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This protocol outlines a systematic review with meta-analysis to evaluate the evidence that hearing aid use versus non-use enhances the health-related quality of life (HRQoL) of adults with sensorineural hearing loss (SNHL). The study has three aims: (1) to provide a graded recommendation regarding hearing aid use and its impact on HRQoL in adults with SNHL; (2) to assess the effects of hearing aid use on mental health, cognition, and balance within this group; and (3) to examine, through subgroup analyses, whether outcomes are influenced by variables such as patient age, degree of hearing loss, sex, amplification type, duration since fitting, or verification method. Participants will be adults over 18 years with mild to profound SNHL. Only those living independently or in assisted living facilities will be included. Excluded are individuals in acute care, or living in skilled nursing facilities, or who are incarcerated.Amplification options include the following: hearing aid styles (behind the ear, in the ear, etc.), power sources (battery, rechargeable, solar), signal processing (analog or digital), microphone type (omnidirectional or directional), fitting (monaural or binaural), service delivery (audiologist fit or direct to consumer), and payment type (self-pay or free).The following databases will be searched: CINAHL (via EBSCOhost), Cochrane Library, EMBASE (via Ovid SP), MEDLINE (via Ovid SP), PubMed, Scopus, Citations Indexes of Web of Science, ISRCTN Registry, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform.The Covidence online platform will be utilized for evidence synthesis, which will include the selection of studies, quality assessment (using Cochrane's Revised Risk-of-Bias Tool for Randomized Trials [RoB 2]), and data extraction for the meta-analyses. No ethical issues are expected. Systematic reviews do not require Institutional Review Board (IRB) approval because data for meta-analyses are available to the public and included studies have already gone through an IRB review. The protocol and findings of the systematic review will be presented at professional meetings and published in scientific journals.
Continuing education in hearing health care encompasses a range of opportunities, including formal academic training, professional certification and credentialing, technical or job-specific instruction, professional development events, and personal or general skill enhancement. This study examined the continuing education experiences and needs of hearing health care professionals to inform the design and delivery of future educational initiatives tailored to this workforce. Members of the National Centre for Audiology at the University of Western Ontario developed a three-part, 40-item online survey to gather information from hearing health care professionals regarding demographic characteristics, experiences and needs related to delivery method, financial considerations, education requirements, professional interests, and learning style alignment. Eighty-one professionals aged between 18 and 64 years participated in this survey-based study. Most respondents were from North America and reported previous participation in some form of continuing education opportunity within the past year, with cost reported as a limiting factor to participation. Various learning opportunities, including developing new hands-on skills, were reported to benefit the respondents' learning styles. Future opportunities of interest were noted to include extension courses and professional certifications. This study highlights the importance of continuing education opportunities specific to the professional development of hearing health care professionals. The understanding of past and future continuing education trends informed the need for targeted, accessible opportunities with a focus on active learning opportunities and those available online in real time. https://doi.org/10.23641/asha.32288262.
Universal newborn hearing screening allows early identification of hearing loss; however, some families face difficulties accessing diagnostic audiology. This study aimed to investigate audiologists' opinions regarding implementing a teleaudiology infant diagnostic audiology service in Victoria, Australia, a region where traditional access barriers persist despite high follow-up rates. Nine experienced infant diagnostic audiologists participated in three focus groups. Prompt questions, based on the Capability, Opportunity, Motivation-Behaviour model of behavior change, explored clinician-identified barriers and facilitators to teleaudiology implementation. Thematic analysis was used to analyze audiologists' opinions of the proposed model. Audiologists identified that teleaudiology infant diagnostic services may introduce a barrier trade-off; while teleaudiology had the capacity to reduce barriers to service access for some families, it may introduce additional challenges compared to in-person testing. Three main barriers or areas of concern regarding a teleaudiology model of infant diagnostic services were identified: communication and support concerns, risk of error, and financial and motivational concerns. Participants proposed a training model, where experienced clinicians could support and upskill less experienced audiologists acting as in-person facilitators of the service, to address both service delivery and workforce development needs. A teleaudiology model of infant diagnostic assessments in Victoria has the potential to improve accessibility if facilitator training, effective family communication, and resource management are prioritized to ensure service quality is not impacted. A proposed training model offers a novel approach to use teleaudiology to maintain service access, as well as improve workforce experience in underserviced areas.
