dB Hearing Level Research Articles

Hearing Loss, Hearing Aids, and Cognition.

Most observational studies examining the association between hearing loss (HL) and cognitive impairment used subjective measures of hearing and addressed only one dimension of cognition, and very few investigated the potential benefit of hearing aids (HAs). To evaluate objectively measured HL and several dimensions of cognition and estimate the association with HA use. A cross-sectional analysis of the CONSTANCES cohort study, which recruited participants from January 1, 2012, to December 31, 2020, was conducted. Participants were a representative sample of adults (age, 45-69 years) with audiometric data and cognitive evaluation from 21 preventive health centers in France. Data analysis was conducted from April 1 to September 15, 2023. The main exposure was HL, which was defined by a pure-tone average in the best ear higher than 20 dB hearing level for mild loss and 35 dB hearing level for disabling loss. Secondary exposure was self-reported HA use. Cognition was evaluated at study inclusion by a standardized battery of 5 cognitive tests conducted by trained neuropsychologists. A global cognitive score was computed from principal component analysis and global cognitive impairment was defined as having a score less than or equal to the 25th percentile of the distribution. The study population included 62 072 participants with audiometric data (mean [SD] age, 57.4 [7] years; 52% women). Overall, 38% (n = 23 768) had mild HL, 10% (n = 6012) had disabling HL, and 3% (n = 1668) were HA users. In multivariable analyses, mild HL (odds ratio [OR], 1.10; 95% CI, 1.05-1.15) and disabling HL (OR, 1.24; 95% CI, 1.16-1.33) were associated with greater global cognitive impairment. The odds of cognitive impairment did not differ significantly between all participants with HA use and participants with disabling HL without HAs (OR, 0.94; 95% CI, 0.83-1.07), except among participants with depression (OR, 0.62; 95% CI, 0.44-0.88). In this cohort study, an association between the severity of HL and global cognitive impairment was found. The use of HAs was not associated with significantly lower odds of cognitive impairment. The findings suggest that it may be useful to monitor cognitive function in middle-aged individuals with HL.

Audiogram Estimation Performance Using Auditory Evoked Potentials and Gaussian Processes.

Auditory evoked potentials (AEPs) play an important role in evaluating hearing in infants and others who are unable to participate reliably in behavioral testing. Discriminating the AEP from the much larger background activity, however, can be challenging and time-consuming, especially when several AEP measurements are needed, as is the case for audiogram estimation. This task is usually entrusted to clinicians, who visually inspect the AEP waveforms to determine if a response is present or absent. The drawback is that this introduces a subjective element to the test, compromising quality control of the examination. Various objective methods have therefore been developed to aid clinicians with response detection. In recent work, the authors introduced Gaussian processes (GPs) with active learning for hearing threshold estimation using auditory brainstem responses (ABRs). The GP is attractive for this task, as it can exploit the correlation structure underlying AEP waveforms across different stimulus levels and frequencies, which is often overlooked by conventional detection methods. GPs with active learning previously proved effective for ABR hearing threshold estimation in simulations, but have not yet been evaluated for audiogram estimation in subject data. The present work evaluates GPs with active learning for ABR audiogram estimation in a sample of normal-hearing and hearing-impaired adults. This involves introducing an additional dimension to the GP (i.e., stimulus frequency) along with real-time implementations and active learning rules for automated stimulus selection. The GP's accuracy was evaluated using the "hearing threshold estimation error," defined as the difference between the GP-estimated hearing threshold and the behavioral hearing threshold to the same stimuli. Test time was evaluated using the number of preprocessed and artifact-free epochs (i.e., the sample size) required for locating hearing threshold at each frequency. Comparisons were drawn with visual inspection by examiners who followed strict guidelines provided by the British Society of Audiology. Twenty-two normal hearing and nine hearing-impaired adults were tested (one ear per subject). For each subject, the audiogram was estimated three times: once using the GP approach, once using visual inspection by examiners, and once using a standard behavioral hearing test. The GP's median estimation error was approximately 0 dB hearing level (dB HL), demonstrating an unbiased test performance relative to the behavioral hearing thresholds. The GP additionally reduced test time by approximately 50% relative to the examiners. The hearing thresholds estimated by the examiners were 5 to 15 dB HL higher than the behavioral thresholds, which was consistent with the literature. Further testing is still needed to determine the extent to which these results generalize to the clinic. GPs with active learning enable automatic, real-time ABR audiogram estimation with relatively low test time and high accuracy. The GP could be used to automate ABR audiogram estimation or to guide clinicians with this task, who may choose to override the GP's decisions if deemed necessary. Results suggest that GPs hold potential for next-generation ABR hearing threshold and audiogram-seeking devices.

