The burdens of age-related and occupational noise-induced hearing loss in the United States.
(2008)
Journal - Ear and hearing (United States )
Abstract :
OBJECTIVES: Aging and noise are generally considered the most common causes of adult hearing loss in developed countries. This study estimates the contributions of aging and occupational noise in the United States. DESIGN: A model of hearing loss burden in American adults was constructed using data from the Census Bureau, from an international standard that predicts age-related and noise-induced hearing loss (ISO-1999), from the American Medical Association method of determining hearing impairment, and from sources estimating the distribution of occupational noise exposure in different age and sex groups. RESULTS: Occupational noise exposure probably accounts for less than 10% of the burden of adult hearing loss in the United States; most of the rest is age-related. Most of the occupational noise burden is attributable to unprotected exposures above 95 dBA, and becomes apparent in middle age, when occupational noise exposure has ceased but age-related threshold shifts are added to prior noise-induced shifts, resulting in clinically significant impairment. CONCLUSIONS: In our current state of knowledge, noise-induced hearing loss is still the most important preventable cause of hearing loss in the United States. The burden of occupational noise-induced hearing loss could probably be reduced by stricter enforcement of existing regulations. Longer lifespans in developed countries and migration of manufacturing jobs to developing countries will continue to reduce the relative contribution of occupational hearing loss in countries like the United States. Preventive interventions for age-related hearing loss, even if only partially effective, could potentially reduce the burden of adult hearing loss more than elimination of occupational noise.
| ISSN : | 1538-4667 |
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| Mesh Heading : | Adult Aged Audiometry, Pure-Tone Auditory Threshold Cross-Sectional Studies Ear Protective Devices Female Hearing Loss, Noise-Induced Hearing Loss, Unilateral Humans Incidence Male Middle Aged Noise, Occupational Occupational Diseases Presbycusis Reference Values Risk Factors United States statistics & numerical data prevention & control diagnosis epidemiology etiology adverse effects diagnosis prevention & control etiology |
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| Mesh Heading Relevant : | epidemiology epidemiology diagnosis epidemiology |
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Noise-induced permanent threshold shifts in the occupational noise and hearing survey: an explanation for elevated risk estimates.
(2007)
Journal - Ear and hearing (United States )
Abstract :
OBJECTIVES: To (1) estimate noise-induced permanent threshold shift (NIPTS) values from the data of the 1968-1972 Occupational Noise and Hearing Survey (ONHS); (2) compare these NIPTS estimates to NIPTS predictions from an international standard (ISO-1999); (3) determine why excess risk estimates based on the ONHS are so much higher than those based on ISO-1999. DESIGN: The ONHS raw data were acquired from the National Institute for Occupational Safety and Health. Binaural average thresholds from 0.5 to 6 kHz were calculated for each of 1291 noise-exposed subjects (80 to 94 dBA, for up to 30 yr, all tested just before their shifts) and 665 non-noise-exposed control subjects (mostly office workers, tested throughout the work day). "Screened" subjects had had no prior significant noise exposure and had no evidence of other ear disease, whereas "excluded" subjects had failed one or more screening criteria. Twenty exposure groups were created (based on exposure level, exposure duration, and screened versus excluded status) and compared with 20 age-matched control groups. The median difference statistic estimated median NIPTS. RESULTS: Median NIPTS estimates in the 3 to 6 kHz region were generally consistent with the NIPTS predictions of ISO-1999. At lower frequencies, especially at 0.5 and 1 kHz, the ONHS estimates were significantly larger than the ISO-1999 predictions, even for exposures below 90 dBA, but these differences did not increase systematically with exposure level and duration. CONCLUSIONS: High-frequency median NIPTS estimates from ONHS data are consistent with the predictions of ISO-1999. Differences between exposed and control low-frequency thresholds in the ONHS are higher than predicted by ISO-1999, but these differences probably are related more to socioeconomic or test procedure effects than to occupational noise exposure. These low-frequency effects explain why excess risk estimates from the ONHS are higher than those based on ISO-1999.
| ISSN : | 0196-0202 |
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| Mesh Heading : | Adult Hearing Loss, Noise-Induced Humans Middle Aged Occupational Diseases Risk Assessment Severity of Illness Index epidemiology epidemiology |
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| Mesh Heading Relevant : | Auditory Threshold Questionnaires diagnosis diagnosis |
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Hearing loss in patients with vestibulotoxic reactions to gentamicin therapy.