Early diagnosis is crucial for infants with hearing loss, but access to specialized services can be challenging for some families. This study piloted a student-facilitated teleaudiology model for infant diagnostics and investigated caregiver opinions of this service in Victoria, Australia. Eight families with infants under 6 months old participated in either in-person or teleaudiology appointments, followed by interviews with caregivers to explore their experiences. Thematic analysis was used to analyze interview data. Four main themes emerged: (a) improved accessibility of appointments; (b) effective rapport building and communication, with concerns for supporting challenging scenarios; (c) varying perceptions of facilitator involvement; and (d) level of concern influencing family preferences for appointment type. Caregivers reported positive experiences with teleaudiology, citing improved convenience and reduced travel time as major benefits. However, some expressed concerns about the provision of adequate emotional support in complex cases via telehealth and some impacts of having student facilitators on caregiver confidence in the results. While a student-facilitated teleaudiology service could improve access to infant diagnostic audiology, family preferences and appointment complexity should be considered when offering this option. Future research should explore the feasibility of this service with a larger sample size. https://doi.org/10.23641/asha.32144953.
Accrediting bodies for Doctor of Audiology (AuD) programs require students to develop competencies related to pharmacological agents and their effects on hearing and balance. This study was designed to assess education on pharmacology in AuD programs. The scope of pharmacology education within AuD curricula was surveyed in 2021-2022 using a survey distributed online to program directors across the United States. About one third of the AuD programs in the United States and Puerto Rico offered a dedicated pharmacology course. Other AuD programs reported that they embedded pharmacology education within the rest of the curriculum. Among colleges/universities offering a pharmacology course, the content included was variable. Review of the content in pharmacology showed little consistency in how pharmacological topics are addressed across programs. The current accreditation standards for AuD programs require knowledge of the effects of pharmaceutical compounds on hearing and balance but provide little specific guidance. More consistency in the education of future audiologists with respect to pharmacological foundations has the potential to benefit patients.
This study describes the patient-centered approach to hearing technology selection and fitting of the participants randomized to a best practice hearing intervention as part of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study (ClinicalTrials.gov identifier NCT03243422). We evaluated associations between hearing technology with daily hours of hearing aid use and listening and communication goal achievement. The ACHIEVE study (n = 977) was a multicenter, randomized controlled trial designed to test the effect of a best practice hearing intervention versus health education control on cognitive decline over 3 years among older adults with untreated hearing loss. Participants were aged 70-84 years, had adult-onset mild-to-moderate hearing loss, had no previous hearing aid use, and were without substantial cognitive impairment at baseline. Participants randomized to the hearing intervention (n = 490) received a patient-centered comprehensive hearing program including hearing aids with varying feature sets, characterized as standard, advanced, and premium technology levels, and offered at least one hearing-assistive technology (HAT). The Client-Oriented Scale of Improvement (COSI) was used to identify listening needs that guided intervention delivery and was used to assess attainment of hearing-related goals following ~10-week intervention period. Hearing aid datalogging was used to measure hours of daily wear. We estimated the association between hearing aid technology level, HATs, hours of wear, and COSI goal attainment using an ordered logistic model adjusting for auditory and sociodemographic characteristics. Proportionality odds assumption was checked for all models. A total of 459 participants completed the hearing intervention and reported outcomes. Selection of hearing aid technology level and HATs was guided through evidence-based protocol-directed recommendations, with 88 (19%) participants receiving standard; 260 (57%) participants, advanced; and 111 (24%) participants, premium hearing aid technology. Mean daily hours of hearing aid use was high (M = 9.3 hr across all participants) and did not differ between hearing technology (levels or HATs). Participant COSI goals, which included categories such as conversation in noise and in quiet or attending church and/or meetings, improved and were not dependent on technology used. Participants benefited from patient-centered hearing intervention, and there were no statistically significant associations among hearing aid technology level, HATs, hours of use, and change in COSI goals. The patient-centered selection of hearing technology used in the ACHIEVE study resulted in high levels of hearing aid and HAT usage, along with positive COSI listening goal attainment for the majority of participants. Carefully assessed and selected technology is needed to meet individual auditory rehabilitation needs. https://doi.org/10.23641/asha.32069253.
