Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population‐Based Study

Abstract

The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aim to characterize the progression, severity, and asymmetry of hearing loss in those 80 years of age and older using a representative, national database. Methods: Cross-sectional, multicentered U.S. epidemiologic analysis using the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006, 2009 to 2010, and 2011 to 2012 cycles. Subjects included noninstitutionalized, civilian adults aged 80 years and older (n = 621). Federal security clearance was granted to access publicly restricted age data. Outcome measures included pure-tone average (PTA) air conduction thresholds and the 4-frequency PTA. Results: Six hundred and twenty-one subjects were 80 years old or older (mean = 84.2 years, range = 80-104 years), representing 10,600,197 Americans. The average PTA was 38.9 dB (95% confidence interval [CI] = 37.8, 40.0). Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year 2 (95% CI = 0.0049, 0.0055). This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. From age 80 years to approximately 100 years, the average PTA difference between the better and worse ear was 6.75 dB (95% CI = 5.8, 7.1). This asymmetry was relatively constant (i.e., nonsignificant linear regression coefficient of asymmetry over age = 0.07 [95% CI = −0.01, 0.2]). Conclusion: Hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100 years, becoming near universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

The Laterality of Early Age-Related Hearing Loss and Brain β-Amyloid

“…Although ARHL is typically bilateral and symmetric, the symmetry is imperfect, conveniently providing variation to study whether the right or left ear may have asymmetrical effects (6,16). The concepts of “right ear advantage” and hemispheric lateralization may support the findings of this study.…”

“…It involves both ears and first affects perception of high frequency sounds, successively followed by lower frequencies. ARHL is highly prevalent, affecting nearly 50% of adults ages 60 to 69 and over 80% of those over 85 years old (1)(2)(3)(4)(5)(6). Moreover, ARHL has been linked to conditions of aging including dementia (7)(8)(9) and depression (9)(10)(11)(12).…”

“…The degree of hearing in the right versus left ear may not initially seem to play a role in the ARHL-cognition relationship due to the symmetric nature of ARHL. However, ARHL is often not perfectly symmetrical (6,16); these subtle asymmetries provide the substrate for further study. Furthermore, the brain does not symmetrically process auditory input.…”

Progressive Asymmetry in Occupational Noise-Induced Hearing Loss: A Large Population-Based Cohort Study With a 15-Year Follow-Up

“…Pure tone asymmetry may increase with age. 28 The three groups included in the present study showed a significant difference in the mean age. In average, the difference between ages in the non-noise-exposed group and 15-year noise-exposed group was 17.7 years.…”

Hearing loss patterns throughout life: Insights from Japan

“…Given that age-related hearing loss is associated with increased risk of incident dementia [1] , [2] , [3] and depressive symptoms [ 4 , 5 ], prompt diagnosis and intervention is important. In addition, the older population is rapidly growing [6] and better characterization of hearing loss in adults ≥80 years old is needed, as public datasets sometimes mask the upper extremes of age to protect anonymity [7] . In this issue, Koichiro Wasano and colleagues descriptively analyze how hearing thresholds, or the softest sound levels an individual can hear, change throughout the lifespan in a large sample of Japanese patients visiting an otolaryngology department [8] .…”