(2006)
Journal - Archives of otolaryngology--head & neck surgery (United States )
Abstract :
OBJECTIVES: To determine whether patients with vestibulotoxic reactions to gentamicin have hearing thresholds worse than predicted by distributions of better-ear hearing thresholds in people of the same age and sex in the general population, and, if so, to measure the severity and audiometric pattern of that hearing loss. DESIGN: Retrospective case series from previously published prospective and retrospective studies of vestibular function in patients receiving gentamicin. SETTING: Tertiary neurotological practice. PATIENTS: Convenience sample of 33 consecutive patients seen for objective evidence of vestibulotoxic reactions after systemic gentamicin therapy. Twenty-five of 33 patients underwent valid and complete audiometry. MAIN OUTCOME MEASURES: Age- and sex-corrected better-ear pure tone thresholds, 0.5 to 6.0 kHz. The better-ear audiogram was defined in 2 ways: primarily, the audiogram of the ear with the better average threshold at 0.5, 1.0, and 2.0 kHz; secondarily, the composite audiogram taking the better threshold for each frequency. RESULTS: Patients exhibiting vestibulotoxic reactions to gentamicin therapy had hearing thresholds that were similar to those seen in the general population at 0.5, 3.0, and 6.0 kHz. Median thresholds were 6 to 7 dB worse than expected at 1.0 and 2.0 kHz (95% confidence intervals, 2-13 dB and 3-12 dB, respectively). The largest median difference was 15 dB at 4.0 kHz (95% confidence interval, 3-23 dB), but this difference was not significant for the more conservative composite definition of the better ear. CONCLUSIONS: Patients with vestibulotoxic reactions to gentamicin therapy have little additional hearing loss compared with the general population. Physicians should monitor both auditory and vestibular function when aminoglycosides, especially gentamicin, must be used.
| ISSN : | 0886-4470 |
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| Mesh Heading : | Adult Audiometry Female Gentamicins Hearing Loss Humans Male Middle Aged Retrospective Studies Vestibular Function Tests Vestibule, Labyrinth physiopathology |
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| Mesh Heading Relevant : | toxicity chemically induced drug effects |
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Methodological issues when comparing hearing thresholds of a group with population standards: the case of the ferry engineers.
(2006)
Journal - Ear and hearing (United States )
Abstract :
OBJECTIVES: To discuss appropriate and inappropriate methods for comparing distributions of hearing thresholds of a study group with distributions in population standards and to determine whether the thresholds of Washington State Ferries engineers are different from those of men in the general population, using both frequency-by-frequency comparisons and analysis of audiometric shape. DESIGN: The most recent hearing conservation program audiograms of 321 noise-exposed engineers, ages 35 to 64, were compared with the predictions of Annexes A, B, and C from ANSI S3.44. There was no screening by history or otoscopy; all audiograms were included. 95% confidence intervals (95% CIs) were calculated for the engineers' median thresholds for each ear, for the better ear (defined two ways), and for the binaural average. For Annex B, where 95% CIs are also available, it was possible to calculate z scores for the differences between Annex B and the engineers' better ears. Bulge depth, an audiometric shape statistic, measured curvature between 1 and 6 kHz. RESULTS: Engineers' better-ear median thresholds were worse than those in Annex A but (except at 1 kHz) were as good as or better than those in Annexes B and C, which are more appropriate for comparison to an unscreened noise-exposed group like the engineers. Average bulge depth for the engineers was similar to that of the Annex B standard (no added occupational noise) and was much less than that of audiograms created by using the standard with added occupational noise between 90 and 100 dBA. CONCLUSIONS: Audiograms from groups that have been selected for a particular exposure, but, without regard to severity, can appropriately be compared with population standards, if certain pitfalls are avoided. For unscreened study groups with large age-sex subgroups, a simple method to assess statistical significance, taking into consideration uncertainties in both the study group and the comparison standard, is the calculation of z scores for the proportion of better-ear thresholds above the Annex B median. A less powerful method combines small age-sex subgroups after age correction. Small threshold differences, even if statistically significant, may not be due to genuine differences in hearing sensitivity between study group and standard. Audiometric shape analysis offers an independent dimension of comparison between the study group and audiograms predicted from the ANSI S3.44 standard, with and without occupational noise exposure. Important pitfalls in comparison to population standards include nonrandom selection of study groups, inappropriate choice of population standard, use of the right and left ear thresholds instead of the better-ear threshold for comparison to Annex B, and comparing means with medians. The thresholds of the engineers in this study were similar to published standards for an unscreened population.
| ISSN : | 0196-0202 |
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| Mesh Heading : | Adult Audiometry, Pure-Tone Auditory Threshold Engineering Hearing Loss, Noise-Induced Humans Male Middle Aged Noise, Occupational Occupational Diseases Otoscopy Patient Selection Reference Standards Ships etiology physiopathology etiology physiopathology |
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| Mesh Heading Relevant : | physiology diagnosis adverse effects diagnosis |
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Audiometric threshold shift definitions: simulations and suggestions.
