Medical Student Columbia University Vagelos College of Physicians and Surgeons New York, New York
Objective: Worse hearing has recently been associated with worse cognition and depressive symptoms. This holds true even among adults considered to have normal hearing (4-frequency pure tone average [PTA4] < 25 dB), thus supporting the term subclinical hearing loss (SCHL). A detailed study of the prevalence of SCHL in the U.S. has not been performed.
Study Design: Analysis of biennial cross-sectional epidemiological survey (NHANES; 1999-2012, 2015-2016).
Setting: Community
Subjects:Non-institutionalized U.S. citizens age ≥12 years
Main Outcome Measures: 4-frequency (500, 1000, 2000, 4000 Hz) PTA (PTA4) and high frequency (6000, 8000Hz) PTA (PTAhf).
Results: 81% percent (95% CI=80.1-82.1%) of participants (~227.3 million Americans) had SCHL defined by 1≤PTA4≤25 dB. 65% (63.1-66.1%) had SCHL defined by 1≤PTAhf≤25 dB (~181 million Americans). The average age of hearing loss (HL) onset at PTA4 thresholds of 25, 20, and 15 dB was 75.4, 67.4, and 58.4 years, respectively. The average age of HL onset at PTAhf thresholds of 25, 20, and 15 dB was 52.4, 46.9, and 40.6 years, respectively. Across the lifespan, the PTA4 showed constant acceleration of 0.0044 dB/year2 (95% CI=0.00429-0.00443). PTAhf showed constant acceleration of 0.0091 dB/year2 (95% CI=0.00900-0.00924).
Conclusions: This study informs national discussions on the definition of HL onset. Recent data has suggested that the threshold to define adult HL may be too high, particularly because even so-called subclinical levels of HL may be associated with deleterious conditions of aging. We present the prevalence of SCHL as well as of HL defined by various stricter cutpoints.
*Professional Practice Gap & Educational Need: Recent evidence has suggested that the association between HL and neurocognitive conditions of aging may begin at earlier levels of HL than previously expected. A granular characterization of the prevalence of so-called SCHL has not been reported.
*Learning Objective: Determine the prevalence of SCHL in Americans. Understand the prevalence of HL based on stricter cutpoints.
*Desired Result: Providers will understand that the current definition of HL has been challenged as well as the prevalence of HL based on stricter definitions.