The effects of smoking and alcohol consumption on age-related hearing loss: the Blue Mountains Hearing Study

Age-Related Hearing Loss: A Cross-Sectional Study of Healthy Older Australians

INTRODUCTION

Hearing loss is common in ageing populations, but thorough investigation of factors associated with objective hearing loss in otherwise healthy, community-dwelling older individuals is rare. We examined prevalence of age-related hearing loss (ARHL) in healthy, community-dwelling older adults, and determined whether sociodemographic, lifestyle, or health factors associate with hearing thresholds. Audiometry assessment was investigated with self-reports of hearing loss and hearing handicap.

METHODS

Australian participants (n = 1,260) of median age 73 years (IQR 71-76) joined ASPirin in Reducing Events in the Elderly (ASPREE)-Hearing, a sub-study of the ASPREE trial with exclusions including cognitive impairment, cardiovascular disease, independence-limiting physical disability, and uncontrolled hypertension. ASPREE collected demographics, anthropometrics, lifestyle, and health data. Audiometry measured better ear pure-tone average (PTA) across four frequencies (0.5-4 kHz) to establish hearing thresholds, categorised as normal or mild, moderate, and severe hearing loss. Questionnaires collected perceived hearing problems and noise exposure.

RESULTS

ARHL prevalence by audiometry was 49.7%, affecting men (59%) more than women (41%). A majority (54.5%) self-reported some hearing problems which mostly aligned with objective assessments; 45.6% self-reported a "little trouble" with hearing, while 35% had objective mild hearing loss; 8.3% reported having a "lot of trouble" hearing, while 13% had moderate hearing loss; and 0.6% reported being "deaf," while 2% demonstrated severe hearing loss. There was a significant association (p < 0.001) between self-reported hearing handicap and audiometric measures of hearing loss. In multivariate analysis of health, demographics, and lifestyle risk factors, only age, gender (men), and education years (<12) remained associated (p < 0.05) with hearing loss. Hearing thresholds were not associated with smoking, living situation, alcohol use, hypertension, diabetes, or chronic kidney disease.

CONCLUSION

ARHL robustly assessed by audiometry is common among healthy older Australians with men more likely to have abnormal hearing thresholds than women. Hearing loss was associated with fewer years of formal education, but not with a range of chronic conditions or alcohol use. Self-reported hearing loss correlates well with higher PTA hearing threshold levels in this healthy cohort where prevalence was lower than previously reported for the age group 70+ years. Hearing health education remains an important public health tool for this age. Targeting hearing in older patient health checks could be beneficial to mitigate the cognitive, social, and mental health consequences of ARHL, even if patients do not report a problem or handicap.

Demographic factors impact the rate of hearing decline across the adult lifespan

BACKGROUND

Little is known about the natural history of hearing loss in adults, despite it being an important public health problem. The purpose of this study is to describe the rate of hearing change per year over the adult lifespan.

METHODS

The 1436 participants are from the MUSC Longitudinal Cohort Study of Age-related Hearing Loss (1988-present). Outcomes are audiometric thresholds at 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz, averaged across right and left ears, and pure-tone average (PTA). Demographic factors are sex (female/male), race, which is categorized as white or racial Minority, and baseline age group (18-39, 40-59, 60-69, 70+ years). Linear mixed regression models are used to estimate the effect of age (per year) on the rate of threshold and PTA change.

RESULTS

Participants' mean age is 63.1 (SD 14.9) years, 57.7% are female, and 17.8% are racial Minority (17.1% were Black or African American). In sex-race-adjusted models, rates of threshold change are 0.42 to 1.44 dB across thresholds. Rates of change differ by sex at most individual thresholds, but not PTA. Females (versus males) showed higher rates of threshold change in higher frequencies but less decline per year in lower frequencies. Black/African American (versus white) participants have lower rates of threshold and PTA change per year. Hearing thresholds decline across the adult lifespan, with older (versus younger) baseline age groups showing higher rates of decline per year.

CONCLUSIONS

Declines to hearing occur across the adult lifespan, and the rate of decline varies by sex, race, and baseline age.

Association between genetic risk and adherence to healthy lifestyle for developing age-related hearing loss

BACKGROUND

Previous studies have shown that lifestyle/environmental factors could accelerate the development of age-related hearing loss (ARHL). However, there has not yet been a study investigating the joint association among genetics, lifestyle/environmental factors, and adherence to healthy lifestyle for risk of ARHL. We aimed to assess the association between ARHL genetic variants, lifestyle/environmental factors, and adherence to healthy lifestyle as pertains to risk of ARHL.

METHODS

This case-control study included 376,464 European individuals aged 40 to 69 years, enrolled between 2006 and 2010 in the UK Biobank (UKBB). As a replication set, we also included a total of 26,523 individuals considered of European ancestry and 9834 individuals considered of African-American ancestry through the Penn Medicine Biobank (PMBB). The polygenic risk score (PRS) for ARHL was derived from a sensorineural hearing loss genome-wide association study from the FinnGen Consortium and categorized as low, intermediate, high, and very high. We selected lifestyle/environmental factors that have been previously studied in association with hearing loss. A composite healthy lifestyle score was determined using seven selected lifestyle behaviors and one environmental factor.

RESULTS

Of the 376,464 participants, 87,066 (23.1%) cases belonged to the ARHL group, and 289,398 (76.9%) individuals comprised the control group in the UKBB. A very high PRS for ARHL had a 49% higher risk of ARHL than those with low PRS (adjusted OR, 1.49; 95% CI, 1.36-1.62; P < .001), which was replicated in the PMBB cohort. A very poor lifestyle was also associated with risk of ARHL (adjusted OR, 3.03; 95% CI, 2.75-3.35; P < .001). These risk factors showed joint effects with the risk of ARHL. Conversely, adherence to healthy lifestyle in relation to hearing mostly attenuated the risk of ARHL even in individuals with very high PRS (adjusted OR, 0.21; 95% CI, 0.09-0.52; P < .001).

CONCLUSIONS

Our findings of this study demonstrated a significant joint association between genetic and lifestyle factors regarding ARHL. In addition, our analysis suggested that lifestyle adherence in individuals with high genetic risk could reduce the risk of ARHL.

The association between dietary total antioxidant capacity and hearing loss: results from the Tehran employees Cohort Study

BACKGROUND

Despite numerous studies that have explored the association between individual antioxidants or specific combinations and the risk of hearing loss, there is lack of information regarding the relationship between dietary total antioxidant capacity (dTAC) and hearing loss. The conflicting results on this association further highlight the need for more research in this area. This study aims to investigate the association between overall dietary antioxidant intake and the risk of hearing loss among Iranian adults.

METHODS

This cross-sectional study recruited 3443 adult participants aged between 19 and 67 years (with an average age of 41.4 years ± 8.8) who were employed at Tehran University of Medical Sciences in Iran. Participants underwent dietary assessment using a validated Food Frequency Questionnaire (FFQ). The hearing status of each participant was evaluated by a licensed audiologist in a soundproof room, using diagnostic audiometry that adhered to American National Standards specifications and followed standard audiometric clinical procedures. The dietary total antioxidant capacity (dTAC) was calculated using the Ferric Reducing-Antioxidant Power (FRAP) values.

RESULTS

43.6% of male participants had hearing loss, while 26.8% among female participants. After accounting for various confounding factors, no significant association was observed between higher levels of dTAC and reduced odds of hearing loss in the overall population. However, among men under the age of 40, higher levels of dTAC were associated with decreased odds of hearing loss, even after adjusting for several covariates (OR: 0.56, 95% CI: 0.31-1.02, Ptrend = 0.02). This relationship was not evident in men over 40 years of age or among women.

CONCLUSION

The study found an inverse relationship between higher antioxidant intake in the diet and lower odds of hearing loss, specifically among men who were 40 years old or younger. However, this relationship was not observed in the overall population or among women. Additional prospective studies are necessary to validate these results.

Ten-year incidence, predictors and impact of dizziness and vertigo in community-dwelling adults

OBJECTIVES

We used a cohort of community-dwelling adults to establish the 10-year incidence and predictors of dizziness/vertigo, and its impacts on health-related quality of life.

STUDY DESIGN

Of the 1152 participants aged 55 + years who did not have dizziness/vertigo at baseline, 799 and 377 participants were followed up after 5 and 10 years, respectively, and had complete data and so were included in the incidence analysis. Hearing loss was determined as the pure-tone average of audiometric hearing thresholds at 500, 1000, 2000 and 4000 Hz, and any hearing loss was defined as >25 dB hearing level. Tinnitus and migraine were assessed by a positive response to a single question.

MAIN OUTCOME MEASURES

Audiologists screened participants for reported dizziness using a single question. Quality of life was measured using the Short Form 36-item Health Survey (SF-36).