Long-term follow-up of Bonebridge BCI 601 implantation for microtia patients with aural atresia: acoustic and subjective benefits.

This study evaluated the long-term acoustic and subjective outcomes of Bonebridge bone conduction implant (BCI) 601 implantation in Taiwanese microtia patients with aural atresia (AA). A total of 41 microtia patients (26 with bilateral AA and 15 with unilateral AA) who received Bonebridge BCI 601 implantation between December 2014 and March 2021 at Chang Gung Memorial Hospital, Linkou, Taiwan, were included in this retrospective study. Acoustic outcomes, including the functional hearing gain (FHG), speech reception threshold (SRT), and word recognition score (WRS), were assessed. Subjective outcomes were assessed using the Chinese versions of four questionnaires: the Abbreviated Profile of Hearing Aid Benefit (APHAB); the Speech, Spatial and Qualities of Hearing Scale; the International Outcome Inventory for Hearing Aids; and the Satisfaction with Amplification in Daily Living. The mean follow-up duration was 6.3 years (range, 2.8-9.1). The mean unaided air conduction pure tone average (PTA4) was 65.3 ± 8.8 decibels (dB) hearing level (HL) and the mean aided sound field PTA4 was 31.1 ± 9.1 dB HL, resulting in a FHG of 34.2 ± 11.7 dB HL (p < 0.05). After Bonebridge implantation, the mean SRT in quiet, SRT in noise, WRS in quiet, and WRS in noise improved from 58.3 ± 7.4 dB HL to 29.4 ± 7.0 dB HL, from -1.4 ± 7.3 dB signal-to-noise ratio (SNR) to -9.6 ± 5.4 dB SNR, from 46.4 ± 26.9% to 93.8 ± 3.1%, and from 46.7 ± 21.8% to 72.7 ± 19.3%, respectively (p < 0.05). Additionally, the bilateral AA group exhibited greater SRT and WRS improvements compared to the unilateral AA group (p < 0.05). All mean subscale scores in the four questionnaires showed improvement after Bonebridge implantation, except for the mean aversiveness to sounds subscale score in the APHAB questionnaire. Bonebridge BCI 601 implantation provided long-term acoustic and subjective benefits to microtia patients with AA, particularly those with bilateral AA.

Distinct audiometric patterns in congenital round window atresia: A comparative study with common congenital middle ear anomalies

ObjectiveLittle is known about the hearing characteristics in patients with congenital round window atresia (CRWA). This study aimed to investigate hearing characteristics in patients with CRWA by comparing them with two relatively common congenital middle ear anomalies: congenital stapedial fixation (CSF) and congenital ossicular discontinuity (COD). MethodsLiterature searches yielded five patients with surgically confirmed CRWA (seven ears), who were included in the CRWA group, along with one of our patients. Air and bone conduction thresholds; air-bone gap (ABG); and presence and depth of the Carhart notch were analyzed. These audiometric variables in the CRWA group were compared with those in the CSF (n = 15) and COD (n = 22) groups, comprising patients identified from our institution's medical database. ResultsAverage bone and air conduction thresholds in the CRWA group were 16.4 (standard deviation [SD]: 2.9; 95 % confidence interval [CI]: 14.6–18.3) and 44.6 (SD: 3.5; 95 % CI: 42.6–47.3) dB hearing level (HL). Bone conduction thresholds at high frequencies (≥2 kHz) were higher than those at low frequencies (<2 kHz), while air conduction thresholds at high frequencies were lower than those at low frequencies: ABGs at high frequencies were significantly smaller than those at low frequencies (2 kHz vs. 0.5 kHz, p = 0.027; 2 kHz vs. 1 kHz, p = 0.041; 4 kHz vs. 0.5 kHz, p = 0.042; 4 kHz vs. 1 kHz, p = 0.027). There were no between-group differences in incidence and depth of the Carhart notch. ConclusionCRWA could manifest as a distinct audiometric pattern with poorer bone conduction and better air conduction at ≥2 kHz, resulting in significantly smaller ABGs at higher frequencies than that at lower frequencies. Our findings indicated that this pattern differed from that of CSF and COD. The unique beer bottle-shaped audiogram associated with CRWA might facilitate its early diagnosis in patients with congenital conductive hearing loss.

