Measurable Hearing Loss Research Articles

Factors Associated With Self-Perceived Hearing Handicap in Adults From Hispanic/Latino Background: Findings From the Hispanic Community Health Study/Study of Latinos.

We sought to determine what factors, including acculturation (language and social contact preferences), were associated with self-perceived hearing handicap among adults from Hispanic/Latino background. We utilized the Aday-Andersen behavioral model of health services utilization to frame our hypotheses that predisposing characteristics (age, sex, education, city of residence, Hispanic/Latino background, and acculturation), enabling resources (annual income and current health insurance coverage), and need (measured hearing loss and self-reported hearing loss) would be related to clinically-significant self-perceived hearing handicap as measured by the Hearing Handicap Inventory - Screening (HHI-S) version. We analyzed baseline data collected from 2008 to 2011 as part of the multisite Hispanic Community Health Study/Study of Latinos. Data were from 6585 adults with hearing loss (defined by a worse-ear 500, 1000, 2000, and 4000 Hz pure-tone average [PTA] of ≥25 dB HL and/or a 4000, 6000, and 8000 Hz high-frequency PTA of ≥25 dB HL) aged 18 to 74 years from various Hispanic/Latino backgrounds. We conducted a series of multivariable logistic regression models examining the roles of independent variables of interest representing predisposing, enabling, and need indicators on the occurrence of clinically-significant self-perceived hearing handicap (e.g., HHI-S score > 8). Among included participants, 953 (14.5%) had an HHI-S score >8. The final model revealed significant associations between predisposing characteristics, enabling resources, need, and HHI-S outcome. Predisposing characteristics and need factors were associated with higher odds of reporting self-perceived hearing handicap (HHI-S score >8) including acculturation as measured by the Short Acculturation Scale for Hispanics (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.09-1.50), female sex (OR = 1.72, 95% CI: 1.27-2.33), and poorer worse ear 500, 1000, 2000, and 4000 Hz PTA (OR = 1.02, 95% CI: 1.01-1.03); suggesting that a 5-decibel increase in a person's PTA was consistent with 10% higher odds of a HHI-S score of >8. Greater enabling resources were associated with lower odds of reporting clinically-significant self-perceived hearing handicap: compared with individuals with income <$10,000/year, the multivariable-adjusted OR among individuals with income $40,000 to $7500/year was 0.55 (95% CI: 0.33-0.89) and among individuals with income >$75,000/year was 0.28 (95% CI: 0.13-0.59]; p-trend < 0.0001). Our findings suggest there are associations between predisposing, enabling and need variables consistent with the Aday-Andersen model and self-perceived hearing handicap among adults from Hispanic/Latino background. The influence of language and culture on perceived hearing loss and associated handicap is complex, and deserves more attention in future studies. Our findings warrant further investigation into understanding the role of language and language access in hearing health care utilization and outcomes, as the current body of literature is small and shows mixed outcomes.

Review of Hearing Loss Among Racial/Ethnic Minorities in the United States.

The purpose of this study is to synthesize the literature on hearing loss among racial/ethnic minorities in the United States. A scoping review of primary source articles from 1950 to 2019 was conducted across four databases-CINAHL, PsycINFO, PubMed, and Scopus-to identify peer-reviewed studies. Twenty-two research studies were included. Of the 22 studies, 19 were descriptive, and 3 were interventions. Among the 19 descriptive studies, five themes related to hearing loss were identified: hearing loss prevalence, accuracy of hearing loss assessment, hearing loss risk factors, access to hearing care, and attitudes toward hearing loss. The three interventional studies focused on measuring hearing loss prevalence and promoting access to hearing care. Findings from this scoping review highlight that hearing loss is prevalent in racial/ethnic minorities. More research is needed on how economic, cultural, and age-related factors may influence hearing outcomes for racial/ethnic minorities.

Survey of Teen Noise Exposure and Efforts to Protect Hearing at School - United States, 2020.