RESULTS

The cumulative 10-year incidence of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo were 39.8 %, 27.1 %, and 11.9 %, respectively. Age and presence of migraine were significant predictors of incident dizziness/vertigo: multivariable-adjusted hazard ratio (HR) 1.03 (95 % confidence interval, CI, 1.01-1.06) and HR 1.63 (95 % CI 1.13-2.35), respectively. A significant decrease in scores for the following SF-36 domains was observed over the 10 years among participants reporting baseline dizziness/vertigo: physical functioning (P-trend ≤ 0.0001), role limitation due to physical problems (P-trend ≤ 0.0001), general health (P-trend = 0.01), and vitality (P-trend = 0.01).

CONCLUSIONS

Dizziness/vertigo was a frequent and detrimental symptom in this population of community-dwelling adults. Our study highlights the burden imposed by dizziness, as evidenced by a significant prospective association with poorer quality of life.

The impact of alcohol consumption on hearing loss in male workers with a focus on alcohol flushing reaction: the Kangbuk Samsung Cohort Study

Background

Despite hearing loss being a prevalent chronic condition, estimated to nearly 20% of the global population by the World Health Organization, the specific association with individual lifestyle factors, particularly alcohol consumption, remains unclear. In South Korea, approximately 80% of the population engages in alcohol consumption, with a notably high prevalence among males, indicating a high-risk drinking pattern. Therefore, this study aimed to assess the correlation between alcohol consumption and hearing loss in male workers, as well as to analyze additional variables such as alcohol flushing reaction, with the intention of improving worker health.

Methods

The study was conducted from January 2012 to December 2019, targeting 114,114 participants who visited Kangbuk Samsung Hospital Total Healthcare Centers. Data were collected through pure-tone audiometry tests and alcohol-related questionnaire, and statistical analysis was performed using Cox regression analysis. Based on previous studies indicating a potential protective effect of light drinking on hearing loss, this group was designated as the reference. Additionally, stratified analyses were conducted based on the presence of alcohol flushing reaction and different working hours.

Results

The hazard ratio (95% confidence interval) for hearing loss was higher in the heavy drinking group (1.23 [1.11-1.37]) compared to the moderate drinking group (1.09 [0.98-1.20]). Stratified analyses revealed a significantly elevated the hazard ratio of hearing loss in groups with alcohol flushing reaction compared to those without this factor.

Conclusions

Our study demonstrated that moderate or heavy alcohol consumption in male workers can increase the risk of hearing loss, particularly in those with alcohol flushing reaction. These findings underscore the importance of addressing alcohol-related factors concerning hearing health among male workers.

Interactions of genetic variations in FAS, GJB2 and PTPRN2 are associated with noise-induced hearing loss: a case-control study in China

BACKGROUND

This study aimed to screen and validate noise-induced hearing loss (NIHL) associated single nucleotide polymorphisms (SNPs), construct genetic risk prediction models, and evaluate higher-order gene-gene, gene-environment interactions for NIHL in Chinese population.

METHODS

First, 83 cases and 83 controls were recruited and 60 candidate SNPs were genotyped. Then SNPs with promising results were validated in another case-control study (153 cases and 252 controls). NIHL-associated SNPs were identified by logistic regression analysis, and a genetic risk model was constructed based on the genetic risk score (GRS), and classification and regression tree (CART) analysis was used to evaluate interactions among gene-gene and gene-environment.

RESULTS

Six SNPs in five genes were significantly associated with NIHL risk (p < 0.05). A positive dose-response relationship was found between GRS values and NIHL risk. CART analysis indicated that strongest interaction was among subjects with age ≥ 45 years and cumulative noise exposure ≥ 95 [dB(A)·years], without personal protective equipment, and carried GJB2 rs3751385 (AA/AB) and FAS rs1468063 (AA/AB) (OR = 10.038, 95% CI = 2.770, 47.792), compared with the referent group. CDH23, FAS, GJB2, PTPRN2 and SIK3 may be NIHL susceptibility genes.

CONCLUSION

GRS values may be utilized in the evaluation of the cumulative effect of genetic risk for NIHL based on NIHL-associated SNPs. Gene-gene, gene-environment interaction patterns play an important role in the incidence of NIHL.

A Narrative Review of Lifestyle Risk Factors and the Role of Oxidative Stress in Age-Related Hearing Loss

Age-related hearing loss affects a significant proportion of adults aged 60 years and above, with a prevalence of 65%. This condition has a negative impact on both physical and mental well-being, and while hearing interventions can help alleviate the effects of hearing loss, they cannot completely restore normal hearing or halt the progression of age-related hearing loss. Oxidative stress and inflammation have been identified as potential contributors to this condition. By addressing modifiable lifestyle risk factors that exacerbate oxidative stress, there may be an opportunity to prevent hearing loss. Therefore, this narrative review provides an overview of the major modifiable lifestyle risk factors associated with age-related hearing loss, that is, exposure to noise and ototoxic chemicals, smoking, diet, physical activity, and the presence of chronic lifestyle diseases, and offers an overview of the role of oxidative stress in the pathophysiology of this condition.

Alcohol as a risk factor for hearing loss: A systematic review and meta-analysis

OBJECTIVE

Growing evidence suggests that alcohol consumption is a risk factor for hearing loss; however, the evidence has been inconsistent. This systematic review and meta-analysis aimed to evaluate the effect of alcohol consumption on hearing loss.

METHODS

We searched several databases up to November 2021, for published articles using the keywords "alcohol drinking" and "hearing loss". Two investigators independently conducted the study selection and data extraction. Based on the results of the heterogeneity analysis (Q statistic and I2 statistic), a fixed- or random-effects model was used to calculate the pooled odds ratios (ORs). Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and robustness of the pooled estimation. Publication bias in the literature was evaluated using Egger's test.

RESULTS

In total, 18 (9 cross-sectional, 5 case-control, and 4 cohort) observational studies were identified in this search; 27,849 participants were included. Compared with non-drinkers, the pooled OR of drinkers was 1.22 (95% confidence interval: 1.09-1.35).

CONCLUSION

Evidence suggests a positive association between alcohol consumption and hearing loss. Drinkers were at a higher risk than non-drinkers. Drinking limitations may be useful for preventing hearing loss.

Food Insecurity and Hearing Loss Are Interrelated: A Cross-Sectional Population-Based Study

OBJECTIVES

We aimed to assess whether objectively measured hearing loss and self-perceived hearing handicap in adults are independently associated with food insecurity, and vice versa.

DESIGN

Cross-sectional population-based study.

POPULATION

2,500 participants aged 50+ years from the Blue Mountains Hearing Study, with both complete pure-tone audiometry data and information on food security status.

MEASUREMENTS

The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4KHz) >25 dB HL in the better ear, established the presence of hearing loss. Self-perceived hearing handicap was assessed by administering the Hearing Handicap Inventory for Elderly Screening (HHIE-S total scores of ≥8 indicates hearing handicap). A 12-item food security survey was administered, comprising statements related to individual and household food situations.

RESULTS

Food insecurity was reported by 12.8% of study participants. After adjusting for all potential confounders, any self-perceived hearing handicap significantly increased the likelihood of participants reporting food insecurity by 94% (p<0.0001). Participants reporting any, mild or severe self-perceived hearing handicap had around 2-fold greater odds of experiencing food insecurity. Objectively measured hearing loss did not significantly influence the food security status of study participants. Conversely, food insecurity was significantly associated with both objectively measured hearing loss and self-perceived hearing handicap: multivariate-adjusted OR 1.37 (95% CI 1.01-1.88) and OR 1.83 (95% CI 1.40-2.39), respectively.

CONCLUSIONS

Food insecurity was an important social determinant of hearing health among community-dwelling adults. Conversely, participants with a significant self-perceived hearing handicap were more likely to experience food insecurity. These findings add to our understanding of the substantial public health impact of both food insecurity and hearing loss and may highlight areas for future intervention.

Hearing and vision difficulty and sequential treatment among older adults in India

Aging not only affect biomarker-related processes, but it also affects the physiological processes of the human body. Of all the physiological processes, hearing and vision are of utmost importance to a human. Therefore, this study examines the prevalence and factors associated with hearing and vision difficulty and their sequential treatment among older adults in India. Utilizing data from Building a Knowledge Base on Population Aging in India, study used two sets of outcome variables; firstly, self-reported hearing and vision difficulty and secondly, treatment-seeking for hearing and vision difficulty. A total of 9541 older adults aged 60+ years from seven major regionally representative states were selected. Descriptive statistics were used to perform preliminary analysis. Additionally, the study employed the Heckprobit selection model. It is a two-equation model. This model is used in order to accommodate the heterogeneity (i.e., shared unobserved factors) among older adults and then address the endogeneity (between hearing and vision loss problems and their treatment-seeking behaviour) for older adults in India, the model offers a two-step analysis and deals with the zero-sample issue. Around 59% and 21% of older adults reported vision and hearing difficulty, respectively. Only 5% of older adults suffering from hearing difficulty reported utilizing hearing aids. Lifestyle factors (smoking tobacco and chewing tobacco) significantly affect hearing and vision difficulty; various chronic diseases were also found to be associated with high levels of hearing and vision difficulty among older adults. Results from Heckprobit model shows that older adults with 11+ years of education had higher probability to use visual [β = 0.54, 95% confidence interval (CI): 0.37, 0.70] and hearing aids [β = 0.6, 95% CI: 0.18, 1.02]. The use of hearing and vision aids was lower among poor older adults, older adults from Scheduled Caste, and older adults in rural areas. The study indicates that more than half of older adults face vision difficulty and almost one-fourth face hearing difficulty in rural India, education and lifestyle appear to be the main driver of health-seeking behaviour. Additional attention shall be given to understand the strategies that may advocate a higher use for hearing aids among older adults.

