methods showed delayed N400 effects in block 2.

CONCLUSIONS

This study suggests that temporal changes in the N400 predictability effect might serve as objective markers of sustained speech processing under different clarity conditions. During clear speech comprehension, listeners appear to maintain efficient semantic processing through additional resource recruitment over time, while noisy speech leads to reduced processing efficiency. When applied to enhanced speech, these N400 patterns reveal both the immediate benefits of SE for semantic processing and potential limitations in supporting sustained listening. These findings demonstrate the potential utility of the N400 predictability effect for understanding sustained listening demands and evaluating SE effectiveness.

Baseline audiometric assessment of newly diagnosed nasopharyngeal carcinoma patients: a multicentre cross-sectional study

Hearing impairment is one of the most common chief complaints in newly diagnosed nasopharyngeal carcinoma (NPC) patients, but baseline audiometric assessments are seldom reported. This study aims to investigate the prevalence of hearing impairment in this population through comprehensive audiometric testing and analyse the associated factors. A cohort of 187 newly diagnosed NPC patients were recruited from three hospitals. Pre-treatment comprehensive audiometric assessments, including pure-tone audiometry, tympanometry, Eustachian tube function tests and distortion product otoacoustic emissions (DPOAE), were performed to evaluate hearing impairment. Patient characteristics and tumour invasion extent were also recorded. Binary logistic regression was employed to analyse factors associated with hearing impairment. Among the patients, 27.5% of ears showed conductive hearing loss (CHL), 13.6% had sensorineural hearing loss (SNHL), and 10.4% demonstrated mixed hearing loss. Additionally, 43.6% of ears exhibited abnormal tympanograms, 86.1% had Eustachian tube dysfunction, and 77.3% failed the DPOAE test. Multivariable analysis identified subjective hearing symptoms, mastoiditis, and invasion of the tensor veli palatini muscle and Eustachian tube as factors associated with CHL. T stage, mastoiditis, and invasion of the tensor veli palatini muscle and nasal cavity were linked to abnormal tympanograms. T stage, sinusitis, and invasion of the levator veli palatini muscle significantly affected Eustachian tube function, while age influenced both SNHL and DPOAE results. Hearing impairment is prevalent among newly diagnosed NPC patients, with over half exhibiting various forms. Comprehensive baseline audiometric assessment in this population is crucial for developing individualized treatment strategies and enabling early intervention to prevent further hearing deterioration.

Self-reported hearing loss is associated with faster cognitive and functional decline but not diagnostic conversion in the ADNI cohort

INTRODUCTION

Hearing loss is identified as one of the largest modifiable risk factors for cognitive impairment and dementia. Studies evaluating this relationship have yielded mixed results.

METHODS

We investigated the longitudinal relationship between self-reported hearing loss and cognitive/functional performance in 695 cognitively normal (CN) and 941 participants with mild cognitive impairment (MCI) enrolled in the Alzheimer's Disease Neuroimaging Initiative.

RESULTS

Within CN participants with hearing loss, there was a significantly greater rate of cognitive decline per modified preclinical Alzheimer's cognitive composite. Within both CN and MCI participants with hearing loss, there was a significantly greater rate of functional decline per the functional activities questionnaire (FAQ). In CN and MCI participants, hearing loss did not significantly contribute to the risk of progression to a more impaired diagnosis.

DISCUSSION

These results confirm previous studies demonstrating a significant longitudinal association between self-reported hearing loss and cognition/function but do not demonstrate an increased risk of conversion to a more impaired diagnosis.

CLINICAL TRIAL REGISTRATION INFORMATION

NCT00106899 (ADNI: Alzheimer's Disease Neuroimaging Initiative, clinicaltrials.gov), NCT01078636 (ADNI-GO: Alzheimer's Disease Neuroimaging Initiative Grand Opportunity, clinicaltrials.gov), NCT01231971 (ADNI2: Alzheimer's Disease Neuroimaging Initiative 2, clinicaltrials.gov), NCT02854033 (ADNI3: Alzheimer's Disease Neuroimaging Initiative 3, clinicaltrials.gov).