Development and validation of a French speech-in-noise self-test using synthetic voice in an adult population

BackgroundSpeech-in-noise (SIN) audiometry is a valuable part of audiological diagnostics and clinical measurements, providing information on an individual's ability to understand in noise. To date, such tests have been developed with natural voice presented monaurally or binaurally (via diotic and dichotic presentation). The time required to develop such tests is often long. The use of synthetic voice would simplify the test creation process and self-testing would improve accessibility.DesignMeasurements were performed using an Android tablet (Samsung Galaxy Tab A7) and calibrated Bluetooth headphones (Tilde Pro C, Orosound). Normative values were first defined using natural or synthetic voice on 69 normal-hearing participants. A total of 463 participants then undertook the SIN test comprising synthetic voice and dichotic antiphasic presentation. Of these, 399 also performed the SIN test with diotic presentation.ResultsNo significant differences in the speech reception threshold (SRT) were found between natural and synthetic voices for diotic presentations (p = 0.824, paired Student t-test) with normative values of −10.7 dB SNR (SD = 1.5 dB) and −10.4 dB SNR (SD = 1.4 dB), respectively. For the SoNoise test with synthetic voice and dichotic antiphasic presentation, the results showed a normative value of −17.5 dB SNR (SD = 1.5 dB), and a strong correlation (r = 0.797, p &amp;lt; 0.001) with the four-frequency pure-tone average (4f-PTA). Receiver operating curves (ROC) were then calculated: for a 4f-PTA of 20 dB hearing level (HL), the SRT was −14.5 dB SNR with a sensitivity of 84% and specificity of 89%. For a 4f-PTA of 30 dB HL, the SRT was −13.7 dB SNR with a sensitivity of 89% and specificity of 91%. For a 4f-PTA of 35 dB HL, the SRT was −13.0 dB SNR with a sensitivity of 88% and specificity of 93%. The normative binaural intelligibility level difference (BILD) value was 8.6 dB (SD = 2.0 dB) with normal-hearing participants. The learning effect due to the task and interface was 1.7 dB (1st to 7th test) and test duration was 3 min.ConclusionThe SoNoise test in its synthetic dichotic antiphasic presentation is a fast and reliable tool to diagnose hearing impairment at 20, 30, and 35 dB HL cut-offs.

Endoscopic Transcanal Stapes Surgery: Our Audiological and Surgical Results

Endoscopic Transcanal Stapes Surgery: Our Audiological and Surgical Results&#x0D; Adem Bora, Tuğberk Salık&#x0D; Sivas Republic University Health Services Application and Research Hospital, Ear Nose Throat Clinic, Sivas, Turkey&#x0D; &#x0D; ABSTRACT&#x0D; Aim: The aim of this study is to investigate the intraoperative and postoperative results of endoscopic stapes surgery performed at our institution.&#x0D; &#x0D; Methods: A total of 25 patients with 28 ears (14 right, 14 left ears) who underwent endoscopic stapes surgery between 2018 and 2022 were analyzed for postoperative hearing outcomes and surgical complications at the 6-month follow-up.&#x0D; &#x0D; Results: The average age of the patients was 43.16 years (range, 24-63 years), and 64.0% of the patients were female. The median preoperative air-bone gap decreased from 30.36 dB hearing level (HL) to 18.95 dB HL after surgery (P &lt; 0.001). The postoperative air-bone gap was 10 dB or lower in 8 patients (28.6%), 11-20 dB in 10 patients (35.7%), and more than 20 dB in 6 patients (21.4%). Intraoperative complications included only tympanic membrane ruptures in one patient, which resolved during the initial follow-up. Postoperatively, 10.7% of the subjects complained of changes in taste sensation. One patient developed facial paralysis responsive to steroid treatment one week after surgery.&#x0D; &#x0D; Conclusion: Endoscopic surgery is particularly suitable for stapedial disorders. Endoscopic stapes surgery is minimally invasive and suitable for surgical training, as surgical anatomy can be easily understood, and both the surgeon and assistant can observe the procedure from the same monitor. The operation should only be performed by experienced surgeons due to the need for single-handed operation and the lack of stereoscopic vision.&#x0D; &#x0D; Keywords: Stapes; Stapedectomy; Outcomes; Endoscopic ear surgery