Effects of Diet and Lifestyle on Audio-Vestibular Dysfunction in the Elderly: A Literature Review

BACKGROUND

The world's age-related health concerns continue to rise. Audio-vestibular disorders, such as hearing loss, tinnitus, and vertigo, are common complaints in the elderly and are associated with social and public health burdens. Various preventative measures can ease their impact, including healthy food consumption, nutritional supplementation, and lifestyle modification. We aim to provide a comprehensive summary of current possible strategies for preventing the age-related audio-vestibular dysfunction.

METHODS

A PubMed, Embase, and Cochrane review databases search was conducted to identify the relationship between diet, lifestyle, and audio-vestibular dysfunction. "Diet", "nutritional supplement", "lifestyle", "exercise", "physical activity", "tinnitus", "vertigo" and "age-related hearing loss" were used as keywords.

RESULTS

Audio-vestibular dysfunction develops and progresses as a result of age-related inflammation and oxidative stress. Diets with anti-inflammatory and antioxidant effects have been proposed to alleviate this illness. A high-fat diet may induce oxidative stress and low protein intake is associated with hearing discomfort in the elderly. Increased carbohydrate and sugar intake positively correlate with the incidence of audio-vestibular dysfunction, whereas a Mediterranean-style diet can protect against the disease. Antioxidants in the form of vitamins A, C, and E; physical activity; good sleep quality; smoking cessation; moderate alcohol consumption; and avoiding noise exposure are also beneficial.

CONCLUSIONS

Adequate diet or nutritional interventions with lifestyle modification may protect against developing audio-vestibular dysfunction in elderly individuals.

Association of Lifestyle Behaviors With Hearing Loss: The UK Biobank Cohort Study

OBJECTIVE

To examine the combined association of five healthy lifestyle behaviors with hearing loss (HL) in the UK Biobank cohort, established between 2006 and 2010 in the United Kingdom.

METHODS

This longitudinal analysis included 61,958 participants aged 40 to 70 years from April 2007 to December 2016. The healthy behaviors examined were: never smoking, high level of physical activity, high diet quality, moderate alcohol intake, and optimal sleep. Hearing loss was self-reported at baseline and in any physical exam during the follow-up.

RESULTS

Over a median follow-up of 3.9±2.5 years, 3072 (5.0%) participants reported incident HL. After adjustment for potential confounders, including age, social factors, exposure to high-intensity noise, ototoxic medication, and comorbidity, the HRs of HL associated with having 1, 2, 3, and 4 to 5 vs 0 behaviors were: 0.85 (95% CI, 0.75 to 0.96), 0.85 (95% CI, 0.75 to 0.96), 0.82 (95% CI, 0.71 to 0.94), and 0.80 (95% CI, 0.67 to 0.97), respectively (P for trend, 0.02). We estimated that the population attributable risk percent for not adhering to any five low-risk lifestyle behaviors was 15.6%.

CONCLUSION

In this large study, an increasing number of healthy behaviors was associated with decreased risk of HL.

Tobacco, but Neither Cannabis Smoking Nor Co-Drug Use, Is Associated With Hearing Loss in the National Health and Nutrition Examination Survey, 2011 to 2012 and 2015 to 2016

INTRODUCTION

A relationship between tobacco smoking and hearing loss has been reported; associations with cannabis smoking are unknown. In this cross-sectional population-based study, we examined relationships between hearing loss and smoking (tobacco, cannabis, or co-drug use).

METHODS

We explored the relationship between hearing loss and smoking among 2705 participants [mean age = 39.41 (SE: 0.36) years] in the National Health and Nutrition Examination Survey (2011 to 12; 2015 to 16). Smoking status was obtained via questionnaire; four mutually exclusive groups were defined: nonsmokers, current regular cannabis smokers, current regular tobacco smokers, and co-drug users. Hearing sensitivity (0.5 to 8 kHz) was assessed, and two puretone averages (PTAs) computed: low- (PTA 0.5,1,2 ) and high-frequency (PTA 3,4,6,8 ). We defined hearing loss as threshold >15 dB HL. Multivariable logistic regression was used to examine sex-specific associations between smoking and hearing loss in the poorer ear (selected based on PTA 0.5,1,2 ) adjusting for age, sex, race/ethnicity, hypertension, diabetes, education, and noise exposure with sample weights applied.

RESULTS

In the age-sex adjusted model, tobacco smokers had increased odds of low- and high-frequency hearing loss compared with non-smokers [odds ratio (OR) = 1.58, 95% confidence ratio (CI): 1.05 to 2.37 and OR = 1.97, 95% CI: 1.58 to 2.45, respectively]. Co-drug users also had greater odds of low- and high-frequency hearing loss [OR = 2.07, 95% CI: 1.10 to 3.91 and OR = 2.24, 95% CI: 1.27 to 3.96, respectively]. In the fully adjusted multivariable model, compared with non-smokers, tobacco smokers had greater odds of high-frequency hearing loss [multivariable adjusted odds ratio = 1.64, 95% CI: 1.28-2.09]. However, in the fully adjusted model, there were no statistically significant relationships between hearing loss (PTA 0.5,1,2 or PTA 3,4,6,8 ) and cannabis smoking or co-drug use.

DISCUSSION

Cannabis smoking without concomitant tobacco consumption is not associated with hearing loss. However, sole use of cannabis was relatively rare and the prevalence of hearing loss in this population was low, limiting generalizability of the results. This study suggests that tobacco smoking may be a risk factor for hearing loss but does not support an association between hearing loss and cannabis smoking. More definitive evidence could be derived using physiological measures of auditory function in smokers and from longitudinal studies.

Association of Cigarette Smoking Patterns Over 30 Years With Audiometric Hearing Impairment and Speech-in-Noise Perception: The Atherosclerosis Risk in Communities Study

IMPORTANCE

The implications of cigarette smoking and smoking cessation for hearing impairment remain unknown. Many studies on this topic have failed to account for attrition among smokers in their findings.

OBJECTIVE

To assess the association of cigarette smoking patterns with audiometric and speech-in-noise hearing measures among participants of the Atherosclerosis Risk in Communities Study.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included participants of the Atherosclerosis Risk in Communities Study from 4 US communities. The analysis includes data from visit 1 (1987-1989) through visit 6 (2016-2017); data were analyzed from March 16 through June 25, 2021. Audiometric hearing and speech-in-noise testing was offered to all participants at visit 6. Participants with incomplete audiometric data or missing data for educational level, body mass index, drinking status, a diabetes or hypertension diagnosis, or occupational noise were excluded. In addition, individuals were excluded if they self-reported as having other than Black or White race and ethnicity, or if they self-reported as having Black race or ethnicity and lived in 2 predominantly White communities.

MAIN OUTCOMES AND MEASURES

Smoking behavior was classified from visit 1 (1987-1989) to visit 6 (2016-2017) using group-based trajectory modeling based on self-reported smoking status at each clinic visit. Hearing was assessed at visit 6. An audiometric 4-frequency (0.5, 1, 2, 4 kHz) pure-tone average (PTA) was calculated for the better-hearing ear and modeled as a continuous variable. Speech-in-noise perception was assessed via the Quick Speech-in-Noise Test (QuickSIN) and modeled continuously. Attrition during the 30 years of follow-up was addressed by inverse probability of attrition weighting.

RESULTS

A total of 3414 participants aged 72 to 94 years (median [IQR] age, 78.8 [76.0-82.9] years; 2032 [59.5%] women) when hearing was measured at visit 6 (2016-2017) were included in the cohort; 766 (22.4%) self-identified as Black and 2648 (77.6%) as White individuals. Study participants were classified into 3 smoking groups based on smoking behavior: never or former smoking at baseline (n = 2911 [85.3%]), quit smoking during the study period (n = 368 [10.8%]), and persistent smoking (n = 135 [4.0%]). In fully adjusted models, persistent smoking vs never or former smoking was associated with an average 2.69 (95% CI, 0.56-4.81) dB higher PTA (worse hearing) and 1.42 (95% CI, -2.29 to -0.56) lower QuickSIN score (worse performance). Associations were stronger when accounting for informative attrition during the study period (3.53 [95% CI, 1.14-5.93] dB higher PTA; 1.46 [95% CI, -2.52 to -0.41] lower QuickSIN scores). Smoking cessation during the study (vs never or former smoking) was not associated with changes in hearing.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, persistent smoking was associated with worse audiometric hearing and speech-in-noise perception. Hearing measures among participants who quit smoking during the study period did not differ from those for never or former smokers, indicating that smoking cessation (as opposed to persistent smoking) may have benefits for hearing health.