The purpose of this study was to understand the experiences of audiology students participating in an online near-peer-led simulated patient program, examining both learner and teacher perspectives. An explanatory sequential mixed methods design was used, combining quantitative data from surveys with qualitative data from semistructured interviews. A total of 51 participants (35 learners and 16 teachers) completed the survey and 14 (nine learners and five teachers) were interviewed. Of the learners, 72%-100% showed agreement with positive statements about what peer learning can offer over traditional teacher led learning. Among teachers, 88% agreed or strongly agreed to statements about benefits of teaching their peers. Four themes were identified from interview data: improving knowledge and confidence, providing help and guidance, social proximity, and external factors. The program was valued by both groups of students and its inclusion in the curriculum appeared to provide an opportunity for students to learn while developing more social connections. Teachers can build confidence in their knowledge through having to advise others on key content, while learners can practice communication skills in a safe environment. Near-peer online simulations offer a flexible learning opportunity and show promise in enhancing students' experience in audiology training programs.
This article describes a new sentence corpus developed for use with children 5 years of age and older that is based on the Basic English Lexicon (BEL) sentence corpus and is referred to as the BabyBEL. Sentences were constructed using words found in the expressive vocabulary of native English-speaking kindergarten and first-grade children and organized into 20 lists of 20 sentences each. A female talker recorded all sentences, and speech-shaped masking noise was created based on these recordings. First, psychometric properties of each list as a function of signal-to-noise ratio (SNR) in a cohort of adults were evaluated. Second, speech recognition in noise by list at -2 dB SNR in a cohort of 5- to 7-year-olds was evaluated. Participants had normal hearing and were native speakers of English. Results indicate some differences between lists. The speech recognition threshold associated with 75% correct in adult data varied by no more than ±0.5 dB for 17 of 20 lists. Percent correct scores for children varied by no more than 3 percentage points for 12 of 20 lists. The pattern of performance across lists was similar for adults and children. The vocabulary and sentence structure of the BabyBEL sentences are appropriate for use with children as young as 5 years of age. Recordings of the BabyBEL corpus are freely available for download. When designing future experiments, it is important to consider performance patterns both across lists and between groups of child and adult listeners. https://doi.org/10.23641/asha.32715975.
The aim of this study was to adapt the Cochlear Implant Skills Review to assess the real-time demonstration of skills and device knowledge of the adults who care for their child's, client's, or student's cochlear implant (CI). This study also sought to assess inter- and intrarater reliability of the newly adapted Pediatric Cochlear Implant Skills Review (Ped-CISR) and provide evidence for its construct validity by assessing group performance differences. The Ped-CISR was administered to (a) caregivers of new pediatric CI recipients (less than 1 year of device use), (b) caregivers of experienced pediatric CI recipients (greater than 1 year of device use), (c) educators of the deaf and hard of hearing, and (d) speech-language service providers working in an educational or hospital setting. Participant skills and knowledge were scored by three independent raters. One rater rewatched and rescored each session at least 4 weeks following initial review. Inter- and intrarater reliability and agreement were assessed for all raters, and between-groups differences were analyzed. Reliability across all raters was high with an intraclass correlation coefficient of .801, 95% confidence interval [.785, .817]. There were no significant between-groups differences on the total score of the Ped-CISR; however, participant groups demonstrated significantly different knowledge and skills in the Battery and Indicator Light subcategories. The Ped-CISR is a valuable clinical tool to help identify deficits in knowledge and skills of caregivers, educators, and speech-language service providers of children who use CIs.