Natural History of Serviceable Hearing During Active Surveillance of Nongrowing Sporadic Vestibular Schwannoma Supports Consideration of Initial Wait-and-Scan Management

ObjectiveThe treatment paradigm of vestibular schwannoma (VS) focuses on preservation of neurologic function, with small tumors increasingly managed with active surveillance. Often, tumor size and hearing outcomes are poorly correlated. The aim of the current work was to describe the natural history of hearing among patients with nongrowing VS during observational management.Study DesignHistorical cohort study.PatientsAdults with sporadic VS.InterventionWait-and-scan management.Main Outcome MeasureMaintenance of serviceable hearing (SH) after diagnosis.ResultsAmong 228 patients with nongrowing VS, 157 patients had SH at diagnosis. Rates of maintaining SH (95% CI; number still at risk) at 1, 3, and 5 years after diagnosis were 94% (89–98; 118), 81% (74–89; 65), and 78% (71–87; 42), respectively. Poorer hearing at diagnosis (hazard ratio [HR] per 10 dB hearing level increase in pure-tone average of 2.51,p&lt; 0.001; HR per 10% decrease in word recognition score of 1.70,p= 0.001) was associated with increased likelihood of developing non-SH during observation. When controlling for baseline hearing status, tumors measuring 5 mm or greater in the internal auditory canal or with cerebellopontine angle extension were associated with significantly increased risk of developing non-SH (HR, 4.87;p= 0.03). At 5 years after diagnosis, 95% of patients with nongrowing intracanalicular VS measuring less than 5 mm maintained SH.ConclusionsHearing worsens during periods of nongrowth in sporadic VS. Patients with small (&lt;5 mm) intracanalicular tumors demonstrate robust maintenance of SH over time, reinforcing the consideration of initial observation in this patient subset.

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

ObjectivesWe 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 designOf 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 measuresAudiologists screened participants for reported dizziness using a single question. Quality of life was measured using the Short Form 36-item Health Survey (SF-36). ResultsThe 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). ConclusionsDizziness/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.

Estimated prevalence of permanent hearing loss among newborns and 6-year-olds: An evaluation of the three auditory screenings in Uppsala

ObjectivesThis study estimated the permanent hearing loss (PHL) prevalence among newborns and 6-year-olds in the Uppsala region (Sweden), compared how different definitions affected this estimation, and evaluated the outcome of the three hearing screening occasions for children. MethodsA retrospective investigation of medical records and audiograms was conducted for children born in 2011–2012. Data extraction was performed when the children had reached 7 years of age. Hearing loss was defined as > 20 dB hearing level in at least one frequency (125–8000 Hz) in one or both ears (clinician's definition). ResultsA total of 1385 children were included, and 95 were diagnosed with PHL. The prevalence of bilateral PHL at 6 years was 5.50 per 1000 children based on the clinician's definition, 3.74 per 1000 children based on the World Health Organization (WHO) 2021 definition, and 2.64 per 1000 children based on the WHO 1991 definition. Adding unilateral PHL resulted in a total prevalence of 10.11 (clinician's definition) and 6.16 (WHO 2021) per 1000 children. ConclusionThis study demonstrates the necessity of repeated hearing testing during childhood to identify PHL and suggests a higher prevalence in 6-year-olds than previously reported. The definition of PHL greatly impacted its estimated prevalence.

Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study

ObjectivesHearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use. DesignCross-sectional study of community-dwelling older adults at visit 6 (2016–2017) of the Atherosclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN). Setting and ParticipantsPopulation-based study of 3179 participants (mean age = 79.2 years, 58.9% female). MethodsPure-tone audiometry at 0.5–4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [≤25 dB hearing level (HL)], mild (26–40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively. ResultsIn our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01–1.57] and frail (OR, 1.62; 95% CI, 1.06–2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity. Conclusions and ImplicationsHearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.