Noise-induced hearing loss (NIHL) is a substantial, often unrecognized, health problem. Various learning environments and activities in school settings are loud. Researchers have reported the prevalence of NIHL among U.S. adolescents ranging between 12.8% and 17.5%, suggesting that one in every six to eight middle and high school students (aged 12-19 years) has measurable hearing loss likely resulting from excessive noise exposure (1). Evidence suggests that even mild levels of hearing loss negatively affect auditory perception and cognitive skills.* CDC analyzed data from a sample of 817 youths aged 12-17 years who responded to the web-based YouthStyles survey in 2020. The survey measured the frequency of exposure to loud noise in school settings, the provision of hearing protection devices (HPDs) during exposure, and whether prevention techniques were part of their educational curriculum. Approximately three in four teenage students reported being exposed to loud sound at school, and nearly one half (46.5%) of respondents reported exposure to loud sounds at school on a regular basis. A majority of students (85.9%) reported that their school did not provide HPDs during classes or activities where they were exposed to loud sounds, and seven out of 10 reported they were never taught how to protect their hearing. Increasing youth's awareness about the adverse health effects of excessive noise exposure and simple preventive measures to reduce risk can help prevent or reduce NIHL. Health care providers and educators have resources and tools available to prevent NIHL among school-aged children. Increased efforts are needed to promote prevention.

Tinnitus impairs segregation of competing speech in normal-hearing listeners

Many tinnitus patients report difficulties understanding speech in noise or competing talkers, despite having “normal” hearing in terms of audiometric thresholds. The interference caused by tinnitus is more likely central in origin. Release from informational masking (more central in origin) produced by competing speech may further illuminate central interference due to tinnitus. In the present study, masked speech understanding was measured in normal hearing listeners with or without tinnitus. Speech recognition thresholds were measured for target speech in the presence of multi-talker babble or competing speech. For competing speech, speech recognition thresholds were measured for different cue conditions (i.e., with and without target-masker sex differences and/or with and without spatial cues). The present data suggest that tinnitus negatively affected masked speech recognition even in individuals with no measurable hearing loss. Tinnitus severity appeared to especially limit listeners’ ability to segregate competing speech using talker sex differences. The data suggest that increased informational masking via lexical interference may tax tinnitus patients’ central auditory processing resources.

Association between vision and hearing impairment and successful aging over five years

ObjectiveWe aimed to prospectively examine the relationship between vision and hearing loss and successful aging in a cohort of older adults. Study designWe analyzed 5-year data (1997-9 to 2002-4) from 1,085 adults aged 55+ years, who were free of cancer, coronary artery disease and stroke at baseline and who had complete data on sensory loss. Main outcome measuresVisual impairment was defined as visual acuity <20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dBHL (500-4000 Hz, better ear). Successful aging was defined as the absence of: disability, depressive symptoms, cognitive impairment, respiratory symptoms and chronic diseases (cancer, coronary artery disease and stroke) at 5-year follow-up. ResultsAt 5-year follow-up, 243 (22.4%) participants had died and 248 (22.9%) had aged successfully. After multivariable adjustment, participants who had either best-corrected visual impairment or bilateral hearing impairment, versus those who did not have sensory impairment at baseline, had 37% reduced odds of successful aging after 5 years: OR 0.63 (95% CI 0.43-0.94). Concurrent vision and hearing loss at baseline was not associated with 5-year aging status. Participants with moderate and severe hearing handicap at baseline had 50% and 61% reduced odds of aging successfully after 5 years, respectively. ConclusionThe presence of a single sensory impairment in older adults was associated with reduced odds of being disease-free and fully functional or having aged successfully, 5 years later. Objectively measured hearing loss and self-perceived hearing handicap, rather than vision loss, was more likely to negatively influence 5-year aging status.

