hearing loss (hearing impairment, hard of hearing, HOH)
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Introduction
A reduction in the ability to perceive sound.
- also see age-associated changes in hearing
Classification
- mild hearing loss: 25-40 bB
- moderate hearing loss: 41-55 dB
- severe hearing loss: 56-80 dB
- profound hearing loss: > 81 dB
Etiology
- conductive hearing loss
- cerumen impactation
- otosclerosis
- tympaninc membrane perforation
- cholesteoma
- ... see conductive hearing loss
- sensorineural hearing loss
- presbycusis (most common cause in elderly)
- Meniere's disease
- acoustic neuromma
- noise-induced
- drug-induced
- ... see sensorineural hearing loss
- combined conductive & sensorineural hearing loss
- infection
- head trauma
- central hearing loss
- acute unlateral hearing loss with vertigo & ataxia suggest CNS ischemia[6]
- risk factors[6][18]
- age
- diabetes mellitus (weak association)[16]
- Alzheimer's disease
- systolic hypertension[6]
- smoking[17]
- cardiovascular risk factors & cardiovascular disease[38]
- alcoholism*[17]
- NSAID & acetaminophen use in women (RR=1.1)[30]
* alcohol in moderation <= 2 drinks/day may be protective[17]
Epidemiology
- affects 10% of the general population
- 60% of childhood hearing loss is preventable[21]
- prevalence increase with age
- 10% of individuals 65-75 years of age
- 25% of individuals > 75 years of age
- 63% of individuals > 70 years of age; 74% among those with heart failure[35]
- prevalence in nursing homes is 50-100%
- hearing declines faster in men
- most common in hispanics[20]
- 1/3 of men & 1/4 of women > 45 years of age
- 45% of Cuban or Puerto Rican men > 45[20]
- 1/3 of men & 1/4 of women > 45 years of age
- associated with loud music festivals in young individuals[37]
- 7-10 years before most elderly bring to physician's attention[6]
Pathology
- loud noises, toxic drugs, viral infections gradually deplete the number of cochlear hair cells, leading to hearing loss[31]
- cochlear stem cells do not replace this loss[31]
- SLC44A2 may be an autoantigen for autoimmune hearing loss
- degeneration of the stria vascularis at the base & apex of the cochlea is the most prominent manifestation of presbycusis (high-frequency hearing loss)[6]
- low-frequency hearing loss is associated with conductive hearing loss
- aging-associated hearing loss results in atrophy of cortical auditory regions & stronger engagement of networks involved in detection of salient events, adaptive control & re-allocation of attention
- these cortical mechanisms are engaged during listening in effortful conditions in normal hearing individuals
- in the elderly with hearing loss, all listening becomes effortful, cognitive load is constantly high, & available resources for attention to other cognitive tasks is reduced[32]
Genetics
History
- ask patient about hearing impairment
- 90% concurrence between self-reported hearing impairment in adults > 50 years & assessment by audiometry[3]
Clinical manifestations
- mild hearing loss: 25-40 bB
- difficult to hear whisper
- difficult understanding soft speech or normal sound in the presence of background noise
- moderate hearing loss: 41-55 dB
- difficult to hear conversational speech
- loud speech needed for communication
- severe hearing loss: 56-80 dB
- difficulty hearing shouting or vacuum cleaner
- can understand only amplified speach
- profound hearing loss: > 81 dB
- difficulty hearing hair dryer, heavy traffic or telephone ringer
- diffulty understanding amplified speech
- may miss telephone calls
- associated findings
- tinnitus
- earache
- vertigo
- impaired ability to hear in noisy environment suggests sensorineural hearing loss
- muffled hearing suggests conductive hearing loss
- other
- decrease in quality of life
- negative impact on social engagement leading to social isolation
- apathy, inattention, avoiding conversations, withdrawing from friends & family
- maintenance of activities of daily living not dependent upon hearing
* see Differential diagnosis
Laboratory
- RPR (rapid plasma reagin) or VDRL to rule out/in syphilis
- DNA testing when indicated
Diagnostic procedures
- whispering is normally heard from about 2 feet: patients with presbycusis have great difficulty hearing a whisper because of high frequency loss
- Hearing Handicap Inventory in the Elderly-Screening Version (HHIE-S)
- screens for functional hearing loss
- most reliable screening tool[6]
- pneumatic otoscopy: examine external auditory canal & tympanic membrane
- next step after HHIE-S &/or if functional hearing loss confirmed[6]
