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Introduction: Over 30 million Americans suffer from hearing loss (HL). Studies suggest that established cardiovascular disease (CVD) risk factors may contribute to the pathophysiology of the inner ear. However, the aggregate effect of CVD risk factors on hearing is not well understood. Hypothesis: We hypothesized that high CVD risk burden is associated with worse hearing. Methods: We assessed younger (ages 18-34) and older (ages 55-64) Hispanic Community Health Study / Study of Latinos participants who underwent audiometry in 2008-11. After excluding those with conductive pathology and asymmetric HL, we randomly chose one ear for analysis. Puretone thresholds were obtained at 0.5-8 kHz; puretone average (PTA) was calculated using thresholds at 0.5, 1, 2, and 4 kHz. Low CVD risk burden was defined as having all of: blood pressure (BP) 160/>100 mmHg (or antihypertensive use); and total cholesterol >240 mg/dL (or statin use). By age group and sex, we estimated hearing thresholds per frequency with linear regression models adjusted for noise exposure. Least squares estimates were calculated using strata-specific means of covariates. Estimates were compared via t-tests. Data were weighted for all analyses and accounted for clustering. Results: Among younger and older individuals in the target population (51.9% female), 28.8% had low and 5.5% had high CVD risk. Younger men with high CVD risk had worse PTA than young men with low risk (7.7 dB HL [7.0-8.4] vs. 10.5 dB HL [8.4-12.5], p =0.02), and had significantly worse thresholds at 1,3,4,6 kHz than those with low risk ( Figure ). There was no difference in PTA or thresholds at any frequency by CVD risk burden in young women, older men, or older women. Conclusions: CVD risk burden is associated with HL among young men, but not young women or older adults. CVD risk burden may be useful for identifying young men at risk for HL.

Sleep apnea (SA) may promote hearing impairment (HI) through ischemia and inflammation of the cochlea. Our objective was to assess an independent association between SA and HI in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants.

Objective The purpose of the current study was to longitudinally assess the development of automatic sound feature discrimination and compare it to behavioral discrimination in late-implanted cochlear implant users. Methods Scalp-recorded auditory evoked potentials (AEPs) and behavioral discrimination of frequency, duration and intensity differences within an oddball paradigm using complex stimuli were recorded in three late-implanted cochlear implant subjects beginning on turn-on day. Results Variable results were obtained in behavioral and AEPs that were consistent with the amount of pre-implant auditory experience each subject had. The best user showed rapid development of neurophysiologic indices of change detection along with improvement in behavioral and real-world auditory skills. In contrast, there were no recordable AEPs in the poorer CI user and there was little change in behavioral outcomes. Conclusion There is evidence of utilization of usual auditory processing pathways in the AEPs of some children who receive cochlear implants late in their childhood. Some plasticity in the auditory cortical pathways may be present despite prolonged auditory deprivation in school-aged children who are late-implanted cochlear implant recipients.

Common modalities of aural rehabilitation include external hearing aids, cochlear implantation, and bone anchored hearing aids. In recent years, there has been research, development, and application of implantable and semi-implantable hearing aids. These devices act by vibration of the ossicular chain by piezoelectric or electromagnetic energy. Although only recently approved by the U.S. Food and Drug Administration, implantable hearing aids are evolving as a plausable option for patients with sensorineural or conductive hearing loss. Here, we review all current devices and surgical techniques for implantation.

Objectives: To discuss the diagnosis and management of children with fluctuating sensorineural hearing loss, especially focusing on those problems dealing with autoimmune inner ear disease. Study Design: A retrospective chart review of a large pediatric otolaryngology practice. A series of 40 children with progressive hearing losses was identified. Of that group, 22 children, aged 1.5 to 12.2 years at first audiogram, were considered to have fluctuating sensorineural hearing loss (FSNHL). Criteria for inclusion in the FSNHL group were threshold variations of 15 dB or more in at least one ear at two or more of the standard audiometric frequencies on at least 2 testing days. Methods: Charts were reviewed for age, sex, otologic history, laboratory evaluations, medical or surgical treatments, significant medical history, and family medical history. Results: Twenty-two children met the criteria for fluctuating sensorineural hearing loss. Of those with fluctuating hearing loss, 15 were idiopathic, 3 had positive lymphocyte transformation tests (LTT) suggestive of autoimmune inner ear disease (AIED), and 4 had fistula on middle ear exploration. Average fluctuation for all groups was 29.1 dB. Average duration of fluctuations was 4.95 years. Conclusions: The majority of pediatric FSNHL cases (15 of 22) were idiopathic in nature. Of those FSNHL children with positive LTTs, only one was treated with steroid therapy. In the other patients with positive LTTs, parents or other physicians were often reluctant to treat, or the patient was lost to follow-up. Mean fluctuations varied substantially across all standard audiometric frequencies for all groups.