The accuracy of a mobile phone application (Wulira app) compared to standard audiometry in assessing hearing loss among patients on treatment for multidrug-resistant tuberculosis in Uganda

Objectives: Our aim was to validate the “Wulira App” a mHealth application against gold standard audiometry as a pragmatic audiometry solution for under-served and vulnerable groups of patients at risk of hearing loss. The specific objectives were as follows: To compare hearing thresholds determined using the Wulira app to standard pure tone audiometry among patients on MDR-TB treatment. To determine the correlation between the measured hearing loss with the Wulira app and standard audiometry with patient reported hearing loss. To determine the proportion of patients on MDR-TB treatment that experience hearing loss? Materials and Methods: We consecutively recruited patients ≥18 years old and receiving kanamycin in their treatment regimen between February and June 2019 for this study. Clinical and demographic data were obtained from each participant and documented in a secure database. Participants had hearing assessment performed once at enrolment with paired standard audiometry and the Wulira mobile phone app in a soundproof room. Results: A total of 120 MDR-TB patients with a mean age of 34.0 (±9.6) years were recruited for this study and 69 (57.5%) were male. When compared to pure tone audiometry, the Wulira app was able to correctly detect 91.4% hearing loss in right ear and 88.4% in the left ear. The specificity of the Wulira app was equally high, reaching 93.2% in the right ear and 91.5% in the left ear. Conclusion: The Wulira app may be a useful alternative home-based tool for hearing assessment in MDR-TB patients, essentially for early detection of hearing loss following commencement of second-line injectable drugs.

Musical Experience Offsets Age-Related Decline in Understanding Speech-in-Noise: Type of Training Does Not Matter, Working Memory Is the Key.

Speech comprehension under "cocktail party" scenarios deteriorates with age even in the absence of measurable hearing loss. Musical training is suggested to counteract the age-related decline in speech-in-noise (SIN) perception, yet which aspect of musical plasticity contributes to this compensation remains unclear. This study aimed to investigate the effects of musical experience and aging on SIN perception ability. We hypothesized a key mediation role of auditory working memory in ameliorating deficient SIN perception in older adults by musical training. Forty-eight older musicians, 29 older nonmusicians, 48 young musicians, and 24 young nonmusicians all with (near) normal peripheral hearing were recruited. The SIN task was recognizing nonsense speech sentences either perceptually colocated or separated with a noise masker (energetic masking) or a two-talker speech masker (informational masking). Auditory working memory was measured by auditory digit span. Path analysis was used to examine the direct and indirect effects of musical expertise and age on SIN perception performance. Older musicians outperformed older nonmusicians in auditory working memory and all SIN conditions (noise separation, noise colocation, speech separation, speech colocation), but such musician advantages were absent in young adults. Path analysis showed that age and musical training had opposite effects on auditory working memory, which played a significant mediation role in SIN perception. In addition, the type of musical training did not differentiate SIN perception regardless of age. These results provide evidence that musical training offsets age-related speech perception deficit at adverse listening conditions by preserving auditory working memory. Our findings highlight auditory working memory in supporting speech perception amid competing noise in older adults, and underline musical training as a means of "cognitive reserve" against declines in speech comprehension and cognition in aging populations.

Protocol for a multi-centre randomised controlled stand-alone feasibility trial to assess potential effectiveness and cost-effectiveness of digital hearing aids in patients with tinnitus and hearing loss (the HUSH trial)

BackgroundThe most common management strategy for tinnitus provided in the UK audiology clinics is education and advice. This may also be combined with some form of sound therapy (e.g. digital hearing aids). While education and advice is generally provided by all clinics, there is a marked variability in provision of hearing aids that depends very much on clinical decisions. A recent Cochrane review concluded a lack of evidence to support or refute hearing aid use as a routine intervention for people with tinnitus and hearing loss. This lack of evidence is reflected in the inconsistency of tinnitus management in the UK. The aim of the HUSH trial is to determine the feasibility of conducting a definitive randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of hearing aids for adults with tinnitus and hearing loss.MethodsThis is a multicentre randomised controlled feasibility trial. Up to 100 adults, aged 18 and over, presenting to 5 UK audiology clinics with a complaint of tinnitus and measurable hearing loss are being randomised to receive either (i) education and advice (treatment as usual) or (ii) education and advice with digital hearing aids. Feasibility outcomes are being collected around recruitment, retention, patient and healthcare professional acceptability and clinical outcome assessment. Outcomes are being collected via postal questionnaire at 12 weeks post baseline. A nested interview study will supplement clinical and other outcome data, providing a detailed understanding of participants’ and audiologists’ experience of both tinnitus management and the research processes.DiscussionThis feasibility trial will help us to (i) determine if it is feasible to conduct a multicentre RCT comparing treatment as usual and treatment as usual plus digital hearing aids; (ii) optimise the design of a future definitive, multicentre RCT; and (iii) inform which outcome(s) is/are relevant for patients. This work presents an important first step in determining the effectiveness of hearing aids as a tinnitus management strategy.Trial registrationISRCTN, ISRCTN14218416. Registered on 30 July 2018.

