Speech audiometry findings from HIV+ and HIV− adults in the MACS and WIHS longitudinal cohort studies

Abstract

The purpose of this study was to compare various speech audiometry measures between HIV+ and HIV- adults and to further evaluate the association between speech audiometry and HIV disease variables in HIV+ adults only. Three hundred ninety-six adults from the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS) completed speech audiometry testing. There were 262 men, of whom 117 (44.7%) were HIV+, and 134 women, of whom 105 (78.4%) were HIV+. Speech audiometry was conducted as part of the standard clinical audiological evaluation that included otoscopy, tympanometry, and pure-tone air- and bone-conduction thresholds. Specific speech audiometry measures included speech recognition thresholds (SRT) and word recognition scores in quiet presented at 40 dB sensation level (SL) in reference to the SRT. SRT data were categorized in 5-dB steps from 0–25 dB hearing level (HL) with one category as ≥30 dB HL while word recognition scores were categorized as <90%, 90–99%, and 100%. A generalized estimating equations model was used to evaluate the association between HIV status and both ordinal outcomes. The SRT distributions across HIV+ and HIV- adults were similar. HIV+ and HIV- adults had a similar percentages of word recognition scores <90%, a lower percentage of HIV- adults had 90–99%, but HIV- adults had a higher percentage of 100%. After adjusting for covariables, HIV+ adults were borderline significantly more likely to have a higher SRT than HIV- adults (odds ratio [OR]=1.45, p=0.06). Among HIV+ adults, HIV-related variables (i.e., CD4+ T-cell counts, HIV viral load, and ever history of clinical AIDS) were not significantly associated with either SRT or word recognition score data. There was, however, a ceiling effect for word recognition scores, probably the result of obtaining this measure in quiet with a relatively high presentation level. A more complex listening task, such as speech-in-noise testing, may be a more clinically informative test to evaluate the effects of HIV on speech communication.

Main Aspects of Peripheral and Central Hearing System Involvement in Unexplained HIV-Related Hearing Complaints

“…Based on our Pubmed and Cochrane search a total of nine articles were found and after subtracting the articles that did not meet the criteria of recent publication and/or adult population, only 4 remained. However, with articles found from references we selected a total of 13 relevant publications related to 11 different study populations from locations in Africa, Asia, South-America and the USA (2, 5–16).…”

“…The pneumatization and function of the middle ear can be assessed by otoscopic evaluation and tympanometry—a readily easy test to perform, also in endemic areas that are most affected by HIV. A total of 7 studies described tympanometry in their study protocol (2, 4, 9–11, 13, 16, 17). It should be stated that often acoustic immittance testing was only performed to exclude middle ear pathology before continuing hearing screening.…”

“…A total of 8 studies looked at variables such as gender, age, stage of disease, use of ART related to PTA hearing loss. The most prominent factor was increased age (5, 6, 11, 15, 16). Increased duration of disease, CD4 + cell count, and advanced stage of disease seemed to increase the risk of hearing loss, but findings were not consistent in all studies (5, 9, 11, 14, 16).…”

“…The most prominent factor was increased age (5, 6, 11, 15, 16). Increased duration of disease, CD4 + cell count, and advanced stage of disease seemed to increase the risk of hearing loss, but findings were not consistent in all studies (5, 9, 11, 14, 16). While Torre et al found no association between treatment variables and PTA (15), Matas et al described an increased odds ratio for hearing loss in HIV infected individuals receiving ART compared to treatment naïve individuals (2).…”

“…The application of three-way ANOVA in the study of Luque et al revealed higher WRS scores in HIV seronegative controls, and a significant difference compared to individuals with HIV infection at late stage disease (adjusted P = 0.03) (11). However, from a clinical perspective this difference seems inconsequential (16). There was also a significant effect of age on WRS regardless of HIV infection.…”