- Weber test, Rinne test & Schwabach test distinguish conductive hearing loss from sensorineural hearing loss[3]
- next step after pneumatic otoscopy[6]
- office screening with audioscope (hand held)
- most accurate with 40 dB tone at 2000 Hz
- 94% sensitivity, 70-70% specificity
- detects mild hearing loss
- audiometry*
- brain stem auditory evoked response
- sensorineural loss caused by retrocochlear pathology
- neonatal screening
* audiology less of a priority than occupational therapy in older drivers with minor automobile accidents, but unchanged functional status[6]
Radiology
- neuroimaging not routinely indicated for bilateral hearing loss
- CT of brain for sudden unilateral hearing loss with vertigo, brain stem or cerebellar signs[6]
- magnetic resonance imaging (MRI)
- asymmetric sensorineural hearing loss
- sudden sensorineural hearing loss*
- visualize internal auditory canal[3]
Complications
- impact of hearing loss with visual impairment compromises cognition, mobility & functional status
- social isolation/withdrawal from conversations
- emotional stress, frustration/resentment
- mislabeled as dementia*
- hearing loss may negatively affect performance on certain cognitive tests[6]
- risk of dementia reduced by hearing aids[53]
- depression[9][25]
- hearing impairment may be associated with diminished physical function in elderly[46]
- hearing loss in the elderly is associated with impaired mobility, frailty, & iADL disability[47]
- cognitive impairment[11][36][49][50][51]
- independently associated with dementia[6]
- tests with verbal & nonverbal stimuli show similar patterns of cognitive impairment[6]
- hearing loss prior to onset of cognitive impairment, associated with increased neurofibrillary tangle burden[43]
- hearing loss in those with cognitive impairment associated with microinfarcts & neocortical Lewy bodies[43]
- hearing loss. especially if accompanied by visual impairment is associated with cognitive impairment[44]
- difficulty accessing health care[9]
- nearly 1/2 of older patients report mishearing a clinician during a visit[33]
- hearing loss may suggest underlying cardiovascular disease[38]
- hearing loss & dual sensory loss are asssociated with excess all-cause & cardiovascular mortality[48]
- hearing loss & peripheral neuropathy are independently & additively associated with premature mortality[55]
- associations may be mediated in part by impaired balance[55]
- hearing loss is associated with increased risk of hospitalization among older adults & this is not mitigated by use of hearing aids[52]
- hearing loss is an independent dose-dependent risk factor for later development of Parkinson's disease - hearing aids attenuate risk[56]
* labeled overdiagnosis or harbinger hypothesis[6]
- disease interaction(s) of hearing loss with peripheral neuropathy
- disease interaction of hearing loss with cardiovascular disease
- disease interaction of hearing loss with osteoporosis
- disease interaction(s) of dementia with hearing loss & visual impairment
Differential diagnosis
- hearing loss accompanied by ear pain & drainage is more likely to be conductive hearing loss
- hearing loss associated with dizziness &/or vertigo is more likely to be sensorineural hearing loss
- vertigo (&/or vestibular dysfunction), asymmetric hearing loss & tinnitus suggests acoustic neuroma
- fluctuating tinnitus, low-frequency hearing loss & episodic vertigo with horizontal nystagmus suggests Meniere's disease
- high-frequecy sensorineural hearing loss, presbycusis
- most common cause in elderly
- dementia: difficulty with activities of daily living dependent upon cognition
- depression: loss of interest in all activities, including hobbies
Management
on
- depends upon etiology & severity
- sudden sensorineural hearing loss (>= 30 dB in <= 3 days) necessitates MRI & urgent referral to ENT[3]
- indications for otolaryngology
- unilateral hearing loss with onset within 90 days
- air-bone gap >= 15 dB at 500, 1000 or 2000 Hz
- history of tympanic membrane perforation or surgery
- deformity of external auditory canal
- accompanying vertigo & ataxia suggest CNS ischemia; neuroimaging indicated[6]
- prednisone & urgent ENT referral for sudden, explained hearing loss (possible Cogan's syndrome)
- general measures
- ear exam
- remove earwax (see ear irrigation)[7]
- cerumen impactation can cause conductive hearing loss
- clean ears, remove cerumen & recheck hearing before sending for audiometry[6]
- audiometry
- hearing aid
- persons with > 40 dB hearing loss should be considered for amplification
- hearing aids improve speech & language development in children with hearing impairment[13]