HIGHLIGHTS

Hearing loss is a potential modifiable risk factor for dementia. We assessed the effect of self-reported hearing loss on cognition and function in the ADNI cohort. Hearing loss contributes to significantly faster cognitive and functional decline. Hearing loss was not associated with conversion to a more impaired diagnosis.

Cohort comparison of vision and hearing in 75- and 80-year-old men and women born 28 years apart

PURPOSE

We compared the vision and hearing of older men and women born 28 years apart. In addition, we explored factors explaining the possible cohort differences.

METHODS

Two independent cohorts of 75- and 80-year-old men and women were assessed as a part of the Evergreen study in 1989-1990 (n = 500) and the Evergreen II study in 2017-2018 (n = 726). Studies were conducted with similar protocols, and differences between cohorts were compared for distance visual acuity and hearing acuity. We also studied whether educational level and health factors (i.e. total cholesterol, blood pressure, BMI, and smoking status) underlie the possible cohort differences. Independent samples t-test, Pearson chi-squared test, and linear regression analyses were used as statistical analyses.

RESULTS

Across age and sex groups, the later-born cohort had better visual acuity and a lower prevalence of visual impairment compared to the earlier-born cohort. In hearing, 75-year-old men in the later-born cohort had better hearing acuity, with average hearing level at 32 dB compared to 36 dB in the earlier-born cohort, and 80-year-old men had a lower prevalence of moderate or worse hearing loss (74 % vs. 54 %) than men in the earlier-born cohort. Similar differences were not observed for women. The cohort differences in distance visual acuity and hearing acuity attenuated when adjusting for education level.

CONCLUSIONS

Today older adults retain better vision longer than before, but cohort differences in hearing are less obvious. Differences between cohorts may be partly due to advances in education.

Hearing loss in patients with dementia in Saudi Arabia

OBJECTIVES

To determine the prevalence of hearing loss in patients with dementia, examine the use of hearing aids in those with hearing loss, and ascertain if the cause of hearing loss is central or peripheral in origin.

METHODS

A retrospective cohort study involving 143 patients with dementia which was conducted in Saudi Arabia from 2020 to 2023 in King Abdulaziz Medical City, Riyadh, Saudi Arabia, to determine hearing loss. The study included patients aged ≥60 years who had dementia, hearing loss, and neurological diseases. Those with Parkinson's disease and secondary epilepsy were excluded. Data was analyzed for its demographics, clinical features, predisposing factors, treatment, dementia duration and progression, and hearing loss outcomes. All statistical analyses were performed using IBM's SPSS software, version 29.0.0. Statistical significance was established at a p-value of ≤0.05 and a confidence interval of 95%.

RESULTS

The findings indicated that 88.8% of the 143 patients exhibited dementia, with Alzheimer's disease being the most prevalent type. Moreover, 18.2% had hearing issues, and 11.2% had other complaints. Audiometry was performed in 15.4% of the cases. Hearing loss was present in 14.7% of the patients, being primarily bilateral, ranging from mild to severe.

CONCLUSION

This study has clarified the link between hearing loss and dementia onset and has emphasized the need for early evaluation and intervention for individuals with hearing impairment.

Global, regional, and national burden of hearing loss in children and adolescents, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

Hearing loss in children and adolescents is attracting increasing attention as a growing public health problem. This study aimed to analyze the burden of hearing loss in children and adolescents from 1990 to 2021 to provide a new basis for further epidemiological research, disease prevention, and public health policy development.

METHODS

The prevalence and years lived with disability (YLDs) of hearing loss in children and adolescents from 1990 to 2021 at the global, regional, and national levels were extracted from the Global Burden of Disease 2021 database. The estimated annual percentage change (EAPC) was used to assess trends in prevalence and YLDs. Pearson correlation analysis was used to assess the relationships between sociodemographic index (SDI) and prevalence and YLDs.