The prevalence and global burden of hearing loss in 204 countries and territories, 1990-2019

We aimed to describe the global prevalence and temporal trends of hearing loss. We collected detailed information of hearing loss from the Global Burden of Disease study between 1990 and 2019. Average annual percentage changes (AAPCs) in hearing loss age-standardized prevalence rate (ASPR), by sex, region, and category, were calculated to quantify the temporal prevalence trends. Globally, the prevalent cases of hearing loss increased from 7514.97×10⁵ in 1990 to 14566.62×10⁵ in 2019, and the ASPR increased from 173.33×10² per 100,000 in 1990 to 177.56×10² per 100,000 in 2019. The years lived with disability (YLDs) increased from 220080.97×10² in 1990 to 402353.05×10² in 2019. The AAPC was 83.27 (95% CI 70.66, 95.88) ×10^-3 in prevalence and -72.87 (95% CI -92.18, -53.56) ×10^-3 in YLDs. Significant correlations of AAPCs with ASPR (r=-0.60, p<0.001), and age-standardized YLD rate (r=-0.43, p=0.0012 for YLD<455, r=0.32, p<0.001 for YLD≥455) were detected. The YLDs of hearing loss owing to occupational noise (HLOON) increased from 39334.39 (95% UI 26881.04, 55999.67) ×10² in 1990 to 70014.49 (98% UI 47605.62, 100593.43) ×10² in 2019, and the increasing AAPC was observed for females and aged between 15 and 49 years old in global and most regions. The age effect was under zero in 7 age groups, the period effect of hearing loss prevalence was increasing and the birth cohort effect was decreasing with the time advance. The number of cases and ASPR of hearing loss in the world is still growing. Efforts to control hearing loss, especially HLOON, are imminent.

Hearing Status of Low-Income, Middle-Aged and Elderly Women in Northern China: A Population-Based, Cross-Sectional Study

Objective

Hearing impairment (HI) has become one of the most common causes of disability worldwide. To date, few studies have examined the hearing of women in these frequently rural regions. Thus, we explored the HI prevalence and risk factors among low-income, middle-aged, and elderly women in Tianjin, China.

Methods

Between October and November 2013, female residents aged ≥45 years of rural Tianjin, China were recruited into the study. The participants completed questionnaire surveys, physical examinations, and hearing tests. The hearing at frequencies of 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz was used to analyze the hearing characteristics of specific frequency bands, and HI was defined as the better ear pure tone averages (PTA) >25 dB HL.

Results

Among the 1416 participants, the prevalence of HI was 46.0%. Among those aged 45-54-years, most (65.3%) demonstrated normal hearing; in other age groups, slight HI accounted for the largest proportions of individuals. Compared with women who did not drink, the odds ratio (OR) of HI among women who consumed alcohol was 4.2 (95% confidence interval [CI]: 1.844-9.574; P = 0.001). Compared with pre-menopausal women, the OR of HI among postmenopausal women was 1.8 (95% CI: 1.261-2.667; P = 0.001). Further, each 1-year increase in age in women resulted in a 7.1% increase in HI risk (P < 0.001).

Conclusion

The burden of HI among women is heavy in rural northern China, especially among those who experienced menopause. Additionally, the results suggest that to further reduce the risk of developing HI, women in rural areas should stop consuming alcohol. The problem of HI among women in rural areas should be taken seriously; moreover, the measures implemented to prevent HI in high-risk women should be strengthened.

Relationship between cigarette smoking and hearing loss in China: A cross-sectional study in Zhejiang province

INTRODUCTION

Hearing loss and cigarette smoking are major challenges that affect public health in China. Revealing the effect of smoking on hearing loss in the Chinese general population is critical for hearing health protection. We investigated the relationship between smoking status and hearing loss in China, especially in stratified sex and age groups.

METHODS

A cross-sectional study was conducted on 4685 individuals aged 20– 80 years in Zhejiang province from 2016 to 2018, with audiometric testing for hearing loss and a structured questionnaire for collecting smoking status and covariates. Logistic regression was used to estimate the association between smoking and hearing loss.

RESULTS

Cigarette smoking was not significantly associated with hearing loss in females and young males. In middle-aged males, after adjusting for covariates, current smokers and past smokers had a significantly higher prevalence of speech-frequency loss (OR=1.65; 95% CI: 1.17–2.33 and OR=1.88; 95% CI: 1.11–3.17; respectively) and high-frequency hearing loss (OR=2.01; 95% CI: 1.43–2.84 and OR=2.64; 95% CI: 1.50–4.66; respectively). In older males, only past smokers had a significantly higher prevalence of speech-frequency hearing loss than never smokers (OR=2.58; 95% CI: 1.38–4.85). Regarding middle-aged and older current smokers, a dose-dependent relationship between smoking intensity and hearing loss was found. Passive smoking was not significantly associated with an increased hearing loss risk in all the three male groups.

CONCLUSIONS

The relationship between cigarette smoking and hearing loss varied according to gender and age. Therefore, the interventions for smoking need to be tailored according to age in males.

Effect of Cigarette Smoking on Hearing Levels in Young and Middle-Aged Males

Introduction: Smoking is a well-recognized risk factor for many health issues; however, its association with hearing loss has been a debate. Some studies have shown a positive association while others did not. In this study, we aim to identify the effect of cigarette smoking on hearing in our population.

Methods: This cross-sectional study was conducted in a tertiary care hospital in Pakistan from August 2020 to March 2021. Five hundred male smokers (n = 500), with a history of smoking for more than three years between the ages of 21 and 50, were enrolled in the study via consecutive convenient non-probability sampling after informed consent. Five hundred male non-smokers (n = 500) were enrolled as a reference group. Audiometry was performed in a soundproof room.

Results: The hearing levels in audiometry were significantly higher in smokers compared to non-smokers (22.8 ± 8.12 decibels vs 18.7 ± 6.12; p-value < 0.0001). Participants who had been smoking for more than 10 years had higher hearing levels in the audiometry test compared to the participants with less than 10 years of smoking history (24.21 ± 8.91 decibels vs. 21.1 ± 8.01 decibels: p-value < 0.0001).

Conclusion: In this study, smokers were associated with greater loss in hearing compared to non-smokers. In addition to other adverse events associated with smoking, smokers should be counselled about hearing loss related to it.

Health Status of Adults with Hearing Loss in the United States

Purpose: The purpose of this study was to identify the current health status of adults in the United States with self-reported hearing loss and compare it with US adults with a self-reported excellent or good hearing in three areas: (1) chronic disease states and general health status, (2) medical screening behaviors, and (3) lifestyle behaviors. Methods: A secondary data analysis was conducted using the 2014 data set from the National Health Interview Survey (NHIS), specifically the Sample Adult Public Use File (samadult). For this questionnaire set, one adult per family was randomly selected. This individual self-reported their response to the questionnaire items. Binary regressions were used to analyze the odds ratio to find differences for selected disease states, screenings, and lifestyle behaviors. Respondents were grouped into one of four categories: excellent/good hearing, a little trouble hearing, moderate/a lot of trouble hearing, and deaf. Results: The excellent/good hearing group was used as the comparison group for the other three levels of hearing. There are many differences in likelihood to self-report disease states; the greatest increased likelihoods include tinnitus and heart disease, with tinnitus being 8.6 times more likely for those who identified as having moderate/a lot of hearing loss. Those with any level of hearing loss were 3 to 5 times more likely to self-report heart disease. Regarding lifestyle factors, individuals with any level of hearing loss were less likely to consume alcohol and 2.5 to 9 times more likely to be unable to engage in moderate or vigorous activity on a weekly basis, respectively. Conclusions: There is a difference in the health status of individuals with hearing loss across all three areas examined (chronic disease states and general health status, medical screening behaviors, and lifestyle behaviors), and those differences vary based on level of hearing loss, the most notable being the self-reported inability to engage in moderate and vigorous physical activity. Disproportionate rates of tinnitus and heart disease were evident in all levels of hearing loss but most notable in those identifying as having moderate/a lot of trouble hearing. Further interdisciplinary research is necessary to improve the health of individuals with all levels of hearing loss, increase awareness of the hearing/health connection, and decrease hearing loss in general.

Sex differences in noise-induced hearing loss: a cross-sectional study in China

BACKGROUND

Significant sex differences exist in hearing physiology, while few human studies have investigated sex differences in noise-induced hearing loss (NIHL), and the sex bias in previous studies resulted in inadequate female data. The study aims to investigate sex differences in the characteristics of NIHL to provide insight into sex-specific risk factors, prevention strategies and treatment for NIHL.

