Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans

Hughes, Charlotte Kaplan; Thapa, Samrita; Theodoroff, Sarah M.; Carlson, Kathleen F.; Schultz, James D.; Grush, Leslie D.; Reavis, Kelly M.

doi:10.1097/mao.0000000000004103

Cited by 3 publications

References 43 publications

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Hearing Loss, Incident Parkinson Disease, and Treatment With Hearing Aids

Neilson,

Reavis,

Wiedrick

et al. 2024

JAMA Neurol

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ImportanceThe risk of developing Parkinson disease (PD) after objective hearing loss is unknown. PD studies using self-reported hearing loss are insensitive, and objective data are lacking.ObjectiveTo examine the association of hearing loss with incident PD in US veterans and its effect modification by well-established prodromal conditions and hearing aids.Design, Setting, and ParticipantsThis cohort study analyzed electronic health record data from the US Department of Veterans Affairs for veterans who had an audiogram from January 1, 1999, to December 30, 2022. Individuals with data missing or a preexisting PD diagnosis were excluded.ExposureAudiogram-confirmed hearing loss.Main Outcomes and MeasuresCumulative incidence of PD was calculated with adjustment for competing risk of death.ResultsAmong 7 296 051 veterans with an audiogram, 3 596 365 were included. They were mostly male (n = 3 452 898 [96%]) and had a mean (SD) age of 67 (10.3) years. A total of 750 010 individuals (20.8%) had normal hearing at the time of audiometry examination; among those with hearing loss, 1 080 651 (30.0%), 1 039 785 (28.9%), 568 296 (15.8%), and 157 623 (4.3%) individuals had mild (20-&lt;35 dB), moderate (35-&lt;50 dB), moderate to severe (50-&lt;65 dB), and severe to profound (65-120 dB) hearing loss, respectively. Age, gender, and smoking history were balanced between all exposed and unexposed groups with further adjustment for race, ethnicity, and frailty. At 10 years after the baseline audiogram, the numbers of additional cases of PD were 6.1 (95% CI, 4.5-7.79, 15.8 (95% CI, 12.8-18.8), 16.2 (95% CI, 11.9-20.6), and 12.1 (95% CI, 4.5-19.6) among veterans with mild, moderate, moderate to severe, and severe to profound hearing loss, respectively, compared with those with normal hearing. When combined with established prodromal conditions, hearing loss was associated with 5.7 (95% CI, 2.2-9.2) additional cases of PD at 10 years compared with either condition alone. With prompt hearing aid dispensation, incident cases of PD decreased by 21.6 cases (95% CI, 19.5-23.6) at 10 years.Conclusions and RelevanceHearing loss appears to be an independent risk factor for later development of PD. Hearing aids attenuate this risk, and therefore widespread screening for hearing loss and appropriate use of hearing aids may reduce the incidence of PD. Additional studies are needed to examine the mechanisms underlying the association between hearing loss and PD.

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Hearing Loss, Incident Parkinson Disease, and Treatment With Hearing Aids

Neilson,

Reavis,

Wiedrick

et al. 2024

JAMA Neurol

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Blast Exposure, Tinnitus, Hearing Loss, and Postdeployment Quality of Life in U.S. Veterans: A Longitudinal Analysis

Mohammed,

Reavis,

Thapa

et al. 2024

Otol Neurotol

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Objective Examine the association between military blast exposure and functional status among veterans with a focus on functional disability as a proxy for quality of life and explore the potential modifying effect of hearing loss on this association. Study Design Prospective cohort. Setting Multi-institutional tertiary referral centers. Patients 540 veterans. Exposure Self-reported military blast exposure with and without tinnitus; high-frequency hearing loss (yes/no). Main Outcome Measure WHO Disability Assessment Schedule 2.0 questionnaires at baseline and annually over 5 years. The odds of membership into three functional disability trajectory groups: low functional disability, moderate functional disability, and high functional disability. Results Of 540 veterans, 197 (36.5%) self-reported a blast exposure history, and 106 of 197 (53.8%) reported tinnitus as a direct result of the blast. Blast exposure without tinnitus increased the odds of moderate functional disability compared with low functional disability (odds ratio [OR] = 1.5; 95% confidence interval [CI], 0.92–2.51), which strengthened among those with blast with tinnitus (OR, 3.6; 95% CI, 2.1–6.1). Blast exposure without tinnitus also increased the odds of membership to high functional disability versus low functional disability (OR, 2.2; 95% CI, 1.1–4.8). Hearing loss further increased the odds of reporting functional disability. The probability of low functional disability was approximately 60% if there was no history of blast or hearing loss, dropping to 20% if there was blast, tinnitus, and hearing loss history. Conclusions Blast exposure negatively affects the quality of life of veterans, especially when compounded with tinnitus and hearing loss.

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