RESULTS

In 2021, approximately 97.83 million children and adolescents under the age of 20 years were affected by hearing loss globally, resulting in approximately 3.91 million YLDs. From 1990 to 2021, the prevalence rate increased from 3537 per 100,000 to 3711 per 100,000, with an EAPC of 0.15% (95% CI: 0.12-0.17). The burden of hearing loss was greater in low-middle-SDI region and low-SDI region. Mild hearing loss accounted for 62.1% of the total cases and was the predominant type of hearing loss. Otitis media was the leading preventable cause of hearing loss, with 46.9% of hearing loss attributed to otitis media. Moreover, in children under 5 years of age, 68.7% of hearing loss was attributed to otitis media. Pearson correlation analysis revealed that the prevalence rates and YLDs rates of hearing loss were negatively correlated with the SDI (R = -0.57, P < 0.001; R = -0.64, P < 0.001).

CONCLUSIONS

The burden of hearing loss in children and adolescents has increased over the past three decades and remains high. The burden is greater in less economically developed countries or regions. Policymakers should pay attention to the increasing burden of hearing loss in children and adolescents and take targeted measures to control this burden.

Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey

BACKGROUND

Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population.

OBJECTIVE

Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms.

METHODS

A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection-related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus.

RESULTS

Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection.

CONCLUSIONS

In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post-COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume.

Ten-year association between change in speech-in-noise recognition and falls due to balance problems: a longitudinal cohort study

BACKGROUND

This study examined the relationship between speech-in-noise recognition and incident/recurrent falls due to balance problems ten years later (RQ-1); 10-year change in speech-in-noise recognition and falls (RQ-2a), as well as the role of dizziness in this relationship (RQ-2b). The association between hearing aid use and falls was also examined (RQ-3).

METHODS

Data was collected from the Netherlands Longitudinal Study on Hearing between 2006 and December 2022. Participants completed an online survey and digits-in-noise test every five years. For this study, data was divided into two 10-year follow-up time intervals: T0 (baseline) to T2 (10-year follow-up), and T1 (5-years) to T3 (15-years). For all RQs, participants aged ≥ 40 years at baseline, without congenital hearing loss, and non-CI users were eligible (n = 592). Additionally, for RQ-3 participants with a speech reception threshold in noise (SRTn) ≥ -5.5 dB signal-to-noise ratio were included (n = 422). Analyses used survey variables on hearing, dizziness, falls due to balance problems, chronic health conditions, and psychosocial health. Logistic regressions using General Estimating Equations were conducted to assess all RQs.

RESULTS

Among individuals with obesity, those with poor baseline SRTn had a higher odds of incident falls ten years later (odds ratio (OR):14.7, 95% confidence interval (CI) [2.12, 103]). A 10-year worsening of SRTn was significantly associated with a higher odds of recurrent (OR: 2.20, 95% CI [1.03, 4.71]) but not incident falls. No interaction was found between dizziness and change in SRTn. Hearing aid use (no use/ < 2 years use vs. ≥ 2 years) was not significantly associated with incident nor recurrent falls. Although there was a significant interaction with sex for this association, the effect of hearing aid use on incident/recurrent falls was not statistically significant among males nor females.

CONCLUSIONS

A longitudinal association between the deterioration in SRTn and recurrent falls due to balance problems after 10 years was confirmed in this study. This result stresses the importance of identifying declines in hearing earlier and justifies including hearing ability assessments within fall risk prevention programs. Mixed results of hearing aid use on fall risk warrant further investigation into the temporality of this association and possible differences between men and women.

Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans

OBJECTIVE

Identify associations between self-reported history of military and nonmilitary traumatic brain injury (TBI) on hearing loss and hearing difficulty from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study.

STUDY DESIGN

Cross-sectional.

SETTING

Multi-institutional tertiary referral centers.

PATIENTS

Four hundred seventy-three Active-Duty Service members (ADSM) and 502 veterans.

EXPOSURE

Self-reported history of no TBI, military TBI only, nonmilitary TBI only, both military and nonmilitary TBI.