METHODS

This cross-sectional study included 2280 industrial noise-exposed shipyard workers (1140 males and 1140 females matched for age, job and employment length) in China. Individual noise exposure levels were measured to calculate the cumulative noise exposure (CNE), and an audiometric test was performed by an experienced technician in a soundproof booth. Sex differences in and influencing factors of low-frequency (LFHL) and high-frequency hearing loss (HFHL) were analyzed using logistic regression models stratified by age and CNE.

RESULTS

At comparable noise exposure levels and ages, the prevalence of HFHL was significantly higher in males (34.4%) than in females (13.8%), and males had a higher prevalence of HFHL (OR = 4.19, 95% CI 3.18 to 5.52) after adjusting for age, CNE, and other covariates. Sex differences were constant and highly remarkable among subjects aged 30 to 40 years and those with a CNE of 80 to 95 dB(A). Alcohol consumption might be a risk factor for HFHL in females (OR = 3.12, 95% CI 1.10 to 8.89).

CONCLUSIONS

This study indicates significant sex differences in NIHL. Males are at higher risk of HFHL than females despite equivalent noise exposure and age. The risk factors for NIHL might be different in males and females.

Explaining better hearing in Norway: a comparison of two cohorts 20 years apart - the HUNT study

Background

The hearing function at a given age seems to have improved in more recent born cohorts in industrialized countries. But the reasons for the improvement have not yet been explained.

Methods

We investigated the extent to which better hearing in Norway is attributed to modifiable risk factors by using representative demographic and audiometric data from two cohorts of the Trøndelag Health Study, HUNT2 (1996–1998) and HUNT4 (2017–2019). We estimated natural indirect effects using causal inference methods in order to assess whether cohort improvement in hearing thresholds (HTs) was mediated by occupational noise exposure, recurrent ear infections, smoking and education.

Results

The improvement in HTs from HUNT2 to HUNT4 was 2.8 and 3.0 dB at low respectively high frequencies. Together all risk factors mediated this improvement by 0.8 dB (95% CI 0.7–0.9) and 0.8 dB (95% CI 0.7–0.9) respectively, corresponding to mediated proportions of 27 and 28%. Substantial mediation was specifically found for occupational noise in men and recurrent ear infections in women (mediated proportions of 11 and 17% at high frequencies, respectively).

Conclusions

Increased education, less occupational noise exposure, ear infections and smoking contributed considerably to better hearing in Norway the last two decades.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10301-1.

Associations Between Hearing and Cognitive Abilities From Childhood to Middle Age: The National Child Development Study 1958

Previous cross-sectional findings indicate that hearing and cognitive abilities are positively correlated in childhood, adulthood, and older age. We used an unusually valuable longitudinal dataset from a single-year birth cohort study, the National Child Development Study 1958, to test how hearing and cognitive abilities relate to one another across the life course from childhood to middle age. Cognitive ability was assessed with a single test of general cognitive ability at age 11 years and again with multiple tests at age 50. Hearing ability was assessed, using a pure tone audiogram, in childhood at ages 11 and 16 and again at age 44. Associations between childhood and middle-age hearing and cognitive abilities were investigated using structural equation modelling. We found that higher cognitive ability was associated with better hearing (indicated by a lower score on the hearing ability variables); this association was apparent in childhood (r  =  -0.120, p <0.001) and middle age (r  =  -0.208, p <0.001). There was a reciprocal relationship between hearing and cognitive abilities over time: better hearing in childhood was weakly associated with a higher cognitive ability in middle age (β  =  -0.076, p  =  0.001), and a higher cognitive ability in childhood was associated with better hearing in middle age (β  =  -0.163, p <0.001). This latter, stronger effect was mediated by occupational and health variables in adulthood. Our results point to the discovery of a potentially life-long relationship between hearing and cognitive abilities and demonstrate how these variables may influence one another over time.

Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people's quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people's health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual's life span; tackling socioeconomic inequalities throughout the life-course could improve the population's health, maximizing the opportunity for healthy aging.

Natural history of tinnitus in adults: a cross-sectional and longitudinal analysis

OBJECTIVE

To assess incidence and changes in tinnitus and bothersome tinnitus as well as associated risk factors in a large sample of UK adults.

DESIGN

Prospective cohort study.

SETTING

UK.

PARTICIPANTS

For cross-sectional analysis, a group of 168 348 participants aged between 40 and 69 years with hearing and tinnitus data from the UK Biobank resource. Longitudinal analysis included a subset of 4746 people who attended a 4-year retest assessment.

MAIN OUTCOME MEASURES

Presence and bothersomeness of tinnitus.

RESULTS

17.7% and 5.8% of participants reported tinnitus or bothersome tinnitus, respectively. The 4-year incidence of tinnitus was 8.7%. Multivariate logistic regression models suggested that age, hearing difficulties, work noise exposure, ototoxic medication and neuroticism were all positively associated with both tinnitus and bothersome tinnitus. Reduced odds of tinnitus, but not bothersome tinnitus, was seen in alcohol drinkers versus non-drinkers. Male gender was associated with increased odds of tinnitus, while female gender was associated with increased odds of bothersome tinnitus. At follow-up, of those originally reporting tinnitus, 18.3% reported no tinnitus. Of those still reporting tinnitus, 9% reported improvement and 9% reported tinnitus becoming more bothersome, with the rest unchanged. Male gender and alcohol consumption were associated with tinnitus being reported less bothersome, and hearing difficulties were associated with the odds of tinnitus being reported as more bothersome.

CONCLUSIONS

This study is one of the few to provide data on the natural history of tinnitus in a non-clinical population, suggesting that resolution is relatively uncommon, with improvement and worsening of symptoms equally likely. There was limited evidence for any modifiable lifestyle factors being associated with changes in tinnitus symptoms. In view of the largely persistent nature of tinnitus, public health strategies should focus on: (1) primary prevention and (2) managing symptoms in people that have tinnitus and monitoring changes in bothersomeness.

Cigarette Smoking, Smoking Cessation, and Risk of Hearing Loss in Women

BACKGROUND

Previous studies demonstrated higher risk of hearing loss among cigarette smokers, but longitudinal data on whether the risk is influenced by smoking cessation are limited. We prospectively investigated relations between smoking, smoking cessation, and risk of self-reported moderate or worse hearing loss among 81,505 women in the Nurses' Health Study II (1991-2013).

METHODS

Information on smoking and hearing status was obtained from validated biennial questionnaires. Cox proportional hazards regression was used to estimate multivariable-adjusted relative risks (MVRR, 95% confidence interval).

RESULTS

During 1,533,214 person-years of follow-up, 2760 cases of hearing loss were reported. Smoking was associated with higher risk of hearing loss and the risk tended to be higher with greater number of pack-years smoked. Compared with never smokers, the MVRR (95% confidence interval) among past smokers with 20+ pack-years of smoking was 1.30 (1.09-1.55) and 1.21 (1.02-1.43) for current smokers. The magnitude of elevated risk diminished with greater time since smoking cessation. Compared with never smokers, the MVRR among smokers who quit <5 years prior was 1.43 (1.17-1.75); 5-9 years prior was 1.27 (1.03-1.56); 10-14 years prior was 1.17 (0.96-1.41); and plateaued thereafter. Additional adjustment for pack-years smoking attenuated the results.

CONCLUSIONS

The higher risk of hearing loss associated with smoking may diminish over time after quitting.

Cadmium, obesity, and education, and the 10-year incidence of hearing impairment: The beaver dam offspring study

OBJECTIVES/HYPOTHESIS

To determine the 10-year incidence of hearing impairment (HI) and associated risk factors in the Beaver Dam Offspring Study (BOSS; 2004-present), a large middle-aged cohort followed for 10 years.

STUDY DESIGN

Prospective cohort study.

METHODS

Hearing thresholds were measured at baseline (2005-2008) and 5- (2010-2013) and 10-year (2015-2017) follow-up examinations. HI was defined as a pure-tone average >25 dB HL in either ear. BOSS participants free of HI at baseline with at least one follow-up examination (N = 2,065) were included. Potential risk factors evaluated included cardiovascular measures, health history, lifestyle factors, inflammatory markers, vitamins D and B12, lead, and cadmium.

RESULTS

Participants were 21 to 79 years (mean age = 47.9 years) at baseline. The 10-year cumulative HI incidence was 17.4% (95% confidence interval [CI]: 15.7-19.2) and was twice as likely in men (24.4%, 95% CI: 21.5-27.7) than in women (12.2%, 95% CI: 10.3-14.3). In a multivariable adjusted model, age (hazard ratio [HR] = 1.48, 95% CI: 1.38-1.59, per 5 years), male sex (HR = 2.47, 95% CI: 1.91-3.18), less than a college education (HR = 1.35, 95% CI: 1.02-1.79), body mass index (HR = 1.03, 95% CI: 1.01-1.05, per kg/m2 ), and higher cadmium levels (HR = 1.42, 95% CI: 1.05-1.92, quintile 5 vs. quintiles 1-4) were associated with the 10-year cumulative incidence of HI. There was no association between high lead levels, vitamins D or B12, and 10-year incidence of HI.