Follow-up care after hearing aid fitting is recommended, yet clinicians lack data on the expected number of follow-up appointments needed and which patients require more support. This study aimed to characterize follow-up service utilization during the first year after hearing aid fitting and to determine whether patient, device, or cost-related factors may predict the number of follow-up appointments. A retrospective chart review was conducted on 223 adult patients who received hearing aids at a university-affiliated audiology clinic between May 2022 and April 2023. Demographic, audiological, device-specific, and cost-related data were extracted. The number of follow-up appointments over 1 year was used as the primary outcome. Negative binomial regression analyses were performed to identify predictors of follow-up service utilization. Patients attended an average of 4.1 follow-up appointments (range: 1-16), with most attending three to five visits. No significant effects were observed for gender, degree of hearing loss, or language. Effects of age and prior hearing aid experience were identified with older patients and those with over 10 years of prior hearing aid use attending more appointments. Device factors, including dispensing of accessories and dispensing of standard-level technology, were associated with increased follow-up utilization. Patients with higher out-of-pocket (OOP) costs or no insurance coverage attended more appointments, though cost and technology level exhibited interdependencies. Overall, most adult hearing aid patients attended approximately three to five appointments over the first year, and most demographic and audiometric factors did not predict follow-up appointment attendance. However, on average, patients with higher OOP costs and those with an accessory attended more appointments. Clinicians can use these data to provide evidence-based counseling to patients and to inform clinical decision making.
The lack of a means to diagnose cochlear synaptopathy, a type of cochlear deafferentation, prevents clinicians from identifying patients with this auditory deficit and providing them with appropriate treatments. The envelope following response (EFR) has potential as a diagnostic indicator of deafferentation. However, it is not clear what constitutes an abnormal EFR. The objectives of this study were to establish normative ranges for EFR magnitude in a population at low risk for cochlear synaptopathy and then compare EFRs from a population at high risk for synaptopathy to those normative ranges. The low-risk sample consisted of young adults with normal audiograms, minimal reported lifetime noise exposure, and no auditory complaints. Normative ranges were generated using rectangular amplitude-modulated (RAM) or sinusoidal amplitude-modulated EFR stimuli and were adjusted for sex and distortion product otoacoustic emission (DPOAE) levels. The high-risk sample consisted of military Veterans with normal audiograms who reported at least one auditory complaint (tinnitus, decreased sound tolerance, or speech-in-noise difficulty). The RAM EFR normative ranges for a 4-kHz carrier resulted in the biggest separation of the low- and high-risk samples, with 31%-34% of Veterans falling below the lower bound of the normative range. There were no consistent effects of DPOAE adjustment on the normative ranges across sex and stimulus condition, and computational modeling suggests that adjusting for DPOAEs may not be necessary in individuals with normal audiograms. EFR normative ranges for the 4-kHz RAM EFR will allow for the clinical identification of patients with normal audiograms who may have significant degrees of cochlear deafferentation. https://doi.org/10.23641/asha.32347524.
Agricultural mechanics (i.e., "shop") teachers may be at risk for noise-induced hearing loss (NIHL) due to exposure to loud tools and equipment in their classes. To address gaps in previous research, the purpose of this study was to survey Texas shop teachers about their risk of NIHL. A nonexperimental survey design was utilized. The online survey was distributed to agriculture teachers in Texas. To participate, respondents had to teach one or more junior high/high school shop classes where loud tools/equipment were used. Questions focused on noise exposure, use of hearing protection, symptoms of hearing loss, and training on hearing conservation. Results from 219 teachers were included in the analyses. Over half the teachers taught three to five courses involving loud tools/equipment each semester. Over two thirds of the teachers reported being exposed to loud noise between 3 and 6 hr a day. For 22/27 tools included in the survey, over 70% of teachers reported exposure. When exposed, between 52% and 93% rarely/never wore hearing protection, depending on the type of tool being used. Over half the teachers reported experiencing different types of hearing problems. In addition, over half of the teachers reported not receiving information on NIHL in college, with only approximately one third receiving such information after college. The current results suggest that many shop teachers may be at risk for NIHL. Future research should include audiometric evaluations and measurement of noise levels in shop classes, in addition to focusing on areas of need (e.g., training and prevention programs). https://doi.org/10.23641/asha.32653461.