(2005)
Journal - Ear and hearing (United States )
Abstract :
OBJECTIVES: Determine (1) whether pure-tone average (PTA) or "any frequency" (AF) definitions of significant threshold shift (STS) are more accurate under different conditions; (2) whether STS definitions applied twice are more accurate than when applied once; (3) whether three surrogate analysis methods applicable to real-world audiometric data can appropriately measure the accuracy of STS definitions; and (4) whether evidence from previous studies supports a change in the current STS definition used by the Occupational Safety and Health Administration (OSHA); (5) make recommendations for future research. DESIGN: Computer simulation of periodic audiograms, with typical test-retest variability, from seven groups of individuals (N = 1000 each), with or without threshold shifts of different sizes at different frequencies; receiver operating characteristic area analysis to determine relative accuracy of PTA and AF decision variables, applied once or twice; testing of surrogate methods (confirmation, variability, and comparison) against receiver operating characteristic areas in estimation of accuracy of decision variables; review of previous studies, considering the limitations of the surrogate methods that were used. RESULTS: Either AF or PTA definitions may be preferable, depending on whether the genuine threshold shift has occurred at a single frequency or across a range of frequencies. Including too few or too many frequencies degrades the performance of both AF and PTA variables. An STS decision variable performs only slightly better when applied twice than when applied once. The surrogate methods can be useful, but all have important caveats: The comparison method is best, but only when an appropriate control group is available; the variability method is intermediate but requires that each decision variable be tested at multiple criterion values for reliable results. The confirmation method, which was the least accurate in assessing true performance, also requires testing at multiple levels. Even when this is done, it markedly exaggerates the benefit of applying an STS definition twice and makes STS definitions that identify large numbers of individuals falsely appear to be more accurate than definitions that identify smaller numbers of individuals. Taking these caveats into account, previous studies do not offer convincing evidence for a change in the current OSHA STS definition. CONCLUSIONS: Choice of an STS definition requires three judgments that cannot be made based on the type of analysis discussed in this report: The range of frequencies to be tested, whether to require that an STS definition be applied twice, and the acceptable magnitude of false-positive error. Once these judgments have been made, the techniques discussed here can assist in selecting the appropriate decision variable (typically PTA or AF) and a criterion value that yields an acceptable false-positive rate. Additional research using the techniques described in this report with either new or old audiometric databases could help determine whether any STS definition is significantly better than the current OSHA definition.
| ISSN : | 0196-0202 |
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| Mesh Heading : | Auditory Threshold Computer Simulation Hearing Loss Humans ROC Curve physiology prevention & control |
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| Mesh Heading Relevant : | Audiometry, Pure-Tone |
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Estimating noise-induced permanent threshold shift from audiometric shape: the ISO-1999 model.
(2005)
Journal - Ear and hearing (United States )
Abstract :
OBJECTIVE: To describe the relation between audiometric shape and noise-induced permanent threshold shift averaged across the speech frequencies (N5123). DESIGN: Using an international standard (ISO-1999), 270 audiograms were created, representing both sexes and a variety of ages, exposure levels, and percentiles. Bulge depth (BD) was defined as the difference between pure-tone average for 2, 3, and 4 kHz and PTA for 1 and 6 kHz. RESULTS: N5123 was well-predicted by quadratic functions of BD, which accounted for 72 to 95% of the variance in N5123. CONCLUSIONS: Estimates of N5123, based on BD, can be helpful in medical-legal diagnosis and allocation of hearing loss.
| ISSN : | 0196-0202 |
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| Mesh Heading : | Adult Audiometry, Pure-Tone Auditory Threshold Cross-Sectional Studies Female Hearing Loss, Noise-Induced Humans Male Middle Aged Models, Biological Speech Perception Speech Reception Threshold Test |
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| Mesh Heading Relevant : | physiology physiopathology physiology |
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Depression and tinnitus.
(2003)
Journal - Otolaryngologic clinics of North America (United States )
Abstract :
Most patients with tinnitus are neither depressed nor seriously bothered by their tinnitus. Patients who complain bitterly of tinnitus, however, are often found to have a MDD. Treatment with tricyclic antidepressant drugs helps these patients, especially those who complain of insomnia. Other types of drugs and psychotherapy may also be helpful.
| ISSN : | 0030-6665 |
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| Mesh Heading : | Depressive Disorder Humans Tinnitus therapy therapy |
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| Mesh Heading Relevant : | etiology psychology |
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