Hearing Impairment and Allostatic Load in Older Adults

Allostatic load, the cumulative strain that results from the chronic stress response, is associated with poor health outcomes. Increased cognitive load and impaired communication associated with hearing loss could potentially be associated with higher allostatic load, but few studies to date have quantified this association. To investigate if audiometric hearing loss is associated with allostatic load and evaluate if the association varies by demographic factors. This cross-sectional survey used nationally representative data from the National Health and Nutrition Examination Survey. Audiometric testing was conducted from 2003 to 2004 (ages 20-69 years) and 2009 to 2010 (70 years or older). The study was restricted to participants aged 50 years or older, and the analysis was stratified based on cycle. The data were analyzed between October 2021 and October 2022. A 4-frequency (0.5-4.0 kHz) pure tone average was calculated in the better-hearing ear and modeled continuously and categorically (<25 dB hearing level [dB HL], no hearing loss; 26-40 dB HL, mild hearing loss; ≥41 dB HL, moderate or greater hearing loss). Allostatic load score (ALS) was defined using laboratory measurements of 8 biomarkers (systolic/diastolic blood pressure, body mass index [calculated as weight in kilograms divided by height in meters squared], and total serum and high-density lipoprotein cholesterol, glycohemoglobin, albumin, and C-reactive protein levels). Each biomarker was assigned a point if it was in the highest risk quartile based on statistical distribution and then summed to yield the ALS (range, 0-8). Linear regression models adjusted for demographic and clinical covariates. Sensitivity analysis included using clinical cut points for ALS and subgroup stratification. In 1412 participants (mean [SD] age, 59.7 [5.9] years; 293 women [51.9%]; 130 [23.0%] Hispanic, 89 [15.8%] non-Hispanic Black, and 318 [55.3%] non-Hispanic White individuals), a modest association was suggested between hearing loss and ALS (ages 50-69 years: β = 0.19 [95% CI, 0.02-0.36] per 10 dB HL; 70 years or older: β = 0.10 [95% CI, 0.02-0.18] per 10 dB HL) among non-hearing aid users. Results were not clearly reflected in the sensitivity analysis with clinical cut points for ALS or modeling hearing loss categorically. Sex-based stratifications identified a stronger association among male individuals (men 70 years or older: β = 0.22 [95% CI, 0.12-0.32] per 10 dB HL; women: β = 0.08 [95% CI, -0.04 to 0.20] per 10 dB HL). The study findings did not clearly support an association between hearing loss and ALS. While hearing loss has been shown to be associated with increased risk for numerous health comorbidities, its association with the chronic stress response and allostasis may be less than that of other health conditions.

Bilateral adhesive bone conduction devices in patients with congenital bilateral conductive hearing loss

PurposeThis study aims to characterize the hearing benefits and sound localization accuracy of bilateral adhesive bone conduction devices (aBCDs) compared to unilateral devices in patients with congenital bilateral conductive hearing loss (BCHL). MethodsSixteen children and adolescents with congenital BCHL were enrolled and tested under four listening conditions: (1) unaided, (2) R aided: aided with a right-side aBCD, (3) L aided: aided with a left-side aBCD, and (4) B aided: aided with aBCDs on both sides. The sound field hearing threshold (SFHT, in dB hearing level [HL]) and the word recognition score (WRS) were measured. The mean absolute error (MAE) of sound source localization was calculated to assess the sound localization accuracy. ResultsThe performance in SFHT and WRS was significantly higher in the B aided condition than that in the unaided, R and L aided conditions; moreover, no significant difference was observed between the R and L aided conditions. Concerning sound source localization, the accuracy of localization exhibited a sharp decline when using a single aBCD, while the application of bilateral aBCDs (B aided condition) resulted in a significantly improved localization accuracy as compared to the unilaterally aided conditions (both R and L); however, no significant difference was found between the unaided and B aided condition. ConclusionPatients with congenital BCHL experienced suboptimal hearing benefits and manifested significant challenges in sound source localization when utilizing a single aBCD, as compared to the utilization of bilateral aBCDs.

Prevalence of Subclinical Hearing Loss in the United States.