Commercially available electronic stethoscopes for auscultation often report amplification levels and may or may not publish amplitude-frequency (spectral) response curves. Additional data may be helpful to consumers who use stethoscopes in less-than-ideal listening environments or have hearing loss. The purpose of this research was to describe our method for evaluating electronic stethoscopes relative to a nonelectronic stethoscope. One nonelectronic and eight electronic stethoscopes at maximum volume with their bell and diaphragm modes were acoustically evaluated using digitized heart and breath sounds, a stethoscope speaker pad, and an industry-standard manikin ear simulator. Some electronic stethoscopes had wireless connectivity to wearable Bluetooth earbuds, and these were evaluated also. For each stethoscope, output measurements of digitized heart and breath sounds were recorded in a quiet room. For direct comparisons, measurements were categorized by expected spectra into heart (bell) sounds (~20-500 Hz) and breath (diaphragm) sounds (~100-1000 Hz). Relative to published human threshold tone and 1/3-octave band data, as well as nonelectronic stethoscope output, all electronic stethoscopes clearly demonstrated some measure of amplification across the amplitude-frequency (spectral) range for digitized normal heart and breath sounds. Differences observed may be specific to bell versus diaphragm modes, acoustical tubing (or lack thereof), wired versus wireless modes, models within the same make, and use of active noise cancellation, to name a few. Importantly, manufacturer-reported amplification values (e.g., "×" specifications) did not reliably reflect frequency-specific acoustic output within clinically relevant heart and breath sound regions. The methodology described to analyze stethoscope outputs appears to be an effective starting point for evaluating various characteristics of stethoscopes with a lens toward assisting health professionals and students working in less-than-ideal listening situations or for those with hearing loss. While all electronic stethoscopes evaluated offered amplification, there was great variability in amplitude-frequency responses, which may help inform stethoscope selection based on listening needs, various listening environments, and/or degree and configuration of hearing loss.
Hearing loss is a common work-related condition. Estimates suggest that 46%-86% of agricultural workers have hearing loss. Agricultural safety programs have been working to increase the use of personal protective equipment (PPE) to protect against noise, respiratory, and chemical exposures, but PPE use remains sporadic. The purpose of this study was to assess factors that might explain the use of hearing protection in agricultural operators working in seven states in the Central United States. The Farm and Ranch Health and Safety Survey data collected in 2018, 2020, and 2023 were used for this study. We examined 24 potential correlates of wearing hearing protection. Bivariate analyses were conducted using a Wilcoxon two-sample test based on dichotomizing the frequency of hearing protection use at the median of 10%. We used XGBoost with training and testing data sets to identify the most important factors that explain wearing hearing protection. The strongest predictors of wearing hearing protection was wearing respiratory and chemical PPE, followed by age. Noise exposure was low in importance. The use of hearing, respiratory, and chemical PPE followed a similar pattern over the age spectrum with chemical PPE use showing the most frequent use. Younger operators more frequently wore PPE. Wearing hearing PPE is more likely to be related to personality traits related to risk perception and less likely due to noise exposures. This is an important consideration when designing hearing loss prevention programs because messaging needs to address safety motivation and unrealistic optimism. https://doi.org/10.23641/asha.32513328.
The use of hearing aid-based step counting may offer objective measurement of activity, but there is little published literature on the perspectives of older adult users in using this feature. The purpose of this study was to qualitatively describe the experiences and motivation for using a hearing aid step-counting feature in a sample of active older adults. A prospective qualitative research design was employed with the use of focus groups with active older adult participants who were fitted with hearing aids with a step-counting feature. Twelve older adults with hearing loss (age range: 64-88 years) were recruited in this study. Half of the participants were experienced hearing aid users. Participants were recruited from two physical activity groups with varying intensity levels. The majority of participants were physically active and had prior experience using step-counting features on alternative devices. Major themes were Goal Setting and Health Monitoring, Device Use, and Movement and Motivation Factors. Background experiences and individual perspectives related to the reasons and motivations for using hearing aids for monitoring daily step count were the major subthemes. Participants who engaged in light-intensity physical activity were more likely to be motivated to monitor daily step count using the hearing aids. Participants' perspectives on the reason for motivation varied between cursory monitoring to stay consistently active and striving to meet a daily step objective. https://doi.org/10.23641/asha.32159181.