MAIN OUTCOME MEASURES

Pure-tone hearing thresholds, Speech Recognition In Noise Test (SPRINT), Hearing Handicap Inventory for Adults (HHIA), and Speech, Spatial and Qualities of Hearing Scale (SSQ)-12.

RESULTS

25% (120/473) of ADSM and 41% (204/502) of veterans self-reported a TBI. Military TBI was associated with poorer hearing thresholds in all frequency ranges in veterans (adjusted mean difference, 1.8 dB; 95% confidence interval [CI], 0.5-3.0; 3.3, 0.8-5.8; 5.1; 1.7-8.5, respectively), and in the high frequency range in ADSM (mean difference, 3.2 dB; 95% CI, 0.1-6.3). Veterans with military TBI only and nonmilitary TBI only had lower odds of correctly identifying speech in noise than veterans with no TBI (odds ratio [OR], 0.78; 95% CI, 0.72-0.83; 0.90; 0.84-0.98). ADSM with a military TBI (OR, 5.7; 95% CI, 2.6-12.5) and veterans with any TBI history (OR, 2.5; 95% CI, 1.5-4.3; OR, 2.2; 95% CI, 1.3-3.8; OR, 4.5; 95% CI, 2.1-9.8) were more likely to report hearing difficulty on HHIA. SSQ-12 results corroborated HHIA findings.

CONCLUSIONS

Military TBI was associated with poorer hearing thresholds in veterans and ADSM, and poorer SPRINT scores in veterans. Military TBI was associated with poorer self-perceived hearing ability in ADSM. All types of TBI were associated with poorer self-perceived hearing ability in veterans, although the strength of this association was greatest for military TBI.

Global, Regional, and National Burdens of Hearing Loss for Children and Adolescents from 1990 to 2019: A Trend Analysis

This study presents a comprehensive analysis of global, regional, and national trends in the burden of hearing loss (HL) among children and adolescents from 1990 to 2019, using data from the Global Burden of Disease study. Over this period, there was a general decline in HL prevalence and years lived with disability (YLDs) globally, with average annual percentage changes (AAPCs) of -0.03% (95% uncertainty interval [UI], -0.04% to -0.01%; p = 0.001) and -0.23% (95% UI, -0.25% to -0.20%; p < 0.001). Males exhibited higher rates of HL prevalence and YLDs than females. Mild and moderate HL were the most common categories across all age groups, but the highest proportion of YLDs was associated with profound HL [22.23% (95% UI, 8.63%-57.53%)]. Among females aged 15-19 years, the prevalence and YLD rates for moderate HL rose, with AAPCs of 0.14% (95% UI, 0.06%-0.22%; p = 0.001) and 0.13% (95% UI, 0.08%-0.18%; p < 0.001). This increase is primarily attributed to age-related and other HL (such as environmental, lifestyle factors, and occupational noise exposure) and otitis media, highlighting the need for targeted research and interventions for this demographic. Southeast Asia and Western Sub-Saharan Africa bore the heaviest HL burden, while High-income North America showed lower HL prevalence and YLD rates but a slight increasing trend in recent years, with AAPCs of 0.13% (95% UI, 0.1%-0.16%; p < 0.001) and 0.08% (95% UI, 0.04% to 0.12%; p < 0.001). Additionally, the analysis revealed a significant negative correlation between sociodemographic index (SDI) and both HL prevalence (r = -0.74; p < 0.001) and YLD (r = -0.76; p < 0.001) rates. However, the changes in HL trends were not significantly correlated with SDI, suggesting that factors beyond economic development, such as policies and cultural practices, also affect HL. Despite the overall optimistic trend, this study emphasizes the continued need to focus on specific high-risk groups and regions to further reduce the HL burden and enhance the quality of life for affected children and adolescents.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review

OBJECTIVES

Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) ( Healthy People 2030 ) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends.

DESIGN

Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL.

RESULTS

Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level.

CONCLUSIONS

Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.