- treatment of choice for presbycusis (age-related sensorineural hearing loss)
- indications for physician examination
- cerumen impactation or foreign body in external auditory canal
- earache
- active drainage from the ear within 90 days
- dizziness, acute or chronic
- complementary amplification devices
- personal sound amplification products for mild-moderate hearing loss[39]
- available for television & telephone
- telephone device for the deaf (TDD)
- without excess noise for others
- screening for hearing impairment
- evidence insufficient to weigh benefits & risks of screening in asymptomatic adults >= 50 years of age[10] (see hearing evaluation)
- treatment improves depression & quality of life[5]
- strategies to improve communication with hearing-impaired people[6]
- ask the listener what is the best way to communicate with him or her
- obtain the listener's attention before communicating
- when speaking
- be sure the listener can see the speaker's lips
- speak face-to-face in the same room
- do not obscure the lips with hands or other objects
- make sure that light shines directly on the speaker's face
- avoid light from behind the speaker
- speak slowly & clearly, but avoid shouting
- speak toward the better ear, if applicable
- change phrasing if listener does not understand at first
- spell words out, use gestures, or write them down
- have the listener repeat back what he or she has heard
- prevention:
- earplugs may help prevent noise-induced hearing loss
Comparative biology
- cochlear stem cells may be induced become hair cells in mice with hearing loss[31]
- the technique appears to work in explanted healthy human ear tissue[31]
More general terms
More specific terms
- conductive hearing loss
- deafness
- functional (factitious) hearing loss
- mixed hearing loss
- sensorineural hearing loss
- sociocusis
Additional terms
- age-associated changes in hearing
- auditory processing disorder (APD); central auditory processing disorder (CAPD); auditory perception problem; auditory comprehension deficit; central auditory dysfunction; central deafness; word deafness
- hearing aid; digital hearing aid
- hearing evaluation
- hearing; audition
- noise
- sound
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018.
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 42-44
- ↑ 5.0 5.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 7.0 7.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Stachler RJ et al Clinical practice guideline: Sudden Hearing Loss Otolaryngology -- Head and Neck Surgery 2012 146: S1 http://www.entnet.org/Community/upload/Sudden-Hearing-Loss-Clinical-Practice-Guideline.pdf
- ↑ 9.0 9.1 9.2 Fellinger J et al Mental health of deaf people The Lancet, 2012, 379(9820):1037-1044 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22423884 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61143-4/abstract
Alexander A et al Deafness might damage your health The Lancet, 2012, 379(9820):977 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22423872 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61670-X/fulltext
Anonymous The health of deaf people: communication breakdown The Lancet, 2012, 379(9820):979-981 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22423869 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60411-5/fulltext - ↑ 10.0 10.1 Moyer VA et al Screening for Hearing Loss in Older Adults: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. 14 August 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22893115 <Internet> http://annals.org/article.aspx?articleid=1309706 (corresponding NGC guideline withdrawn Feb 2018)
- ↑ 11.0 11.1 Lin FR et al Hearing Loss and Cognitive Decline in Older Adults. JAMA Intern Med. 2013;():1-7 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23337978 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1558452
O'Malley PG Evolving Insights About the Impact of Sensory Deficits in the Elderly. JAMA Intern Med. 2013;():1 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23338615 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1558459 - ↑ Laplante-Levesque A, Hickson L, Worrall L. Rehabilitation of older adults with hearing impairment: a critical review. J Aging Health. 2010 Mar;22(2):143-53 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20056812
- ↑ 13.0 13.1 Tomblin JB et al The Influence of Hearing Aids on the Speech and Language Development of Children With Hearing Loss. JAMA Otolaryngol Head Neck Surg. Published online April 03, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24700303 <Internet> http://archotol.jamanetwork.com/article.aspx?articleid=1851413