This study provides the first independent evaluation of the Apple Over-the-Counter Hearing Aid Feature (OTC-HAF), examining its usability and laboratory performance among adults with self-perceived mild-to-moderate hearing loss. A cross-sectional evaluation was conducted at a university audiology clinic. Digitally literate iPhone users (n = 25, ages 20-72 years) independently used AirPods Pro 2 to complete the Apple Hearing Test Feature and activate the OTC-HAF. The sample size aligns with usability model recommendations for moderately complex systems. Outcomes were assessed immediately after setup. Usability was high, with a mean mHealth App Usability Questionnaire score of 6.7/7 (SD = 0.3) and a mean Hearing Aid Skills and Knowledge Inventory-Clinical score of 93.4% (SD = 9.0%). Study-specific questionnaire responses showed high satisfaction, good sound quality, and ease of use. Qualitative feedback highlighted affordability, convenience, and dual-purpose design, with some noting occlusion and difficulty locating settings. Some participants reported they would only use the device situationally. The audiogram import feature showed limited accuracy: 71% of thresholds were within 5 dB of the reference when both ears were scanned together and 73% when each ear was scanned separately, with 12% and 8% of thresholds missing for these methods, respectively. Objective performance measures showed nonsignificant speech-in-noise benefit (Quick Speech-in-Noise Test mean benefit of 0.1 dB SNR, SD = 1.9), and real-ear measurements showed gain levels generally below National Acoustic Laboratories-Non-Linear 2 targets. The Apple OTC-HAF showed high usability and satisfaction among digitally literate iPhone users, but nonsignificant speech-in-noise benefit and gain levels generally lower than prescriptive targets. Further research should explore broader applicability, long-term outcomes, and strategies to support uptake and consistent use. https://doi.org/10.23641/asha.31366123.
Timely access to hearing technology is paramount to ensure early auditory access to the sounds needed for listening and learning in children with early hearing loss (HL). Although children typically move to cochlear implants (CIs) after first having tried hearing aids (HAs), there are some cases where the HA trial may create unnecessary additional delays. This clinical focus article presents three categories of patients where implantation appears warranted without an HA trial. This study examines 3 years of retrospective chart data for pediatric CI patients at a tertiary care center who did not complete an HA trial before surgery. We identified 22 cases and examined their diagnostic audiological profiles and preimplant trajectory of care. Our results coalesced around three broad categories where omission of the HA trial appears warranted: cases of late-onset/progressive HL, cases of children lost to follow-up after newborn hearing screening, and cases of auditory neuropathy spectrum disorder where hearing technology was deferred until behavioral testing was possible. Following surgery, we observed wide variability in device use rates, suggesting that some families may struggle with full-time use of CIs despite the streamlined candidacy process. Taken together, our results show that, in appropriate cases, CIs may be considered for children with HL without first completing an HA trial. This has important implications for closing the timing gaps introduced by loss to follow-up in the United States' national Early Hearing Detection and Intervention program.