Perceptions of Adults With Hearing Loss About the Communication Difficulties Generated by the COVID-19 Preventive Measures: A Qualitative Study

PURPOSE

The COVID-19 pandemic led to the implementation of preventive measures that exacerbated communication difficulties for individuals with hearing loss. This study aims to explore the perception of adults with hearing loss about the communication difficulties caused by the preventive measures and about their experiences with communication 1 year after the adoption of these preventive measures.

METHOD

Individual semistructured interviews were conducted via videoconference with six adults who have hearing loss from the province of Québec, Canada. Data were examined using qualitative content analysis.

RESULTS

The study found that face masks and in-person work (i.e., in opposition to remote work) were important barriers to communication because of hindered lipreading and competing noise in many workplaces. In contrast, preventive measures that allowed visual information transmission (e.g., transparent face masks, fixed plastic partitions) were considered favorable for communication. Communication partners were perceived as playing an important role in communication success with preventive measures: Familiar communication partners improved communication, whereas those with poor attitude or strategies hindered communication. Participants found that videoconferences could provide satisfactory communication but were sometimes hindered by issues such as bad audiovisual quality or too many participants.

CONCLUSIONS

This study identified reduced access to speech reading and lack of general awareness about hearing issues as key barriers to communication during the pandemic. The decreased communication capabilities were perceived to be most problematic at work and during health appointments, and tended to cause frustration, anxiety, self-esteem issues, and social isolation. Suggestions are outlined for current and future public health measures to better consider the experience of people with hearing loss.

Prevalence and Risk Factors of Self-reported Dizziness in Post-9/11 Service Members and Veterans

INTRODUCTION

Dizziness is prevalent in the general population, but little is known about its prevalence in the U.S. military population. Dizziness is commonly associated with blast exposure and traumatic brain injury (TBI), but the potential independent contributions of blast and TBI have yet to be evaluated. This study's goal was to estimate the prevalence of dizziness among post-9/11 service members and Veterans and to examine independent and joint associations between military TBI history, blast exposure, and self-reported dizziness.

MATERIALS AND METHODS

The study sample consisted of service members (n = 424) and recently separated (< ∼2.5 years) Veterans (n = 492) enrolled in the Noise Outcomes in Service members Epidemiology (NOISE) Study. We examined associations between self-reported history of probable TBI and blast exposure and recent dizziness using logistic regression. Models were stratified by service member versus Veteran status and adjusted to account for potentially confounding demographic and military characteristics.

RESULTS

Overall, 22% of service members and 31% of Veterans self-reported dizziness. Compared to those with neither TBI nor blast exposure history, both service members and Veterans with TBI (with or without blast) were three to four times more likely to self-report dizziness. Those with blast exposure but no TBI history were not more likely to self-report dizziness. There was no evidence of an interaction effect between blast exposure and a history of TBI on the occurrence of dizziness.

CONCLUSION

Self-reported dizziness was prevalent in this sample of service members and Veterans. Probable TBI history, with or without blast exposure, was associated with dizziness, but blast exposure without TBI history was not. This suggests that treatment guidelines for TBI-related dizziness may not need to be tailored to the injury mechanism. However, future efforts should be directed toward the understanding of the pathophysiology of TBI on self-reported dizziness, which is fundamental to the design of treatment strategies.

At-home computerized executive-function training to improve cognition and mobility in normal-hearing adults and older hearing aid users: a multi-centre, single-blinded randomized controlled trial

BACKGROUND

Hearing loss predicts cognitive decline and falls risk. It has been argued that degraded hearing makes listening effortful, causing competition for higher-level cognitive resources needed for secondary cognitive or motor tasks. Therefore, executive function training has the potential to improve cognitive performance, in turn improving mobility, especially when older adults with hearing loss are engaged in effortful listening. Moreover, research using mobile neuroimaging and ecologically valid measures of cognition and mobility in this population is limited. The objective of this research is to examine the effect of at-home cognitive training on dual-task performance using laboratory and simulated real-world conditions in normal-hearing adults and older hearing aid users. We hypothesize that executive function training will lead to greater improvements in cognitive-motor dual-task performance compared to a wait-list control group. We also hypothesize that executive function training will lead to the largest dual-task improvements in older hearing aid users, followed by normal-hearing older adults, and then middle-aged adults.