Early Onset Region and Cell Specific Alterations of Doublecortin Expression in the CNS of Animals with Sound Damage Induced Hearing Loss

Sound damage induced hearing loss has been shown to elicit changes in auditory and non-auditory brain regions. A protein critical for neuronal migration and brain development, doublecortin (DCX), has been used as a marker of central nervous system (CNS) neuroplasticity. DCX is expressed in unipolar brush cells (UBCs) of the dorsal cochlear nucleus (DCN), cerebellar parafloccular lobe (PFL) and neuronal precursor cells in the sub-granular zone of the hippocampal dentate gyrus (DG). Sound damage induced hearing loss has been shown to differentially impact DCX expression months later. To identify earlier alterations in DCX expression, we utilized immunohistochemistry to detect DCX protein in three brain regions (DCN, PFL, DG) approximately one month following unilateral sound damage. Auditory brainstem response was used to measure hearing loss. Unilateral hearing loss was evident in all sound damaged animals. Hearing loss related decreases in DCX expression were evident bilaterally in the DG while hearing loss related increases in DCX expression were evident bilaterally in the PFL. No changes to DCX expression were evident in the auditory DCN. Gap detection was used to assess whether this sound damage paradigm induced tinnitus-like behavior. However, results obtained from this behavioral test as used here were inconclusive and are presented here only as a guide to others wishing to design similar studies.

Unperceived hearing loss among Canadians aged 40 to 79.

People with audiometrically measured hearing loss do not always self-report a hearing impairment. Data were collected from 2012 through 2015 as part of the Canadian Health Measures Survey. The study sample was composed of respondents aged 40 to 79 with valid audiometric results for both ears (n = 3,964). Unperceived hearing loss was defined by four criteria: audiometrically measured hearing loss, no self-reported hearing impairment, no hearing aid(s) and no history of a hearing problem diagnosis. Of the 8.2 million older adults with measured high-frequency hearing loss, an estimated 77% (6.3 million) had hearing loss that was unperceived. Individuals who had never worked in a noisy environment were more likely to have unperceived hearing loss. People who had experienced tinnitus were less likely than others to have unperceived hearing loss. Unperceived hearing loss occurs more often among those with mild or unilateral hearing loss and those who may not expect to experience hearing loss. Regular screening has been proposed to help raise awareness about hearing loss and to promote earlier detection and intervention that may ultimately improve the quality of life of those experiencing diminished hearing acuity.

Relationship between occupational noise exposure and hypertension: A cross-sectional study in steel factories.

Hazardous exposure to occupational noise may be associated with an increased risk of cardiovascular disease and hypertension. This study was performed to assess the relationship between noise exposure and hypertension prevalence in steelworkers. A cross-sectional survey using self-reported noise exposure and audiometrically measured hearing loss was performed. One thousand eight hundred and seventy-four workers were interviewed. Multiple logistic regression was used to calculate odds ratios for hypertension by noise exposure. Linear regression analysis was used to test associations between noise exposure and systolic blood pressure (SBP) and diastolic blood pressure (DBP). Occupational noise-exposed subjects had significantly higher blood pressure levels than nonexposed subjects (SBP: 123.18 ± (standard deviation) 12.44 vs 119.80 ± 12.50 mm Hg; DBP: 77.86 ± 9.34 vs 75.49 ± 8.73 mmHg). The prevalence of hypertension was approximately 5% in the control group without noise exposure or hearing impairment and increased from 6% to 21% across the range of increasing degree of hearing loss and, separately, of cumulative exposure time. Noise exposure (any) was associated with an increase in the prevalence of hypertension (odds ratio, 2.03, 95% confidence interval [CI]: 1.15-3.58). Noise-induced hearing loss and cumulative noise exposure time were positively correlated with BP (hearing loss: SBP: β = .09, 95% CI: 0.04-0.15 mm Hg, DBP: β = .11, 95% CI: 0.06-0.17 mm Hg; cumulative exposure time: SBP: β = .10, 95% CI: 0.04-0.15 mm Hg, DBP: β = .09, 95% CI: 0.04-0.15 mm Hg). Noise exposure measured in two different ways was strongly associated with the prevalence of hypertension in steelworkers. Reducing noise in the steel factory could be a way of decreasing the risk of hypertension in this population.