The purpose of this study was to create a database of Medicaid fee-for-service hearing aid coverage policies for adults over 20 years old from 2003 to 2023 and quantify yearly averages of the share of beneficiaries living with hearing aid coverage benefits. Policy surveillance and data triangulation were used to retrieve and code Medicaid fee-for-service coverage policies. Policy data were combined with a subset of individual-level data from the American Community Survey to estimate the annual share of adult Medicaid beneficiaries over 20 years old residing in states with hearing aid coverage. Policy data were combined with sociodemographic variables from the American Community Survey to estimate the share of adult Medicaid beneficiaries covered by a Medicaid hearing aid coverage policy from 2003 to 2023. States (N = 32) offered Medicaid hearing aid coverage for adults in 2003. By 2013, that decreased to 27 states but increased to 31 states in 2023. Between 2003 and 2023, four states implemented, four states interrupted, and four states removed coverage. In 2008, 65.4% of adults with Medicaid had hearing aid coverage; this percentage increased to 70.3% by 2023. The longitudinal Medicaid hearing aid policy database is active and continues to be updated. Given the known impacts of untreated hearing loss on quality of life and health, a lack of Medicaid hearing aid coverage for adults may undermine states' health equity goals and public health efforts to promote health over the life course. https://doi.org/10.23641/asha.32270619.
Although age-related auditory changes are well recognized, limited studies have examined how aging affects middle ear mechanics, which can be assessed using wideband tympanometry (WBT). Unlike conventional tympanometry, WBT offers frequency-specific insights into middle ear acoustic transfer function. Ethnic differences in the anatomy of the external and middle ear such as canal length, ossicular dimensions, and stapes configuration may influence acoustic transmission. This study aimed to investigate the effect of aging on middle ear absorbance across frequencies using WBT. A nonexperimental, standard group comparison design was used to test 60 ears from older adults (50-70 years of age) and young adults (20-30 years of age) with clinically normal hearing. Wideband absorbance was measured using click stimuli (0.2-8 kHz) at 100 dB peSPL under both ambient and peak pressure. Data were analyzed using mixed repeated-measures analysis of variance to assess the main and interaction effects of group, gender, frequency, and pressure condition; independent t test for between-group comparisons at each frequency; and paired t test between pressure within-group comparisons. Both groups showed a similar wideband absorbance pattern. However, older adults exhibited a significantly higher absorbance at low frequencies (250-600 Hz) and a lower absorbance at high frequencies (2000-8000 Hz) compared to young adults. These differences indicate age-related alterations in middle ear mechanics, likely due to ossicular joint loosening and tissue degeneration. Pressure-related absorbance changes were more pronounced in younger adults at low to mid frequencies, suggesting that middle ear function in this group is more sensitive to pressure variations. Moreover, gender did not show a significant main effect on absorbance across frequencies. WBT appears to be a sensitive tool to detect subtle age-related changes that may not be evident with conventional tympanometry. The findings offer insights into age-related middle ear changes and suggest possible modification that might be considered during hearing aid fitting in older adults. Additionally, it also suggests that gender may not be a significant factor in assessing middle ear transfer function.
Hearing loss is the most prevalent sensory disability in older adults and has been linked to various forms of psychological distress. However, the extent to which hearing loss contributes to anger remains unclear. This study investigated the association between self-reported hearing loss and expressions of anger in U.S. males and females. We examined data from a nationally representative prospective cohort of older adults in the 2006-2012 Health and Retirement Study (n = 10,664). Hearing status was assessed at each wave by self-reported hearing loss (higher scores indicated greater hearing loss). Outcomes included internalized anger (anger-in) and externalized anger (anger-out) scales based on participants' reported frequency of anger (range: 1-4). Linear mixed models were used to estimate anger scores while adjusting for sociodemographic and health-related characteristics. Among study participants (Mage = 66.77 years [±9.06]), males were more likely to report worse hearing compared to females (1.77 [1.08] vs. 1.40 [0.99]) and had greater levels of anger at baseline than females. Multivariable mixed models showed that worse hearing was associated with significantly greater levels of anger-in (β = 0.04, 95% confidence interval [CI] [0.03, 0.05], p < .001) and anger-out (β = 0.03, 95% CI [0.03, 0.04], p < .001). There was no significant sex difference in anger-in (interaction p = .362); however, males with worse hearing reported greater levels of anger-out than females (interaction p = .010). The associations remained largely unchanged after accounting for covariates. Results demonstrate the influence of hearing loss on anger and suggest that interventions for anger management may promote healthy aging in U.S. males and females with hearing loss. https://doi.org/10.23641/asha.32292633.