Clinical pure-tone versus three-interval forced-choice thresholds: effects of hearing level and age

Longitudinal Changes in Auditory and Cognitive Function in Middle-Aged and Older Adults

Purpose This article aimed to document longitudinal changes in auditory function, including measures of temporal processing, and to examine the associations between observed changes in auditory and cognitive function in middle-aged and older adults. Method This was a prospective longitudinal study of 98 adults (66 women) with baseline ages ranging from 40 to 85 years. The mean interval between T1 baseline and T2 follow-up measurements was 8.8 years with a range of 7-11 years. Measures of hearing threshold, gap detection, and auditory temporal-order identification were completed at T1 and T2. Cognitive measures completed at T1 and T2 were the 13 scales of the Wechsler Adult Intelligence Scale-Third Edition. Three approaches were taken to analyze these data: (a) examination of changes over time in group performance, (b) correlations and slopes between auditory and cognitive measures to examine concomitant rates of decline over the 9-year T1-to-T2 period, and (c) regression analyses examining associations between auditory performance at T1 and cognitive performance 9 years later at T2. Results For the group data, there were significant declines in hearing loss, gap-detection thresholds at one frequency, and process-type measures of cognitive function from T1 to T2 matching the trends in the baseline cross-sectional data. Regression analyses of the longitudinal data revealed the strongest connection between auditory temporal-order processing and cognitive processing typically explaining 10%-15% of the variance. Conclusions A significant amount of variance in rates of cognitive decline, T1 to T2, and subsequent cognitive performance (T2) was explained by measures of auditory function. Although hearing loss occasionally emerged as a significant factor, auditory temporal-order identification emerged much more frequently as the auditory measure most strongly associated with cognitive function.

Reliability of Measures Intended to Assess Threshold-Independent Hearing Disorders

OBJECTIVES

Recent animal studies have shown that noise exposure can cause cochlear synaptopathy without permanent threshold shift. Because the noise exposure preferentially damaged auditory nerve fibers that processed suprathreshold sounds (low-spontaneous rate fibers), it has been suggested that synaptopathy may underlie suprathreshold hearing deficits in humans. Recently, several researchers have suggested measures to identify the pathology or pathologies underlying suprathreshold hearing deficits in humans based on results from animal studies; however, the reliability of some of these measures have not been assessed. The purpose of this study was to assess the test-retest reliability of measures that may have the potential to relate suprathreshold hearing deficits to site(s)-of-lesion along the peripheral auditory system in humans.

DESIGN

Adults with audiometric normal hearing were tested on a battery of behavioral and physiologic measures that included (1) thresholds in quiet (TIQ), (2) thresholds in noise (TIN), (3) frequency-modulation detection threshold (FMDT), (4) word recognition in four listening conditions, (5) distortion-product otoacoustic emissions (DPOAE), (6) middle ear muscle reflex (MEMR), (7) tone burst-elicited auditory brainstem response (tbABR), and (8) speech-evoked ABR (sABR). Data collection for each measure was repeated over two visits separated by at least one week. The residuals of the correlation between the suprathreshold measures and TIQ serve as functional and quantitative proxies for threshold-independent hearing disorders because they represent the portion of the raw measures that is not dependent on TIQ. Reliability of the residual measures was assessed using intraclass correlation (ICC).

RESULTS

Reliability for the residual measures was good (ICC ≥ 0.75) for FMDT, DPOAEs, and MEMR. Residual measures showing moderate reliability (0.5 ≤ ICC < 0.75) were tbABR wave I amplitude, TIN, and word recognition in quiet, noise, and time-compressed speech with reverberation. Wave V of the tbABR, waves of the sABR, and recognition of time-compressed words had poor test-retest reliability (ICC < 0.5).

CONCLUSIONS

Reliability of residual measures was mixed, suggesting that care should be taken when selecting measures for diagnostic tests of threshold-independent hearing disorders. Quantifying hidden hearing loss as the variance in suprathreshold measures of auditory function that is not due to TIQ may provide a reliable estimate of threshold-independent hearing disorders in humans.

Social inequalities in pure-tone hearing assessed using occupational stratification schemes

OBJECTIVE

The objective of this study is to analyse the performance of two occupational stratification approaches and the impact of social position on adult hearing.

DESIGN

The prevalence of hearing impairment, pure-tone averages (PTA) and prevalence ratios (PR) for relative hearing loss, which focuses on the position of one's PTA in the age- and gender-specific distribution, were compared in groups defined by ISCO Skill Level and the International Socio-Economic Index (ISEI).

STUDY SAMPLE

About 1571 subjects aged 30-89, including 677 highly screened adults, from the cross-sectional study HÖRSTAT.

RESULTS

ISCO Skill Level and ISEI yielded qualitatively the same results. The prevalence difference between the socially least and most advantaged group ranges between 10 and 16%, varying with the scheme applied. Low- and high-frequency PTA and PR for relative hearing loss confirm the gradient. Screening reduced, but did not negate the social differences. The prevalence difference dropped to 6-7% in the otologically normal subsample.