- ↑ Pacala JT, Yueh B. Hearing deficits in the older patient: "I didn't notice anything". JAMA. 2012 Mar 21;307(11):1185-94. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22436959
- ↑ Dubno JR, Lee FS, Matthews LJ, Ahlstrom JB, Horwitz AR, Mills JH. Longitudinal changes in speech recognition in older persons. J Acoust Soc Am. 2008 Jan;123(1):462-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18177174
- ↑ 16.0 16.1 Bainbridge KE, Hoffman HJ, Cowie CC. Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med. 2008 Jul 1;149(1):1-10. Epub 2008 Jun 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18559825
Bainbridge KE, Hoffman HJ, Cowie CC. Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999-2004. Diabetes Care. 2011 Jul;34(7):1540-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21593298 - ↑ 17.0 17.1 17.2 17.3 Gopinath B, Flood VM, McMahon CM et al The effects of smoking and alcohol consumption on age-related hearing loss: the Blue Mountains Hearing Study. Ear Hear. 2010 Apr;31(2):277-82. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20054277
- ↑ 18.0 18.1 Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hearing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci. 2011 May;66(5):582-90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21357188
- ↑ Mitchell P, Gopinath B, Wang JJ et al Five-year incidence and progression of hearing impairment in an older population. Ear Hear. 2011 Mar-Apr;32(2):251-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21084986
- ↑ 20.0 20.1 20.2 Cruickshanks KJ Hearing Impairment Prevalence and Associated Risk Factors in the Hispanic Community Health Study/Study of Latinos. JAMA Otolaryngol Head Neck Surg. Published online May 28, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26021283 <Internet> http://archotol.jamanetwork.com/article.aspx?articleid=2297058
- ↑ 21.0 21.1 World Health Organization (WHO). March 2016 Childhood Hearing Loss http://www.who.int/pbd/deafness/world-hearing-day/WHD2016_Brochure_EN_2.pdf
- ↑ 22.0 22.1 Ramakers GG et al Effectiveness of Earplugs in Preventing Recreational Noise- Induced Hearing Loss. A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online April 07, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27054284 <Internet> http://archotol.jamanetwork.com/article.aspx?articleid=2507069
- ↑ Walling AD, Dickson GM. Hearing loss in older adults. Am Fam Physician. 2012 Jun 15;85(12):1150-6. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22962895 Free Article
- ↑ Foley DM, Frick KD, Lin FR. Association between hearing loss and healthcare expenditures in older adults. J Am Geriatr Soc. 2014 Jun;62(6):1188-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24925555 Free PMC Article
- ↑ 25.0 25.1 Mener DJ, Betz J, Genther DJ, Chen D, Lin FR. Hearing loss and depression in older adults. J Am Geriatr Soc. 2013 Sep;61(9):1627-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24028365 Free PMC Article
- ↑ Genther DJ, Frick KD, Chen D, Betz J, Lin FR. Association of hearing loss with hospitalization and burden of disease in older adults. JAMA. 2013 Jun 12;309(22):2322-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23757078 Free PMC Article
- ↑ Gopinath B, Hickson L, Schneider J et al Hearing-impaired adults are at increased risk of experiencing emotional distress and social engagement restrictions five years later. Age Ageing. 2012 Sep;41(5):618-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22591986 Free Article
- ↑ 28.0 28.1 28.2 CPT :accession 81430
- ↑ 29.0 29.1 29.2 CPT :accession 81431
- ↑ 30.0 30.1 30.2 Lin B, Curhan SG, Wang M et al Duration of Analgesic Use and Risk of Hearing Loss in Women. Am J Epidemiol (2016) 1-8. Published 14 December 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27974293 https://academic.oup.com/aje/article/doi/10.1093/aje/kww154/2661733/Duration-of-Analgesic-Use-and-Risk-of-Hearing-Loss
- ↑ 31.0 31.1 31.2 31.3 31.4 Komaroff AL NEJM Journal Watch. March 23, 2017 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
McLean WJ, Yin X, Lu L et al. Clonal expansion of Lgr5-positive cells from mammalian cochlea and high-purity generation of sensory hair cells. Cell Reports 2017 Feb 21; 18:1917 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28228258 Free Article - ↑ 32.0 32.1 NEJM Knowledge+ Question of the Week. May 23, 2017 https://knowledgeplus.nejm.org/question-of-week/1532/
Hederstierna C, Rosenhall U. Age-related hearing decline in individuals with and without occupational noise exposure. Noise Health. 2016 Jan-Feb;18(80):21-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26780958 Free PMC Article