Prevalence of hearing loss among preschool children in Hanoi, Vietnam

Background: Hearing loss in children is a common entity worldwide. This study examined the prevalence of hearing loss among preschool children in Hanoi, Vietnam.Methods: A cross sectional was conducted among pre-schoolers aged 2-5 years in Hanoi, Vietnam to determine the prevalence of hearing loss according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step Automated Oto-Acoustic Emissions (AOAE) program, completed by an Auditory Brainstem Response (ABR) for the positive diagnosis of hearing impairment.Results: In total, there were 7,191 preschoolers and kindergarten screened. Three hundred and thirty-seven (4.7%) of children screened failed and were referred for further testing. The percentage of children with true hearing loss was 4.4% confirmed by ABR test. Majority of the hearing loss children was conductive hearing loss (70.4%). Mild hearing loss (21–≤40 dB) accounted for almost half of the children with hearing loss.Conclusions: This study provides the first estimates of audiometrically measured hearing loss prevalence among preschool children in Hanoi, Vietnam. The study found that hearing loss is common among pre-primary school children in the country. Routine hearing screening of school-age children should be included in annual school health programs in Vietnam.

Hidden hearing deficits in military service members with persistent post concussive symptoms

Individuals with persistent symptoms after mild traumatic brain injury (mTBI) often have auditory complaints. In this study, we used the auditory brainstem response (ABR) to determine whether cochlear synaptopathy could explain auditory symptoms. 69 adult military service members with mTBI and 25 adults without brain injury (NCT01611194 and NCT01925963) completed pure-tone audiometry, ABR, and central auditory processing tests. All participants were male, ages 21-50. 37/69 mTBI participants had measurable hearing loss, while another 20%-30% had hearing complaints or tinnitus. While mTBI participants with measurable hearing loss had reduced wave I and III amplitude and decreased III-V interpeak latency, those with no measurable hearing loss did not significantly differ from controls on any ABR parameter. Those with measurable hearing loss were also more likely to have abnormal central auditory processing. mTBI participants with no measurable hearing loss but who reported hearing concerns had some ABR findings (III-V interpeak latency, I and V amplitudes, V/I amplitude ratio) more like the measurable hearing loss mTBI group than normative controls. Cochlear synaptopathy may have contributed to some of the auditory impairment in service members with mTBI with measurable hearing loss. However, these results are likely confounded by cochlear hair cell damage.

Discrepancies between self-reported hearing difficulty and hearing loss diagnosed by audiometry: prevalence and associated factors in a national survey

ObjectiveTo evaluate discrepancies prevalent between self-reported hearing difficulty (SHD) and audiometrically measured hearing loss (AHL) and factors associated with such discrepancies.DesignNationwide cross-sectional survey.SettingData from 2010 to 2012 Korea National Health...

Hearing in Adults: A Digital Reprint of the Main Report From the MRC National Study of Hearing.

The 1011-page book, Hearing in Adults, published in 1995, contains the fullest report of the United Kingdom’s Medical Research Council National Study of Hearing. It was designed to determine the prevalence and distribution in Great Britain of audiometrically measured hearing loss as a function of age, gender, occupation, and noise exposure. The study’s size, quality, and breadth made it unique when it was done in the 1980s. These qualities remain, and its data are still the primary U.K. source for the prevalence of auditory problems. However, only 550 copies were printed, and the book is essentially unobtainable today. We describe here a fully searchable, open-access, digital (PDF) “reprinting” of Hearing in Adults, summarizing the study’s design and the book’s contents, together with a brief commentary in the light of subsequent developments.

