Medical Student Columbia University Vagelos College of Physicians and Surgeons New York, New York
Objective: Subclinical hearing loss (SCHL, defined as a 4-frequency pure tone average [PTA] of 1-25 dB) has recently been associated with depressive symptoms and cognitive decline. This suggests that the common 25 dB adult cutpoint for normal hearing may not be sensitive enough. We aim to characterize real-world hearing difficulties, as measured by hearing aid use and self-reported hearing difficulty, among individuals with SCHL and borderline hearing loss (PTA4 of 21-25 dB).
Study Design: Analysis of biennial cross-sectional epidemiological survey (NHANES 1999-2012, 2015-2016)
Setting: Community
Subjects: Non-institutionalized U.S. citizens >12 years old, n=19,259
Main Outcome Measures: PTA4 (500, 1000, 2000, 4000 Hz), PTAhf (6000, 8000 Hz), subjective difficulty hearing, and hearing aid use
Results: Nearly 1 million Americans with SCHL wore hearing aids (~795,000, or 0.35%, 95% CI=0.23%-0.54%). 15.0% (13.9-16.3%; or 34.1 million) of those with SCHL reported at least “a little trouble” hearing, which increased to 41.8% for those with borderline hearing loss. Among those with SCHL who wore hearing aids, 80.8% had an abnormal PTAhf (i.e. PTAhf>25 dB). Among those with SCHL who reported at least “a little trouble” hearing, 50.4% had an abnormal PTAhf.
Conclusions: Despite hearing loss traditionally being defined by PTA4≤25, nearly 1 million adults and adolescents with SCHL (PTA4 of 1-25 dB) wore hearing aids, and nearly half with borderline HL (PTA4 of 21-25 dB) had subjective difficulty hearing. To better reflect real-world difficulties, stricter definitions of hearing loss should be explored, including a lower cutpoint for the PTA4 or by using the more sensitive PTAhf.
*Professional Practice Gap & Educational Need: SCHL has recently been associated with cognitive decline and depressive symptoms. This raises the question of whether the traditional definition of hearing loss may be too insensitive. It is unclear whether those with so-called SCHL are truly asymptomatic.
*Learning Objective: To understand the prevalence of hearing aid use and reported difficulty hearing among those with SCHL and borderline hearing loss.
*Desired Result: Practitioners will understand that a substantial fraction of those with SCHL have reported difficulty hearing and a meaningful absolute number wear a hearing aid. Practitioners should recognize that the 25 dB PTA4 cutoff commonly used to define hearing loss may be too insensitive.