METHODS

A multi-site (Concordia University and KITE-Toronto Rehabilitation Institute, University Health Network) single-blinded randomized controlled trial will be conducted whereby participants are randomized to either 12 weeks of at-home computerized executive function training or a wait-list control. Participants will consist of normal-hearing middle-aged adults (45-60 years old) and older adults (65-80 years old), as well as older hearing aid users (65-80 years old, ≥ 6 months hearing aid experience). Separate samples will undergo the same training protocol and the same pre- and post-evaluations of cognition, hearing, and mobility across sites. The primary dual-task outcome measures will involve either static balance (KITE site) or treadmill walking (Concordia site) with a secondary auditory-cognitive task. Dual-task performance will be assessed in an immersive virtual reality environment in KITE's StreetLab and brain activity will be measured using functional near infrared spectroscopy at Concordia's PERFORM Centre.

DISCUSSION

This research will establish the efficacy of an at-home cognitive training program on complex auditory and motor functioning under laboratory and simulated real-world conditions. This will contribute to rehabilitation strategies in order to mitigate or prevent physical and cognitive decline in older adults with hearing loss.

TRIAL REGISTRATION

Identifier: NCT05418998. https://clinicaltrials.gov/ct2/show/NCT05418998.

Women with hearing loss show increased dementia risk and brain atrophy

Hearing loss is a modifiable risk factor for dementia. However, it is unknown whether risk differs by sex. Study 1 used Cox proportional hazard models to examine sex differences in the association between hearing loss (measured by speech-reception thresholds) and dementia risk. Study 2 examined how 2-year changes in hearing is associated with changes in brain volume in auditory-limbic regions. Both studies used UK Biobank data. Women with poor hearing had the greatest risk of dementia, whereas women and men with insufficient hearing were at similar risk. Men with poor hearing did not have increased risk. Presence of social isolation/depressed mood minimally contributed to dementia risk in men and women. Women, but not men, with hearing loss had greater atrophy in auditory and limbic regions compared to normal hearing women and men. Women with hearing loss show greater risk of dementia and brain atrophy, highlighting the need to examine sex-specific mechanisms.

Metformin Protects Against Noise-Induced Hearing Loss in Male Mice

HYPOTHESIS

Metformin treatment will protect mice from noise-induced hearing loss (NIHL).

BACKGROUND

We recently identified metformin as the top-ranking, Food and Drug Administration-approved drug to counter inner ear molecular changes induced by permanent threshold shift-inducing noise. This study is designed to functionally test metformin as a potential otoprotective drug against NIHL.

METHODS

Male and female B6CBAF1/J mice were obtained at 7 to 8 weeks of age. A cohort of the females underwent ovariectomy to simulate menopause and eliminate the effect of ovarian-derived estrogens. At 10 weeks of age, mice underwent a permanent threshold shift-inducing noise exposure (102.5 or 105 dB SPL, 8-16 kHz, 2 h). Auditory brainstem response (ABR) thresholds were obtained at baseline, 24 h after noise exposure, and 1 week after noise exposure. Mice were administered metformin (200 mg/kg/d) or a saline control in their drinking water after the baseline ABR and for the remainder of the study. After the 1-week ABR, mice were euthanized and cochlear tissue was analyzed.

RESULTS

Metformin treatment reduced the 1-week ABR threshold shift at 16 kHz ( p < 0.01; d = 1.20) and 24 kHz ( p < 0.01; d = 1.15) as well as outer hair cell loss in the 32-45.5 kHz range ( p < 0.0001; d = 2.37) in male mice. In contrast, metformin treatment did not prevent hearing loss or outer hair cell loss in the intact or ovariectomized female mice.