CONCLUSIONS

In addition to age and sex, obesity, education, and blood cadmium levels were associated with increased incidence of HI. These prospective results add to evidence that age-related HI is a multifactorial preventable disorder.

LEVEL OF EVIDENCE

2b Laryngoscope, 130:1396-1401, 2020.

Relationship between Inflammatory Food Consumption and Age-Related Hearing Loss in a Prospective Observational Cohort: Results from the Salus in Apulia Study

Age related hearing loss (ARHL) affects about one third of the elderly population. It is suggested that the senescence of the hair cells could be modulated by inflammation. Thus, intake of anti- and pro-inflammatory foods is of high interest.

METHODS

From the MICOL study population, 734 participants were selected that participated in the 2013 to 2018 examination including hearing ability and from which past data collected in 2005/2008 was available. ARHL status was determined and compared cross-sectionally and retrospectively according to clinical and lifestyle data including food and micronutrient intake.

RESULTS

ARHL status was associated with higher age but not with education, smoking, relative weight (BMI), and clinical-chemical blood markers in the crossectional and retrospective analyses. Higher intake of fruit juices among ARHL-participants was seen cross-sectionally, and of sugary foods, high-caloric drinks, beer, and spirits retrospectively. No difference was found for the other 26 food groups and for dietary micronutrients with the exception of past vitamin A, which was higher among normal hearing subjects.

CONCLUSIONS

Pro-inflammatory foods with a high-sugar content and also beer and spirits were found to be assocated with positive ARHL-status, but not anti-inflammatory foods. Diet could be a candidate for lifestyle advice for the prevention of ARHL.

Socioeconomic and lifestyle factors associated with hearing loss in older adults: a cross-sectional study of the English Longitudinal Study of Ageing (ELSA)

OBJECTIVES

Aims were (1) to examine whether socioeconomic position (SEP) is associated with hearing loss (HL) among older adults in England and (2) whether major modifiable lifestyle factors (high body mass index, physical inactivity, tobacco consumption and alcohol intake above the low-risk-level guidelines) are associated with HL after controlling for non-modifiable demographic factors and SEP.

SETTING

We used data from the wave 7 of the English Longitudinal Study of Ageing, which is a longitudinal household survey dataset of a representative sample of people aged 50 and older.

PARTICIPANTS

The final analytical sample was 8529 participants aged 50-89 that gave consent to have their hearing acuity objectively measured by a screening audiometry device and did not have any ear infection.

PRIMARY AND SECONDARY OUTCOME MEASURES

HL defined as >35 dBHL at 3.0 kHz (better-hearing ear). Those with HL were further subdivided into two categories depending on the number of tones heard at 3.0 kHz.

RESULTS

HL was identified in 32.1% of men and 22.3% of women aged 50-89. Those in a lower SEP were up to two times more likely to have HL; the adjusted odds of HL were higher for those with no qualifications versus those with a degree/higher education (men: OR 1.87, 95%CI 1.47 to 2.38, women: OR 1.53, 95%CI 1.21 to 1.95), those in routine/manual occupations versus those in managerial/professional occupations (men: OR 1.92, 95%CI 1.43 to 2.63, women: OR 1.25, 95%CI 1.03 to 1.54), and those in the lowest versus the highest income and wealth quintiles (men: OR 1.62, 95%CI 1.08 to 2.44, women: OR 1.36, 95%CI 0.85 to 2.16, and men: OR1.72, 95%CI 1.26 to 2.35, women: OR 1.88, 95%CI 1.37 to 2.58, respectively). All regression models showed that socioeconomic and the modifiable lifestyle factors were strongly associated with HL after controlling for age and gender.

CONCLUSIONS

Socioeconomic and lifestyle factors are associated with HL among older adults as strongly as core demographic risk factors, such as age and gender. Socioeconomic inequalities and modifiable lifestyle behaviours need to be targeted by the health policy strategies, as an important step in designing interventions for individuals that face hearing health inequalities.

Longitudinal associations between hearing loss and general cognitive ability: The Lothian Birth Cohort 1936

Hearing impairment is associated with poorer cognitive function in later life. We tested for the potential contribution of childhood cognitive ability to this relationship. Childhood cognitive ability is strongly related to cognitive function in older age, and may be related to auditory function through its association with hearing impairment risk factors. Using data from the Lothian Birth Cohort, 1936, we tested whether childhood cognitive ability predicted later-life hearing ability then whether this association was mediated by demographic or health differences. We found that childhood cognitive ability was negatively associated with hearing impairment risk at age 76 (odds ratio = .834, p = .042). However, this association was nonsignificant after subsequent adjustment for potentially mediating demographic and health factors. Next, we tested whether associations observed in older age between hearing impairment and general cognitive ability level or change were accounted for by childhood cognitive ability. At age 76, in the minimally adjusted model, hearing impairment was associated with poorer general cognitive ability level (β = -.119, p = .030) but was not related to decline in general cognitive ability. The former association became nonsignificant after additional adjustment for childhood cognitive ability (β = -.068, p = .426) suggesting that childhood cognitive ability contributes (potentially via demographic and health differences) to the association between levels of hearing and cognitive function in older age. Further work is needed to test whether early life cognitive ability also contributes to the association (documented in previous studies) between older-age hearing impairment and cognitive decline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

RISK FACTORS FOR HEARING IMPAIRMENT IN TYPE 1 DIABETES

Objective: Studies have demonstrated that glycated hemoglobin (HbA1c) is a significant predictor of hearing impairment in type 1 diabetes. We identified additional factors associated with hearing impairment in participants with type 1 diabetes from the Diabetes Control and Complications Trial and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods: A total of 1,150 DCCT/EDIC participants were recruited for the Hearing Study. A medical history, physical measurements, and a self-administered hearing questionnaire were obtained. Audiometry was performed by study-certified personnel and assessed centrally. Logistic regression models assessed the association of risk factors and comorbidities with speech- and high-frequency hearing impairment. Results: Mean age was 55 ± 7 years, duration of diabetes 34 ± 5 years, and DCCT/EDIC HbA1c 7.9 ± 0.9% (63 mmol/mol). In multivariable models, higher odds of speech-frequency impairment were significantly associated with older age, higher HbA1c, history of noise exposure, male sex, and higher triglycerides. Higher odds of high-frequency impairment were associated with older age, male sex, history of noise exposure, higher skin intrinsic florescence (SIF) as a marker of tissue glycation, higher HbA1c, nonprofessional/nontechnical occupations, sedentary activity, and lower low-density-lipoprotein cholesterol. Among participants who previously completed computed tomography and carotid ultrasonography, coronary artery calcification (CAC) >0 and carotid intima-medial thickness were significantly associated with high-but not speech-frequency impairment. Conclusion: Consistent with previous reports, male sex, age, several metabolic factors, and noise exposure are independently associated with hearing impairment. The association with SIF further emphasizes the importance of glycemia-as a modifiable risk factor-over time. In addition, the macrovascular contribution of CAC is novel and important. Abbreviations: AER = albumin excretion rate; CAC = coronary artery calcification; CVD = cardiovascular disease; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; eGFR = estimated glomerular filtration rate; ETDRS = Early Treatment Diabetic Retinopathy Study; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; IMT = intima-media thickness; LDL = low-density lipoprotein; NHANES = National Health and Nutrition Examination Survey; OR = odds ratio; SIF = skin intrinsic fluorescence; T1D = type 1 diabetes.

Age-Related Hearing Loss

Age-related hearing loss (ARHL) is the most prevalent sensory deficit in the elderly. This progressive hearing impairment leads to social isolation and is also associated with comorbidities, such as frailty, falls, and late-onset depression. Moreover, there is a growing evidence linking it with cognitive decline and increased risk of dementia. Given the large social and welfare burden that results from ARHL, and because ARHL is potentially a modifiable risk factor for dementia, there is an urgent need for therapeutic interventions to ameliorate age-related auditory decline. However, a prerequisite for design of therapies is knowledge of the underlying molecular mechanisms. Currently, our understanding of ARHL is very limited. Here, we review recent findings from research into ARHL from both human and animal studies and discuss future prospects for advances in our understanding of genetic susceptibility, pathology, and potential therapeutic approaches in ARHL.

Risk Factors for Distortion Product Otoacoustic Emissions in Young Adults

Young adults with normal hearing may exhibit risk factors for hearing loss. The purpose of this study was to evaluate how self-reported personal music (PM) system volume use, preferred listening level, and self-reported alcohol use affects distortion product otoacoustic emissions (DPOAEs). Two-hundred, sixteen young adults, 161 women and 55 men, participated. Questionnaire data included the PM system and alcohol use. DPOAEs were obtained from 1–6 kHz and collapsed into 1/3rd octave bands and a probe microphone was used to determine preferred listening level. Alcohol was defined as drinks per month (DPM), categorized as No, Light (≤14), and Heavy (>14). Men who reported loud/very loud volume use had statistically significant lower DPOAEs at 1.5, 2, and 3 kHz than men who reported lower volume use. Light and Heavy DPM men had lower DPOAEs at 1.5, 2, and 3 kHz than no DPM men, but this was not statistically significant. There were no DPOAE differences for either variable in women and there was no association between preferred listening level and DPOAEs for women or men. Men who reported loud/very loud volume use and any DPM had poorer mid-frequency DPOAEs. There was not an association for volume use or DPM and DPOAEs in women.