Cardin V. Effects of Aging and Adult-Onset Hearing Loss on Cortical Auditory Regions. Front Neurosci. 2016 May 11;10:199. eCollection 2016. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27242405 Free PMC Article - ↑ 33.0 33.1 Cudmore V, Henn P, O'Tuathaigh CMP, Smith S. Age-Related Hearing Loss and Communication Breakdown in the Clinical Setting. JAMA Otolaryngol Head Neck Surg. online Aug 24, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28837709 <Internet> http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2649281
Weinreich HM Hearing Loss and Patient-Physician Communication. The Role of an Otolaryngologist. JAMA Otolaryngol Head Neck Surg. online Aug 24, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28837710 <Internet> http://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2649280 - ↑ Cunningham LL, Tucci DL Hearing Loss in Adults. N Engl J Med 2017; 377:2465-2473. Dec 21, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29262274 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1616601
- ↑ 35.0 35.1 Sterling MR, Lin FR, Jannat-Khah DP et al. Hearing loss among older adults with heart failure in the United States: Data from the National Health and Nutrition Examination Survey. JAMA Otolaryngol Head Neck Surg 2018 Jan 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29372239 https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2668608
- ↑ 36.0 36.1 Deal JA, Sharrett AR, Albert MS et al. Hearing impairment and cognitive decline: a pilot study conducted within the atherosclerosis risk in communities neurocognitive study. Am J Epidemiol 2015 May 1; 181:680. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25841870 Free PMC Article
- ↑ 37.0 37.1 Kraaijenga VJC, van Munster JJCM, van Zanten GA Association of Behavior With Noise-Induced Hearing Loss Among Attendees of an Outdoor Music Festival. A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online April 19, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29710132 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2677777
- ↑ 38.0 38.1 38.2 Wattamwar K, Qian ZJ, Otter J et al Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old. JAMA Otolaryngol Head Neck Surg. 2018 Jun 14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29902313 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2684509
- ↑ 39.0 39.1 Cho YS, Park SY, Seol HY et al Clinical Performance Evaluation of a Personal Sound Amplification Product vs a Basic Hearing Aid and a Premium Hearing Aid. JAMA Otolaryngol Head Neck Surg. Published online May 16, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31095263 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2733788
- ↑ 40.0 40.1 40.2 Chandrasekhar SS, Tsai Do BS, Schwartz SR et al Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology - Head and Neck Surgery. Aug 1, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31369349 https://journals.sagepub.com/doi/full/10.1177/0194599819859883
Chandrasekhar SS, Tsai Do BS, Schwartz SR et al Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019 Aug;161(1_suppl):S1-S45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31369359 - ↑ ARUP Consult: Hearing Loss https://arupconsult.com/ati/Hearing-Loss-Panel
- ↑ 42.0 42.1 42.2 Bang S-H et al. Association between hearing loss and postural instability in older Korean adults. JAMA Otolaryngol Head Neck Surg 2020 Apr 23; 146:530 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32324231 Free PMC article https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2764671
Lubetzky AV. Balance, falls, and hearing loss: Is it time for a paradigm shift? JAMA Otolaryngol Head Neck Surg 2020 Apr 23; 146:535. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32324206 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2764668 - ↑ 43.0 43.1 43.2 Brenowitz WD, Besser LM, Kukull WA et al Clinician judged hearing impairment and associations with neuropathologic burden. Neurology. Aug 5, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32759190 https://n.neurology.org/content/early/2020/08/05/WNL.0000000000010575
- ↑ 44.0 44.1 Ge S et al. Longitudinal association between hearing loss, vision loss, dual sensory loss, and cognitive decline. J Am Geriatr Soc 2021 Mar; 69:644. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33258497 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16933
- ↑ Jilla AM, Reed NS, Oh ES, Lin FR. A Geriatrician's Guide to Hearing Loss. J Am Geriatr Soc. 2021 May;69(5):1190-1198. First piblished March 9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33687733 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17073