CONCLUSIONS

Metformin exhibits sex-dependent efficacy as a therapeutic for NIHL. These data compel continued investigation into metformin's protective effects and demonstrate the importance of evaluating the therapeutic efficacy of drugs in subjects of both sexes.

A mouse model of repeated traumatic brain injury-induced hearing impairment: Early cochlear neurodegeneration in the absence of hair cell loss

PURPOSE

Traumatic Brain Injury (TBI) is a major cause of death and disability worldwide. Mounting evidence suggests that even mild TBI injuries, which comprise >75% of all TBIs, can cause chronic post-concussive neurological symptoms, especially when experienced repetitively (rTBI). The most common post-concussive symptoms include auditory dysfunction in the form of hearing loss, tinnitus, or impaired auditory processing, which can occur even in the absence of direct damage to the auditory system at the time of injury. The mechanism by which indirect damage causes loss of auditory function is poorly understood, and treatment is currently limited to symptom management rather than preventative care. We reasoned that secondary injury mechanisms, such as inflammation, may lead to damage of the inner ear and parts of the brain used for hearing after rTBI. Herein, we established a model of indirect damage to the auditory system induced by rTBI and characterized the pathology of hearing loss.

METHODS

We established a mouse model of rTBI in order to determine a timeline of auditory pathology following multiple mild injuries. Mice were subject to controlled cortical impact at the skull midline once every 48 h, for a total of 5 hits. Auditory function was assessed via the auditory brainstem response (ABR) at various timepoints post injury. Brain and cochleae were collected to establish a timeline of cellular pathology.

RESULTS

We observed increased ABR thresholds and decreased (ABR) P1 amplitudes in rTBI vs sham animals at 14 days post-impact (dpi). This effect persisted for up to 60 days (dpi). Auditory temporal processing was impaired beginning at 30 dpi. Spiral ganglion degeneration was evident at 14 dpi. No loss of hair cells was detected at this time, suggesting that neuronal loss is one of the earliest notable events in hearing loss caused by this type of rTBI.

CONCLUSIONS

We conclude that rTBI results in chronic auditory dysfunction via damage to the spiral ganglion which occurs in the absence of any reduction in hair cell number. This suggests early neuronal damage that may be caused by systemic mechanisms similar to those leading to the spread of neuronal death in the brain following TBI. This TBI-hearing loss model provides an important first step towards identifying therapeutic targets to attenuate damage to the auditory system following head injury.

Change in the Characteristics of Patients Qualified for Hearing Aids over the Last 25 Years in Poland

Hearing loss is one of the most common causes of disability worldwide. The aim of the study was to compare the demographic structure and the results of hearing tests in people qualified for hearing aids over the last 25 years. The material covered 1246 patients qualified for hearing aids in the years 1996-2001 and 2016-2021. Patients were divided into two groups according to the time of qualifying for hearing aids. Group 1 (G1) consisted of 759 people qualified in the years 1996-2001, and Group 2 (G2) comprised 487 people qualified in the years 2016-2021. Statistical analysis was performed on the results of pure tone threshold audiometry and the demographic structure in both groups. Patients in G1 had statistically significantly elevated hearing thresholds (HT) in the air conduction range at frequencies from 2000 to 8000 Hz in relation to G2 patients. The opposite situation was observed for the bone conduction threshold. G2 patients had significantly elevated bone conduction HT at frequencies from 250 to 1000 Hz compared to G1 patients. The age structure in both groups was similar; however, the gender distribution was statistically significantly different. In G1 women accounted for 40%, and in G2, they became the dominant gender (53%). Over the last twenty years, there has been a change in the structure of patients qualified for hearing aids. Although the age has remained similar, today, patients decide to use hearing aids at an earlier stage of hearing loss than 25 years ago. Modern women began to use hearing aids much more often.