Dietary patterns and hearing loss in older men enrolled in the Caerphilly Study

The association between dietary patterns (DP) and prevalence of hearing loss in men enrolled in the Caerphilly Prospective Study was investigated. During 1979-1983, the study recruited 2512 men aged 45-59 years. At baseline, dietary data were collected using a semi-quantitative FFQ, and a 7-d weighed food intake (WI) in a 30 % subsample. Five years later, pure-tone unaided audiometric threshold was assessed at 0·5, 1, 2 and 4 kHz. Principal component analysis (PCA) identified three DP and multiple logistic and ordinal logistic regression models examined the association with hearing loss (defined as pure-tone average of frequencies 0·5, 1, 2 and 4 kHz &gt;25 dB). Traditional, healthy and high-sugar/low-alcohol DP were found with both FFQ and WI data. With the FFQ data, fully adjusted models demonstrated significant inverse association between the healthy DP and hearing loss both as a dichotomous variable (OR=0·83; 95 % CI 0·77, 0·90; P&lt;0·001) and as an ordinal variable (OR=0·87; 95 % CI 0·81, 0·94; P&lt;0·001). With the WI data, fully adjusted models showed a significant and inverse association between the healthy DP and hearing loss (OR=0·85; 95 % CI 0·73, 0·99; P&lt;0·03), and a significant association between the traditional DP (per fifth increase) and hearing loss both as a dichotomous variable (OR=1·18; 95 % CI 1·02, 1·35; P=0·02) and as an ordinal variable (OR=1·17; 95 % CI 1·03, 1·33; P=0·02). A healthy DP was significantly and inversely associated with hearing loss in older men. The role of diet in age-related hearing loss warrants further investigation.

The association between obesity, diet quality and hearing loss in older adults

BACKGROUND

With the aging population, the prevalence of age-related hearing loss will increase substantially. Prevention requires more knowledge on modifiable risk factors. Obesity and diet quality have been suggested to play a role in the etiology of age-related hearing loss. We aimed to investigate independent associations of body composition and diet quality with age-related hearing loss.

METHODS

We performed cross-sectional and longitudinal analyses (follow-up: 4.4 years) in the population-based Rotterdam Study. At baseline (2006-2014), 2,906 participants underwent assessment of body composition, diet, and hearing. Of these 2,906 participants, 636 had hearing assessment at follow-up (2014-2016). Association of body composition and of diet quality with hearing loss were examined using multivariable linear regression models.

RESULTS

Cross-sectionally, higher body mass index and fat mass index were associated with increased hearing thresholds. These associations did not remain statistically significant at follow-up. We found no associations between overall diet quality and hearing thresholds.

CONCLUSIONS

This study shows that a higher body mass index, and in particular a higher fat mass index, is related to age-related hearing loss. However, whether maintaining a healthy body composition may actually reduce the effects of age-related hearing loss in the aging population requires further longitudinal population-based research.

Hearing Loss in Type 2 Diabetes in Association with Diabetic Neuropathy

BACKGROUND

Reports assessing hearing abnormalities in diabetes are debated. We aimed to evaluated auditory alterations and their possible associations with vascular and neurological dysfunction in 160 Type 2 diabetes mellitus individuals and 100 age and sex-matched healthy controls.

METHODS

Participants underwent pure tone audiometry (PTA). Associations with demographic, metabolic and neuropathic variables were assessed.

RESULTS

Compared with healthy controls, diabetic patients had higher mean hearing thresholds at each frequency, with statistical significance at 2-8 kHz (p <0.05). Prevalence of hearing loss in diabetics was 67.5% (108/160), including high-frequency (72.22%, 78/108), and low/mid- and high-frequency (27.78%, 30/108). The mild hearing loss was predominant in diabetics with high-frequency impairment (52.56%), while the moderate/severe hearing loss was high in individuals with both low-and high-frequency hearing loss (80.00%). Multiple logistic regression analysis of PTA parameters showed that higher Semmes Weinstein Monofilament (OR 1.24, 95% CI 1.02-1.52), Michigan Neuropathy Screening Instrument score (OR 1.38, 95% CI 1.14-1.68), and vibration perception threshold (OR 1.19, 95% CI 1.05-1.34) were independent risk factors for hearing impairment in diabetics after adjusting for potential covariates.

CONCLUSIONS

These findings suggest that hearing loss is common in T2DM subjects, with predominantly high frequency involved. Diabetic neuropathic factors may explain the underlying mechanism of the association between diabetes and hearing loss.

Gender Differences in the Association between Moderate Alcohol Consumption and Hearing Threshold Shifts

Hearing loss is a global public health problem with a high prevalence, significantly impairing communication and leading to a decrease in the quality of life. The association between moderate alcohol consumption (MAC) and hearing impairment has been addressed in several studies with inconsistent results. The intent of our study is to clarify the correlation between MAC and the hearing threshold and further investigate the interplay between MAC and the hearing threshold categorized by gender. The study included 4,075 participants aged 20–69 years from the 1999–2004 data of National Health and Nutrition Examination Survey (NHANES). The associations among MAC, gender differences, and high-frequency and low-frequency hearing thresholds were analyzed. We found that current female drinkers with MAC tended to have lower hearing thresholds. There is a significant protective effect of MAC on hearing threshold shifts in the US adult population, especially in females. Our research was the first study to further indicate that there is a gender difference in the association between MAC and hearing impairment. In accordance with our results, if people drink, they should consume moderate rather than higher amounts, especially in women, which may result in a reduced risk of hearing loss.

Hearing loss and use of health services: a population-based cross-sectional study among Finnish older adults

Background

Older adults with hearing difficulties face problems of communication which may lead to underuse of health services. This study investigated the association of hearing loss and self-reported hearing difficulty with the use of health services and unmet health care needs in older adults.

Methods

Data on persons aged 65 and older (n = 2144) drawn from a population-based study, Health 2000, were analyzed. Hearing loss was determined with screening audiometry (n = 1680). Structured face-to-face interviews were used to assess self-reported hearing difficulty (n = 1962), use of health services (physician and nurse visits, health examinations, mental health services, physical therapy, health promotion groups, vision test, hearing test, mammography, PSA test) and perceived unmet health care needs. Multivariable logistic regression analyses were used.

Results

After adjusting for socio-economic and health-related confounders, persons with hearing loss (hearing level of better ear 0.5–2 kHz > 40 dB) were more likely to have used mental health services than those with non-impaired hearing (OR = 3.2, 95 % CI 1.3–7.9). Self-reported hearing difficulty was also associated with higher odds for mental health service use (OR = 2.1 95 % CI 1.2–3.5). Hearing was not associated with use of the other health services studied, except presenting for a hearing test. Persons with self-reported hearing difficulty were more likely to perceive unmet health care needs than those without hearing difficulty (OR = 1.7, 95 % CI 1.4–2.1).

Conclusions

Older adults with hearing loss or self-reported hearing difficulty are as likely to use most health services as those without hearing loss. However, self-reported hearing difficulty is associated with experiencing unmet health care needs. Adequate health services should be ensured for older adults with hearing difficulties.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0356-5) contains supplementary material, which is available to authorized users.

Impact of Work Environments and Occupational Hazards on Smoking Intensity in Korean Workers

The purpose of this study was to investigate the influence of work environments and occupational hazards on smoking intensity by occupation type in Korean workers. This study used the data from the Fourth Korea National Health and Nutrition Examination Survey in 2009. The sample of this study included 3,769 adults who were aged 18 years or older and had an occupation of office work, sales, or manufacturing. After controlling for sociodemographic characteristics, the generalized linear models revealed that office workers and the sales force who had smoking co-workers at the workplace were more likely to smoke than those who did not. A dirty workplace and exposure to occupational noise were significant factors increasing the smoking intensity for manufacturers. A smoking cessation program considering physical work environments and co-workers' support should be developed for Korean workers.

Joint Associations of Dual Sensory Impairment and No-Activity Involvement With 1-Year Mortality in Nursing Homes: Results From the SHELTER Study

BACKGROUND

Concurrent vision and hearing impairment, known as dual sensory impairment (DSI), is associated with increased mortality. We aimed to examine individual and joint associations of DSI and involvement in activities with mortality in a large European nursing home study.

METHODS

In total, 2,851 nursing home residents in 59 facilities in eight countries were followed for 1 year in the Services and Health for Elderly in Long TERm Care study. Vision and hearing impairment and average time of involvement in activities were assessed by trained research staff using the interRAI Long Term Care Facilities. Association between DSI and 1-year all-cause mortality was examined using Cox proportional hazards models adjusted for age, sex, facility, diagnoses of coronary heart disease and diabetes mellitus, self-rated health, end-stage disease, and functional and cognitive status. The modifying effect of involvement in activities on the association was investigated by the additive hazard model.