CONCLUSIONS

Social groups defined by hierarchical, occupational measures differ in their pure-tone hearing, even if the main risk factors are controlled for. This underlines the need for population-based sampling, the relevance of reporting the study group's social composition and the importance of advancing the discussion on appropriate social measures in hearing research.

Are age-related changes in cognitive function driven by age-related changes in sensory processing?

Although there has been keen interest in the association among measures of sensory function and cognitive function for many years, in general, measures of sensory function have been confined to one or two senses and measures of threshold sensitivity (acuity). In this study, rigorous psychophysical measures of threshold sensitivity, temporal gap detection, temporal order identification, and temporal masking have been obtained, in hearing, vision, and touch. In addition, all subjects completed 15 subtests of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS-III). Data were obtained from 245 adults (18-87 years old) for the WAIS-III and for 40 measures of threshold sensitivity and temporal processing. The focus in this report is on individual differences in performance for the entire data set. Principal-components (PC) factor analysis reduced the 40 psychophysical measures to eight correlated factors, which were reduced further to a single global sensory processing factor. Similarly, PC factor analysis of the 15 WAIS-III scores resulted in three correlated factors that were further reduced to a single global cognitive function factor. Age, global sensory processing, and global cognitive function were all moderately and significantly correlated with one another. However, paired partial correlations, controlling for the third of these three measures, revealed that the moderate correlation between age and global cognitive function went to zero when global sensory processing was controlled for; the other two partial correlations remained intact. Structural models confirmed this result. These analyses suggest that the long-standing observation of age-related changes in cognitive function may be mediated by age-related changes in global sensory processing.

Stuart Gatehouse: a brief life

Stuart Gatehouse was an internationally renowned auditory scientist whose work on basic research, government policy, and clinical practice has directly improved the quality of life of adult hearing aid users. He addressed issues of relevance to the lives of hearing-impaired adults, especially on the impact of a hearing loss on an individual, the management of hearing loss, and the measurement of the benefits offered by hearing aids. He also influenced practice and service delivery and made major contributions to the delivery of audiological services in the United Kingdom, including chairing a report that directly led to their modernization in Scotland. This article describes his life and career.

Magnitude estimation scaling of the loudness of a wide range of auditory stimuli

The study of the perception of loudness lends itself well to the psychophysical scaling technique of magnitude estimation. This study was designed to extend the range of auditory stimuli used to study the magnitude estimation scaling of loudness. The five stimuli chosen were a 1000-Hz pure tone, narrow band noise (700-1300 Hz band width), broad band noise (100-10,000 Hz band width), rock music, and babble speech, i.e., speech in which meaning is not discernible because several individuals are talking at once. Subjects were 30 normal young women (M = 19 yr.). During the auditory magnitude-estimation task for each of the five stimuli, a subject was instructed to assign numbers to stimulus presented in a randomly ordered series of nine sensation levels (10, 20, 30, 40, 50, 60, 70, 80, and 90 dB SL). Multivariate analysis of variance for repeated measures indicated there were no significant differences in the numerical responses of the subjects for the five stimuli. A possible explanation for these results is the presence of an underlying stabilizing factor (internal scaling mechanism) that allows adults to scale loudness consistently irrespective of the type of auditory stimulus.

The effect of preference for three different types of music on magnitude estimation-scaling behavior in young adults

The purpose of the present study was to assess the effect of preference for three different types of music on magnitude estimation scaling behavior in young adults. Three groups of college students, 10 who liked rock music, 10 who liked big band music, and 10 who liked classical music were tested. Subjects were instructed to assign numerical values to a random series of nine suprathreshold intensity levels of 10-sec, samples of rock music, big band music, and classical music. Analysis indicated that subjects who liked rock music scaled that stimulus differently from those subjects who liked big band and classical music. Subjects who liked big band music scaled that stimulus differently from those subjects who liked rock music and classical music. All subjects scaled classical music similarly regardless of their musical preferences. Results are discussed in reference to the literature concerned with personality and preference as well as spectrographic analyses of the three different types of music used in this study.

The distribution of hearing threshold levels in the general population aged 18-30 years

Hearing threshold levels at audiometric frequencies between 0.25 and 8 kHz were obtained by manual audiometry using 5-dB steps in adults aged 18-30 years, as part of a large random survey of hearing in the UK. After screening to ensure otological normality, including careful analysis of any noise exposure history, the median thresholds of the 241 screened subjects deviated from audiometric zero by an average of 4.3 dB over the frequencies from 0.5 to 4 kHz in the direction of poorer hearing. Even greater deviations were evident at 0.25, 6 and 8 kHz, consistent with the discrepancies between normal hearing threshold and ISO 389 standard reference zero that have been reported previously. Within the age band from 18 to 30 years, age did not influence hearing threshold levels. Socio-economic status defined by occupational group (manual or non-manual) had a significant effect at frequencies up to 2 kHz, with those in non-manual occupations having better hearing than those in manual occupations by an average of 2.4 dB, despite screening for middle-ear disease, noise exposure and other possibly confounding factors. In a screened sample, males had better hearing threshold levels than females, but this difference was sensitive to screening criteria. The unscreened sample had median hearing threshold levels that were at most 2 dB worse than the screened sample across the frequency range.