- ↑ 46.0 46.1 Martinez-Amezcua P, Powell D, Kuo PL et al Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US. JAMA Netw Open. 2021;4(6):e2113742. June 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34170305 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781351
Brenowitz WD, Wallhagen MI. Does Hearing Impairment Affect Physical Function?Current Evidence, Potential Mechanisms, and Future Research Directions for Healthy Aging. JAMA Netw Open. 2021;4(6):e2114782 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34170308 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781354 - ↑ 47.0 47.1 Yevenes-Briones H, Caballero FF, Struijk EA et al Association Between Hearing Loss and Impaired Physical Function, Frailty, and Disability in Older Adults. A Cross-sectional Study JAMA Otolaryngol Head Neck Surg. 2021;147(11):951-958. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34554203 PMCID: PMC8461549 (available on 2022-09-23) https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2784550
- ↑ 48.0 48.1 Kye Jyn Tan B, Yu Ci Ng F; Jun Jie Muhammad Danial Song H et al Associations of Hearing Loss and Dual Sensory Loss With Mortality. A Systematic Review, Meta-analysis, and Meta-regression of 26 Observational Studies With 1,213,756 Participants. JAMA Otolaryngol Head Neck Surg. Published online December 30, 2021 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2787760
- ↑ 49.0 49.1 Fortunato S, Forli F, Guglielmi V et al. A review of new insights on the association between hearing loss and cognitive decline in ageing. Acta Otorhinolaryngol Ital. 2016;36(3):155-166 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27214827 PMCID: PMC4977003 Free PMC article https://www.actaitalica.it/issues/2016/3-2016/01-Fetoni-Berrettini.pdf
- ↑ 50.0 50.1 Loughrey DG, Kelly ME, Kelley GA et al. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29222544 PMCID: PMC5824986 Free PMC article https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2665726
- ↑ 51.0 51.1 Uchida Y, Sugiura S, Nishita Y et al. Age-related hearing loss and cognitive decline - the potential mechanisms linking the two. Auris Nasus Larynx. 2019;46(1):1-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30177417 https://www.aurisnasuslarynx.com/article/S0385-8146(18)30458-9/fulltext
- ↑ 52.0 52.1 Thai A, Khan ST, Choi J et al Associations of Hearing Loss Severity and Hearing Aid Use With Hospitalization Among Older US Adults. JAMA Otolaryngol Head Neck Surg. 2022;148(11):1005-1012. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36048464 PMCID: PMC9437822 (available on 2023-09-01) https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2795562
- ↑ 53.0 53.1 George J Dementia Tied to Hearing Loss Likelihood of developing dementia was lower for older adults who used hearing aids. MedPage Today January 10, 2023 https://www.medpagetoday.com/neurology/dementia/102578
Huang AR, Jiang K, Lin FR et al Hearing Loss and Dementia Prevalence in Older Adults in the US. JAMA. 2023;329(2):171-173 PMID: https://www.ncbi.nlm.nih.gov/pubmed/3662581 https://jamanetwork.com/journals/jama/fullarticle/2800197 - ↑ Pittman CA, Ward BK, Nieman CL. A Review of Adult-Onset Hearing Loss: A Primer for Neurologists. Curr Treat Options Neurol. 2021 Jul;23(7):20. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34483646 PMCID: PMC8415291 Free PMC article.
- ↑ 55.0 55.1 55.2 Mold JW, Lawler FH, Liao X, Bard DE. Associations between hearing loss, peripheral neuropathy, balance, and survival in older primary care patients. J Am Geriatr Soc. 2024 Aug 14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39143038 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19142
- ↑ 56.0 56.1 George J Hearing Loss May Signal Early Parkinson's Disease Early interventions with hearing aids attenuated the risk https://www.medpagetoday.com/neurology/parkinsonsdisease/112508
Neilson LE, Reavis KM, Wiedrick J, Scott GD. Hearing Loss, Incident Parkinson Disease, and Treatment With Hearing Aids. JAMA Neurol. 2024 Oct 21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39432289 https://jamanetwork.com/journals/jamaneurology/fullarticle/2824569 - ↑ American Tinnitus Association It's A Noisy World We Live In. How Loud is Too Loud? http://www.ata.org/for-patients/how-loud-too-loud
- ↑ Hearing, Ear Infections, and Deafness [NIDCD Health Information] http://www.nidcd.nih.gov/health/hearing/
Hearing Loss and Bone Disorders http://www.osteo.org/newfile.asp?doc=r604i&doctitle=Hearing+Loss+%26+Bone+Disorders&doctype=HTML+Fact+Sheet