Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Study
Editor's Note: This Manuscript was accepted for publication on June 22, 2020.
Supported by the National Institute on Aging (NIA)/the National Institutes of Health (NIH) grants K23AG057832, L30AG060513 (j.s.g.). COI: Anil K. Lalwani, MD: advisory board (Advanced Bionics, Med El, Spiral Therapeutics). Justin S. Golub: travel expenses for industry-sponsored meetings (Cochlear, Advanced Bionics, Oticon Medical), consulting fees or honoraria (Oticon Medical, Auditory Insight, Optinose, Abbott, Decibel Therapeutics), department received unrestricted educational grants (Storz, Stryker, Acclarent, 3NT, Decibel Therapeutics). The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objective
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/year2 (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.
Level of Evidence
3 Laryngoscope, 131:879–884, 2021