Tinnitus Management in Lateral Skull Base Lesions.

Tinnitus, the phantom perception of sound in the absence of a physical sound source, is a complex problem with multiple etiologies. While most commonly presenting in a subjective fashion caused by measurable hearing loss, other etiologies including lateral skull base tumors that encroach on middle and inner ear structures can lead to phantom sound perception as well. In addition to discussing the basic background of tinnitus, here we also review current theories of etiology that include central auditory and nonauditory neural mechanisms and potential treatments that range from sound therapy to medications to cognitive and behavioral therapies and cranial nerve and brain stimulation. One main purpose of this article is to relate tinnitus causes to skull base tumors, surgical removal, and resultant sequelae, including damage to cranial nerves resulting in audiovestibular dysfunction. We also discuss the utility of microvascular decompression for both tumor and nontumor-associated tinnitus and the current literature regarding hearing preservation rates and tinnitus perception, where documented, with the three common treatment modalities employed for most lateral skull base tumors that includes watchful waiting with serial imaging, stereotactic radiosurgery and primary surgical resection using hearing preservation and hearing ablative approaches. The management of skull base tumors is a complex process that depending upon the approach and sequelae, may lead to manageable or worsening phantom sound perception that must be considered when discussing the multiple treatment options with patients.

Non-Occupational Noise-Induced Hearing Loss - an Emerging Epidemics: Current Status and Prevention Strategies

Noise is the most common preventable cause of hearing loss, the third most common chronic physical condition in the U.S. Sources of noise in the community and the numbers of those attending loud events, have increased in recent decades. As this preventable hearing loss often progresses insidiously for years before being self-perceived or diagnosed, it underscores the need for improving the availability of public health information for individuals and their healthcare providers. In early 2016 the Centers for Disease Control and Prevention (CDC) formed a small unfunded intra-agency workgroup to address the issues of non-occupational noise-induced hearing loss. The vision of this workgroup is to provide data and education, increase awareness and prevent noise-related hearing loss at home and in the community.We analyzed audiometric and health survey data from the National Health and Nutrition Examination Surveys (NHANES) 2007-2010 and 2011-2012. We estimated prevalence of audiometric notches as indicators for hearing damage. We found that 17% of US adolescents (12 to 19 years old) and 24% of US adults have audiometric notches. The presence of noise-induced hearing loss increased from one in five among young adults aged 20&amp;#8211;29 years to one in four among adults aged 50&amp;#8211;59 years. The prevalence rate of audiometric notches for females increased from 16% in the 2005-2006 survey to 20% in 2007-2010, and are now higher than in males. Almost one in four adults who reported excellent to good hearing already have measurable hearing loss. About 20 million American adults have hearing damage indicative of noise expose that may likely be due to everyday activities in their home and community. Prevention steps include avoidance and keeping noise down, as well as using personal hearing protection devices. CDC is also encouraging primary care providers and other clinicians, especially those involved in primary care, to ask about difficulty with hearing as part of routine care.

Little evidence for a chronotolerance effect for impulse noise exposure in the C57BL/6J mouse

Noise-induced hearing loss affects a large number of adults and children worldwide, and continues to be a major public health problem. The cochlea is an organ that maintains delicate metabolic homeostasis and precise mechanical architecture. Disruption of either can cause temporary or permanent injury. Impulse noises, which are short-duration, high-level bursts of sound caused by explosions, such as gunfire, can injure the cochlea through combinations of mechanical and metabolic injury. Susceptibility to the metabolic component of noise injury may vary with the circadian rhythm, a phenomenon known as chronotolerance. Chronotolerance to noise injury has been demonstrated for a one-hour noise exposure at a fixed level, but chronotolerance for impulse noise-induced hearing loss has never been studied. Forty-four mice were exposed to 500 short-duration clicks at 137 dB peSPL at one of four hours after light onset: 2, 8, 14, or 20. Auditory brainstem response threshold shifts were measured at 3, 7, and 21 days after the exposure to measure hearing loss, and post mortem outer hair cell counts were used to confirm cochlear injury. The testing revealed no significant differences between the four exposure times for hearing threshold shifts, but did detect a small, but statistically significant, difference in outer hair cell loss, in which the loss was greatest for the mice exposed two hours after light offset. Therefore, a weak chronotolerance effect for impulse noise was detected, though the functional significance of the effect is low. Further investigation is required to more fully understand the relationship between circadian rhythm and hearing loss from different types of noise exposure.