Current definitions of hearing loss (HL) may be insufficiently strict, as subclinical hearing loss (SCHL;>0and ≤25 dB hearing level) has been associated with deleterious age-related conditions. SCHL prevalence and mean age of HL onset in the United Stateshas not been characterized. A cross-sectional epidemiologic prevalence study. USCommunity. We analyzed cross-sectional audiometric data in the USNational Health and Nutrition Examination Survey (2005-2012, 2015-2018, n = 15,649). Results were scaled to the current population using weighting. 79.6% of participants (227.32 million Americans) had SCHL. The mean age of HL onset at thresholds of 25, 20, and 15 dB was 74, 66, and 55 years, respectively, for the 4-frequency pure-tone average, and 48, 44, and 35 years for the high-frequency pure-tone average. We present SCHL prevalence and define HL onset by various sensitive definitions. These results inform ongoing public health efforts to increase hearing aid utilization, particularly given the arrival of over-the-counter hearing aids.

The Longitudinal Relationship Between Hearing Loss and Cognitive Decline

The Longitudinal Relationship Between Hearing Loss and Cognitive Decline

Relationship of cardiovascular disease risk and hearing loss in a clinical population

Hearing loss has been associated with individual cardiovascular disease (CVD) risk factors and, to a lesser extent, CVD risk metrics. However, these relationships are understudied in clinical populations. We conducted a retrospective study of electronic health records to evaluate the relationship between hearing loss and CVD risk burden. Hearing loss was defined as puretone average (PTA0.5,1,2,4) > 20 dB hearing level (HL). Optimal CVD risk was defined as nondiabetic, nonsmoking, systolic blood pressure (SBP) < 120 and diastolic (D)BP < 80 mm Hg, and total cholesterol < 180 mg/dL. Major CVD risk factors were diabetes, smoking, hypertension, and total cholesterol ≥ 240 mg/dL or statin use. We identified 6332 patients (mean age = 62.96 years; 45.5% male); 64.0% had hearing loss. Sex-stratified logistic regression adjusted for age, noise exposure, hearing aid use, and body mass index examined associations between hearing loss and CVD risk. For males, diabetes, hypertension, smoking, and ≥ 2 major CVD risk factors were associated with hearing loss. For females, diabetes, smoking, and ≥ 2 major CVD risk factors were significant risk factors. Compared to those with no CVD risk factors, there is a higher likelihood of hearing loss in patients with ≥ 2 major CVD risk factors. Future research to better understand sex dependence in the hearing loss-hypertension relationship is indicated.

Subtemporalis Muscle Middle Cranial Fossa Bone-Island Craniotomy Technique for Placement of an Active Transcutaneous Bone-Conduction Implant.

Placement of an active transcutaneous bone-conduction implant (BCI) requires drilling of a precise bone bed to accommodate the device and allow for fixation points to make appropriate contact with bone, which can be difficult even when lifts are used. We describe a subtemporalis muscle middle cranial fossa bone-island craniotomy technique that simplifies the procedure and obviates the need for lifts in securing the device. Prospective case series. Tertiary academic medical center. Seventeen patients underwent surgery for placement of 18 transcutaneous BCIs, 14 for conductive or mixed hearing loss, and 4 for single-sided deafness. Surgical placement of a transcutaneous BCI with a bone-island craniotomy technique. Functional gain in air-conduction thresholds, aided air-bone gap, frequency of need for lifts, and minor and major complications. For the conductive or mixed hearing loss cohort, with the transcutaneous BCI in place, there was a highly statistically significant mean functional gain of 35.4 dB hearing level (HL) (range, 16.7-50.25 dB HL; standard deviation, 12.4 dB HL) compared with the unaided condition (p < 0.0001; 95% confidence interval, 36.6-51.6 dB HL). Lifts were not needed in any case. There was one minor complication requiring a second procedure in a patient who had previously received radiation and no major complications. There was no device loss or failure. A subtemporalis muscle middle cranial fossa bone-island craniotomy technique eliminates the need for lifts and is a safe and effective method for placement of a transcutaneous BCI.

Further Evidence for Individual Ear Consideration in Cochlear Implant Candidacy Evaluation.

To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing. Retrospective review. Tertiary referral center. One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear. PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ). Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% ( p < 0.0001) at 6 months and 49.3% ( p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% ( p < 0.0001) at 6 months and 64.3% ( p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month ( p = 0.936) or 12-month ( p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%). CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria.

Audiometric Outcomes After Surgical Repair of Congenital Aural Atresia: Does Age Matter?