RESULTS

DSI, defined as moderate to severe impairment in both senses, was independently associated with a 35% increased risk of 1-year mortality compared with non-DSI. Residents with DSI who were involved in activities did not have higher mortality, while residents with DSI who were not involved in activities had 51% higher mortality than non-DSI residents who were involved in activities, equivalent to approximately 209 additional deaths per 1,000 person-years (p = .012) due to the interaction between DSI and no involvement in activities.

CONCLUSIONS

DSI is associated with increased mortality at nursing homes when combined with no involvement in activities.

Cardiovascular risk factors and hearing loss: The HUNT study

OBJECTIVE

The purpose of the present paper was to examine the association between prospectively and cross-sectionally assessed cardiovascular risk factors and hearing loss.

DESIGN

Hearing was assessed by pure-tone average thresholds at low (0.25-0.5 kHz), middle (1-2 kHz), and high (3-8 kHz) frequencies. Self-reported or measured cardiovascular risk factors were assessed both 11 years before and simultaneously with the audiometric assessment. Cardiovascular risk factors were smoking, alcohol use, physical inactivity, waist circumference, body mass index, resting heart rate, blood pressure, triglycerides, total serum cholesterol, LDL cholesterol, HDL cholesterol, and diabetes.

STUDY SAMPLE

A population-based cohort of 31 547 subjects.

RESULTS

After adjustment for age, sex, level of education, income, recurrent ear infections, and noise exposure, risk factors associated with poorer hearing sensitivity were smoking, diabetes, physical inactivity, resting heart rate, and waist circumference. Smoking was only associated with hearing loss at high frequencies. The effects were very small, in combination explaining only 0.2-0.4% of the variance in addition to the component explained by age and the other cofactors.

CONCLUSION

This cohort study indicates that, although many cardiovascular risk factors are associated with hearing loss, the effects are small and of doubtful clinical relevance.

Occupational noise exposure and hearing: a systematic review

Purpose

To give a systematic review of the development of noise-induced hearing loss (NIHL) in working life.

Methods

A literature search in MEDLINE, Embase, Web of Science, Scopus, and Health and Safety Abstracts, with appropriate keywords on noise in the workplace and health, revealed 22,413 articles which were screened by six researchers. A total of 698 articles were reviewed in full text and scored with a checklist, and 187 articles were found to be relevant and of sufficient quality for further analysis.

Results

Occupational noise exposure causes between 7 and 21 % of the hearing loss among workers, lowest in the industrialized countries, where the incidence is going down, and highest in the developing countries. It is difficult to distinguish between NIHL and age-related hearing loss at an individual level. Most of the hearing loss is age related. Men lose hearing more than women do. Heredity also plays a part. Socioeconomic position, ethnicity and other factors, such as smoking, high blood pressure, diabetes, vibration and chemical substances, may also affect hearing. The use of firearms may be harmful to hearing, whereas most other sources of leisure-time noise seem to be less important. Impulse noise seems to be more deleterious to hearing than continuous noise. Occupational groups at high risk of NIHL are the military, construction workers, agriculture and others with high noise exposure.

Conclusion

The prevalence of NIHL is declining in most industrialized countries, probably due to preventive measures. Hearing loss is mainly related to increasing age.

Electronic supplementary material

The online version of this article (doi:10.1007/s00420-015-1083-5) contains supplementary material, which is available to authorized users.

Analysis of Predisposing Factors for Hearing Loss in Adults

We aimed to estimate the effects of various risk factors on hearing level in Korean adults, using data from the Korea National Health and Nutrition Examination Survey. We examined data from 13,369 participants collected between 2009 and 2011. Average hearing thresholds at low (0.5, 1, and 2 kHz) and high frequencies (3, 4, and 6 kHz), were investigated in accordance with various known risk factors via multiple regression analysis featuring complex sampling. We additionally evaluated data from 4,810 participants who completed a questionnaire concerned with different types of noise exposure. Low body mass index, absence of hyperlipidemia, history of diabetes mellitus, low incomes, low educational status, and smoking were associated with elevated low frequency hearing thresholds. In addition, male sex, low body mass index, absence of hyperlipidemia, low income, low educational status, smoking, and heavy alcohol consumption were associated with elevated high frequency hearing thresholds. Participants with a history of earphone use in noisy circumstances demonstrated hearing thresholds which were 1.024 dB (95% CI: 0.176 to 1.871; P = 0.018) higher, at low-frequencies, compared to participants without a history of earphone use. Our study suggests that low BMI, absence of hyperlipidemia, low household income, and low educational status are related with hearing loss in Korean adults. Male sex, smoking, and heavy alcohol use are related with high frequency hearing loss. A history of earphone use in noisy circumstances is also related with hearing loss.

Determinants of Single and Multiple Sensory Impairments in an Urban Population

OBJECTIVE

To describe the co-occurrence pattern and determinants of auditory, olfactory, visual, and gustatory impairment across the life spectrum of adults.

STUDY DESIGN

Cross-sectional analysis.

SETTING

An urban population.

SUBJECTS AND METHOD

In total, 1208 persons from the general adult population (age range, 25-74 years; 46.7% men) were included. Sensory impairments were assessed with validated tests. Alternating logistic regression was applied to characterize (1) the dependence of sensory impairments on selected independent variables and (2) the pairwise association between sensory impairments. The dependence of impairment grade (no to multisensory impairment) on the same set of independent variables was examined using ordinal logistic regression.

RESULTS

The prevalence of single sensory impairment was 38.8%, of dual 27.3%, and of multisensory impairment 7.5%. Auditory impairment was the most frequent impairment type (43.9%), followed by olfactory (21.5%), gustatory (20.3%), and visual impairment (14.1%). Besides age and sex, social status (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.80-3.79), smoking status (OR, 1.45; 95% CI, 1.12-1.88), and diabetes (OR, 1.75; 95% CI, 1.16-2.63) were related to an elevated odds of moving from a lower into a higher impairment category.

CONCLUSIONS

The presence of certain risk factors, such as a low social status, diabetes, and smoking, appears likely to increase the risk of multisensory impairment.

Smoking, central adiposity, and poor glycemic control increase risk of hearing impairment

OBJECTIVES

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).

DESIGN

A longitudinal population-based cohort study (1993-95 to 2009-10), the Epidemiology of Hearing Loss Study (EHLS).

SETTING

Beaver Dam, Wisconsin.

PARTICIPANTS

Participants in the Beaver Dam Eye Study (1988-90; residents of Beaver Dam, WI, aged 43-84 in 1987-88) were eligible for the EHLS. There were 1,925 participants with normal hearing at baseline.

MEASUREMENTS

Fifteen-year cumulative incidence of HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz greater than 25 decibels hearing level in either ear). Cigarette smoking, exercise, and other factors were ascertained according to questionnaire. Blood pressure, waist circumference, body mass index, and glycosylated hemoglobin were measured.

RESULTS

Follow-up examinations (≥1) were obtained from 87.2% (n=1,678; mean baseline age 61). The 15-year cumulative incidence of HI was 56.8%. Adjusting for age and sex, current smoking (hazard ratio (HR)=1.31, P=.048), education (<16 years; HR=1.35, P=.01), waist circumference (HR=1.08 per 10 cm, P=.02), and poorly controlled diabetes mellitus (HR=2.03, P=.048) were associated with greater risk of HI. Former smokers and people with better-controlled diabetes mellitus were not at greater risk.

CONCLUSION

Smoking, central adiposity, and poorly controlled diabetes mellitus predicted incident HI. These well-known risk factors for CVD suggest that vascular changes may contribute to HI in aging. Interventions targeting reductions in smoking and adiposity and better glycemic control in people with diabetes mellitus may help prevent or delay the onset of HI.

Prospective study of alcohol consumption and self-reported hearing loss in women

Chronic excess alcohol intake has been associated with irreversible hearing loss and acute alcohol intake may temporarily impair auditory function; however, some evidence suggests that long-term moderate alcohol intake may be related to lower risk of hearing loss. This study prospectively examined the association between total alcohol and individual alcoholic beverage consumption and risk of hearing loss in women. Data were prospectively collected from 65,424 participants in the Nurses' Health Study II (NHS II), aged 27-44 years at baseline (follow-up 1991-2009). Alcohol consumption was assessed using a validated questionnaire every 4 years. An incident case was defined as a self-reported hearing problem that began after 1991. Cox proportional hazards multivariate regression was used to adjust for potential confounders. During 1,024,555 person-years of follow-up, 12,384 cases of hearing loss occurred. After multivariate adjustment, there was no significant association between total alcohol consumption and risk of hearing loss. In exploratory analyses, beer consumption was associated with increased risk and wine consumption was associated with reduced risk. No significant association was observed for consumption of liquor. Total alcohol consumption is not associated with risk of hearing loss in women. The modest associations observed for beer (direct) and wine (inverse) may be due to chance or residual confounding but merit further study.