Abstract
Background: The definition of notched audiogram for noise-induced hearing loss (NIHL) is presently based on clinical experience, but audiometric phenotypes of NIHL are highly heterogeneous. The data-driven clustering of subtypes could provide refined characteristics of NIHL, and help identify individuals with typical NIHL at diagnosis.Methods: This cross-sectional study initially recruited 12,218 occupational noise-exposed employees aged 18–60 years from two factories of a shipyard in Eastern China. Of these, 10,307 subjects with no history of otological injurie or disease, family history of hearing loss, or history of ototoxic drug use were eventually enrolled. All these subjects completed health behavior questionnaires, cumulative noise exposure (CNE) measurement, and pure-tone audiometry. We did data-driven cluster analysis (k-means clustering) in subjects with hearing loss audiograms (n = 6,599) consist of two independent datasets (n = 4,461 and n = 2,138). Multinomial logistic regression was performed to analyze the relevant characteristics of subjects with different audiometric phenotypes compared to those subjects with normal hearing audiograms (n = 3,708).Results: A total of 10,307 subjects (9,165 males [88.9%], mean age 34.5 [8.8] years, mean CNE 91.2 [22.7] dB[A]) were included, 3,708 (36.0%) of them had completely normal hearing, the other 6,599 (64.0%) with hearing loss audiograms were clustered into four audiometric phenotypes, which were replicable in two distinct datasets. We named the four clusters as the 4–6 kHz sharp-notched, 4–6 kHz flat-notched, 3–8 kHz notched, and 1–8 kHz notched audiogram. Among them, except for the 4–6 kHz flat-notched audiogram which was not significantly related to NIHL, the other three phenotypes with different relevant characteristics were strongly associated with noise exposure. In particular, the 4–6 kHz sharp-notched audiogram might be a typical subtype of NIHL.Conclusions: By data-driven cluster analysis of the large-scale noise-exposed population, we identified three audiometric phenotypes associated with distinct NIHL subtypes. Data-driven sub-stratification of audiograms might eventually contribute to the precise diagnosis and treatment of NIHL.
Highlights
Noise-induced hearing loss (NIHL) is one of the most common hearing loss in adults [1], with increasing incidence in children and adolescents [2] due to widespread recreational and transport noise exposure [3, 4]
The total subjects were recruited from two independent factories in a shipyard, who had similar types of occupational tasks, despite significantly different distributions of sex, age, cumulative noise exposure (CNE), hearing loss, and other characteristics
We repeated the cluster process, respectively, in total dataset, dataset 1 and dataset 2 to verify that the cluster structure described for each dataset was reproducible
Summary
Noise-induced hearing loss (NIHL) is one of the most common hearing loss in adults [1], with increasing incidence in children and adolescents [2] due to widespread recreational and transport noise exposure [3, 4]. The majority of studies have adopted different definitions of high-frequency hearing loss [12, 13] and notched audiogram [14,15,16], which were chosen mainly by specialized intuition or clinical experience, rather than by data-driven analysis. These inconsistent assessment methods were manifested by various ranges of frequency and degrees of hearing loss, which may represent different subtypes of NIHL with inconsistent responses to intervention, and inevitably result in incomparable conclusions between studies. The data-driven clustering of subtypes could provide refined characteristics of NIHL, and help identify individuals with typical NIHL at diagnosis
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