To determine if there is an age-based difference in audiometric outcomes for patients undergoing primary congenital aural atresia (CAA) repair. Retrospective chart review. Single academic, high-volume, tertiary care hospital. Individuals undergoing primary CAA repair by a single surgeon between 2004 and 2020. CAA repair. Preoperative and postoperative four tone (500, 1,000, 2,000, 4,000 Hz) air-conduction pure-tone average (PTA), bone-conduction PTA, air-bone gap and speech reception threshold, and preoperative to postoperative change in values. We identified 247 patients (262 ears) who underwent repair. The mean and median ages were approximately 12 and 8.5 years, respectively, both of which served as cutoff ages to compare younger versus older patients. The average preoperative to postoperative improvement values in air-conduction PTA, air-bone gap, and speech reception threshold for individuals younger than 12 years were 26.6 ± 10.2, 23.8 ± 12.6, and 30.1 ± 12.1 dB hearing level (HL), respectively, and those for individuals 12 years or older were 25.9 ± 15.7, 26.2 ± 10.3, and 31.3 ± 12.8 dB HL, respectively. For individuals younger than 8.5 years, the values were 25.8 ± 9.5, 24.9 ± 9.4, and 30.0 ± 10.6 dB HL, respectively, and those for individuals 8.5 years or older were 27.1 ± 13.5, 25.7 ± 11.0, and 30.0 ± 14.6 dB HL, respectively. The improvement did not differ significantly between the younger and older groups, using both cutoff ages. There was no difference in revision surgery rates or complications between groups. An individual at any age can enjoy audiometric improvement from atresia repair.

Clinical Performance, Safety, and Patient-Reported Outcomes of an Active Osseointegrated Steady-State Implant System.

ObjectiveTo investigate the clinical performance, safety, and patient-reported outcomes of an active osseointegrated steady-state implant system that uses piezoelectric technology.Study DesignA prospective, multicenter, open-label, single-arm, within-subject clinical investigation.SettingThree tertiary referral clinical centers located in Melbourne, Sydney, and Hong Kong.PatientsTwenty-nine adult subjects, 24 with mixed hearing loss or conductive hearing loss and 5 with single-sided sensorineural deafness.InterventionImplantation with the Cochlear Osia 2 System.Main Outcome MeasuresAudiological threshold evaluation and speech recognition in quiet and in noise. Patient satisfaction and safety.ResultsAt 6-month follow-up after surgery, a mean improvement in pure-tone average of 26.0 dB hearing level and a mean improvement of 8.8 dB signal-to-noise ratio in speech reception threshold in noise was achieved with the investigational device as compared with the unaided situation. Usability of the investigational device was rated 71.4/100 mm for sound processor retention and 81.4/100 mm for overall comfort using a visual analog scale.ConclusionThese outcomes confirm the clinical safety, performance, and benefit of an innovative active transcutaneous bone conduction implant using a piezoelectric transducer design in subjects with conductive hearing loss, mixed hearing loss, or single-sided sensorineural deafness.

Obstructive sleep apnea risk and hearing impairment among occupational noise-exposed male workers

This study aimed to investigate the association between obstructive sleep apnea (OSA) risk and hearing impairment among workers exposed to occupational noise. A cross-sectional study was conducted among 607 healthy male workers at a tire-manufacturing factory. The subjects underwent audiometric testing, and their OSA risk was examined based on the STOP-Bang questionnaire. Hearing impairment was defined as a hearing threshold >25 dB hearing level (HL) in any frequency of 1, 2, 3 and 4 kHz in either ear. High OSA risk was defined as a STOP-bang score of ≥3. Hearing thresholds at 1, 2, 3 and 4 kHz in both ears were significantly higher among workers with high OSA risk than among those with low OSA risk after adjusting for confounders. Multiple logistic regression analysis examining the association of OSA risk and STOP-Bang score with hearing impairment revealed an odds ratio of 1.738 (95% confidence interval [CI] 1.113–2.713, p = 0.015) and 1.256 (95% CI 1.031–1.529, p = 0.023), respectively, after adjusting for confounders. In addition, when the hearing impairment was reclassified into high- and low-frequency hearing impairment, a statistically significant OR was seen for high-frequency hearing impairment. In conclusion, high OSA risk was associated with hearing impairment in occupational noise-exposed workers, especially in the high-frequency range of 3 and 4 kHz. More efforts are required to improve the management of OSA and its risk factors to preserve hearing in occupational noise-exposed workers.