Steroid hormones: risk and resilience in women's Alzheimer disease

More women have Alzheimer disease (AD) than men, but the reasons for this phenomenon are still unknown. Including women in clinical research and studying their biology is key to understand not just their increased risk but also their resilience against the disease. In this sense, women are more affected by AD than men, but their reserve or resilience mechanisms might delay symptom onset. The aim of this review was to explore what is known about mechanisms underlying women's risk and resilience in AD and identify emerging themes in this area that merit further research. We conducted a review of studies analyzing molecular mechanisms that may induce neuroplasticity in women, as well as cognitive and brain reserve. We also analyzed how the loss of steroid hormones in aging may be linked to AD. We included empirical studies with human and animal models, literature reviews as well as meta-analyses. Our search identified the importance of 17-b-estradiol (E2) as a mechanism driving cognitive and brain reserve in women. More broadly, our analysis revealed the following emerging perspectives: (1) the importance of steroid hormones and their effects on both neurons and glia for the study of risk and resilience in AD, (2) E2's crucial role in women's brain reserve, (3) women's verbal memory advantage as a cognitive reserve factor, and (4) E2's potential role in linguistic experiences such as multilingualism and hearing loss. Future directions for research include analyzing the reserve mechanisms of steroid hormones on neuronal and glial plasticity, as well as identifying the links between steroid hormone loss in aging and risk for AD.

Associations of Dietary Intake With Self-Reported Hearing Loss: Findings From the Survey of the Health of Wisconsin

PURPOSE

The purpose of this study was to evaluate associations of dietary intake components with hearing loss.

METHOD

Participants were from the population-based Survey of the Health of Wisconsin. The Block food frequency questionnaire measured dietary intake of carbohydrates, fiber, protein, free (added) sugars, fruits, vegetables, saturated and trans fats, and glycemic index. Intake was categorized into quintiles (Q). Hearing loss was self-reported. Logistic regression models were used to evaluate associations of dietary determinants with hearing loss. Results are presented as odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs). Final models were adjusted for age, sex, total energy intake, race/ethnicity, education, smoking, and regular physical activity.

RESULTS

There were 2,839 participants (56% women; M_age = 48.2 [SD = 14.5] years) included. Higher consumption of trans fat (Q5: OR = 1.83, 95% CI [1.27, 2.64]) and higher glycemic index (Q5: OR = 1.34, 95% CI [1.00, 1.80]) were associated with increased odds of hearing loss. Hearing loss was associated with fruit, saturated- and trans-fat intake in women, and trans-fat intake and glycemic index in men.

CONCLUSIONS

Dietary intake was associated with self-reported hearing loss. Research on mechanistic pathways of associations and public health interventions to prevent hearing loss is needed.

Tinnitus Screener: Short-Term Test-Retest Reliability

PURPOSE

The Tinnitus Screener was introduced in 2015 as a four-item algorithmic instrument to assess the temporal characteristics of a person's reported tinnitus. The Tinnitus Screener was then revised as a six-item version to include a new temporal category and to capture tinnitus duration (acute < 6 months vs. chronic ≥ 6 months). When contrasted with audiologist assessment, the four-item Tinnitus Screener was determined to be highly valid, but the short-term reliability of either version remained unknown. The present analysis focused on determining the test-retest reliability of the six-item Tinnitus Screener. Additionally, we sought to determine whether reliability differed by respondent age, sex, military status, and hearing loss.

METHOD

The Tinnitus Screener was administered to 190 military Service members and 250 military Veterans at two time points separated by 7-31 days. Our analysis focused on test-retest reliability of responses as measured by the kappa coefficient, overall and within subsamples. Percent agreement of tinnitus categorization (temporal categories) and classification (positive/negative) between the two time points was also evaluated.

RESULTS

Constant or intermittent tinnitus was found in 31% of Service members and 53% of Veterans. Overall, kappa reliability coefficients were high, near .80, indicating substantial reliability. The majority (96%) of reliability coefficients for the Tinnitus Screener within subsamples were similarly high, ranging from .68 to .88.

CONCLUSIONS

The updated version of the Tinnitus Screener is shown to be a reliable instrument. The Tinnitus Screener is recommended to inform clinical decision making by determining the temporal characteristics of tinnitus.