A protocol for a network meta-analysis of interventions to treat patients with sudden sensorineural hearing loss

BackgroundHearing loss is one of the leading causes of disability worldwide, with greater than 20% of Canadian adults having measurable hearing loss in at least one ear. Patients with hearing loss experience impaired quality of life, and emotional and financial consequences that affect themselves and their families. Sudden sensorineural hearing loss (SSNHL) is a common but difficult to treat form of hearing loss that has a sudden onset of ≤ 72 h associated with various etiologies, with the majority of cases being idiopathic. Some patients may partially or completely recover hearing ability, but for 32 to 65% of patients whose hearing does not recover, feelings of social isolation elevate the risk of anxiety and depression. Hearing loss is also associated with poorer functional status, including difficulty with sound localization and hearing in noise. There exists a wide range of therapeutic options; however, treatment of idiopathic SSNHL is controversial because some patients recover spontaneously. The planned systematic review and network meta-analysis (NMA) will assess the relative effects of competing treatments for management of idiopathic SSNHL in adults.MethodsElectronic search strategies were developed by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, and the Cochrane Library with no date or language restrictions. Key clinical trial registries will also be searched for in-progress and completed trials. Two reviewers will independently screen the literature using pre-specified eligibility criteria, and assess the quality of included studies using the Cochrane Risk of Bias tool. Disagreements will be resolved through consensus or third party adjudication. Bayesian NMAs will be pursued to compare interventions in terms of their effects on hearing (including audiometric thresholds and speech recognition scores), extent of hearing recovery, quality of life, and incidence of harms (including vestibular dysfunction, incidence of infections, and withdrawals due to adverse events).DiscussionThis systematic review and NMA will offer new and informative evaluations of current therapies for SSNHL. The results will inform clinicians as to the relative benefits of the currently available interventions for managing this difficult condition, provide optimal clinical treatment strategies, establish evidence gaps, and identify promising treatments for evaluation in future trials.Systematic review registrationPROSPERO registration number: CRD 42017073756.

Chronic Health Risks in Commercial Fishermen: A Cross-Sectional Analysis from a Small Rural Fishing Village in Alaska

ABSTRACTObjectives: The purpose of this study is to evaluate chronic health risks before and during the fishing season in a sample of commercial fishermen, addressing the NIOSH priority of Total Worker HealthTM.Methods: Gillnet license holders in Cordova, Alaska (n = 607) were contacted to participate in a preseason survey (March 2015) assessing health behaviors. A mid-season survey (July 2015) was also conducted. Physical exams and additional assessments were performed on a subset of these fishermen.Results: Sixty-six fishermen participated in the preseason survey and 38 participated in the mid-season survey. The study population was overwhelmingly white males with an average age of 49. The average BMI was 27 with 70% of the participants overweight or obese. Nearly 80% of the sample considered their health good or better. Participants reported longer working hours, less sleep, and less aerobic exercise during the fishing season (P < .05). FitBitTM monitoring (n = 8) confirmed less sleep and fewer steps during fishing season. In one exam (n = 20), 80% of participants showed measured hearing loss at 4 kz (conversation range), and 70% had one or more upper extremity disorders, including 40% with rotator cuff tendonitis.Conclusions: The prevalence of hearing loss, upper extremity disorders, and sleep apnea risk factors were higher than in the general population both before and during the fishing season. Occupational factors including exposure to noise, the upper extremity demands of gillnetting, and long working hours while fishing exacerbate these chronic health conditions. Health promotion programs targeted toward these conditions may present opportunities for improving total worker health.