Although several studies have previously reported on patients presenting with “normal” audiologic parameters in acoustic neuroma, the present study is, to our knowledge, the first to exclusively examine in detail cases involving exceptionally stringent objective audiometric features. Of 369 patients with acoustic neuroma who were operated on between April 1980 and April 1997 by our group, 10 had strictly normal hearing, defined as follows: (1) pure-tone average 90%; and (3) interaural differences ≤ 10 dB at every hertz level. A high level of audiologic functioning was found to significantly lower the sensitivity of auditory brainstem response in the detection of acoustic neuroma. Magnetic resonance imaging was the only preoperative test exhibiting 100% sensitivity in this setting. Thus, a high level of clinical suspicion appears warranted in any case involving unexplained unilateral audiovestibular symptoms—including those instances in which strictly normal hearing parameters exist and are associated with negative auditory brainstem response findings. (Otolaryngol Head Neck Surg 2000;122:157-62.)

Cochlear implantation is evolving into a common modality of auditory rehabilitation for the patient with severe to profound sensorineural hearing loss. In order to provide the patient considering cochlear implantation with an understanding of how best to integrate the device into his daily life, adequate evaluation, counseling, and instruction are required. Using the multidisciplinary model, our initial experience has shown that evaluation by specialists in audiology, otolaryngology, speech pathology, pediatric genetics, social work, and child life may lead to better patient and family understanding of cochlear implantation.

Objectives/Hypothesis: The environmental complexity that sounds are presented in, as well as the stimulus presentation rate, influences how sound intensity is centrally encoded with differences between children and adults. Study Design: Cortical auditory evoked potential (CAEP) comparison study in children and adults examining two stimulus rates and three different stimulus contexts. Methods: Twelve 10 and 11 year olds and 11 adults were studied in two experiments examining the CAEP to a 1-KHz, 50-ms tone. A Slow-Rate experiment at 750-ms stimulus onset asynchrony (SOA) compared the CAEPs of 78 dB to 86 dB SPL in 2 complexity conditions. A Fast-Rate experiment was performed at 125 ms SOA with the same conditions plus an additional complexity condition. Repeated measures and mixed-model analysis of variance (ANOVA) was used to examine the latency and amplitude of the CAEP components. Results: CAEP amplitudes and latencies were significantly affected by rate, intensity, and age with complexity interacting in multiple mixed-mode ANOVAs. P1 was the only CAEP component present at the Fast Rate. There were main effects of rate, age, and stimulus intensity level on the CAEP amplitudes and latencies. Maturational differences were seen in the interactions of intensity with complexity for the different CAEP components. Conclusions: Complexity of the sound environment was reflected in the relative amplitude of the CAEPs evoked by sound intensity. The effect of stimulus intensity depended on the complexity of the surrounding environment. Effects of the surrounding sounds were different in children than in adults.

Summary Objective The ability to understand speech requires processing of rapidly changing acoustic information. Much more is known about processing the rapid spectro-temporal properties of speech than is known about processing of intensity, even though intensity is a fundamental cue for accurate speech perception. The purpose for the current study was to characterize, in 9–11-year-old typically language-developing children, the auditory event-related brain potentials elicited by different tone intensities when presented in complex environments (i.e., varying in frequency and intensity) at rapid rates. Methods Pure tones of four different intensity levels (66, 74, 78, and 86 dB SPL) and five different stimulus frequencies were presented at a stimulus rate of 10 Hz. The latency and amplitude of the auditory event-related brain potentials were measured. Results At this fast rate, a positive (P1) followed by a negative component was elicited. The lowest intensity sound elicited the lowest P1 amplitude and the highest intensity sound elicited the highest P1 amplitude. The P1 elicited by the two middle tone intensities had amplitudes that fell between the lowest and highest amplitudes but they were not significantly different from each other. The negative component following the P1 was unaffected by intensity variation. Conclusions Intensity variation of sounds presented in a complex environment at a rapid rate modulated only the amplitude of the earliest obligatory auditory component (P1), consistent with our previous studies in which only the P1 could follow the rapid stimulation rate. P1 amplitude changes reflected the relative differences among the sounds, not the absolute differences in loudness among the sounds presented together in the sequence. The results suggest that the environment, or context, within which rapid sounds occur, influences the relative amplitude of the P1 in children.

Importance Hearing impairment is common in adults, but few studies have addressed it in the US Hispanic/Latino population. Objective To determine the prevalence of hearing impairment among US Hispanic/Latino adults of diverse backgrounds and determine associations with potential risk factors. Design, Setting, and Participants The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a population-based sample of Hispanics/Latinos in four US communities (Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California). Examinations were conducted from 2008 through 2011. The HCHS/SOL examined 16 415 self-identified Hispanic/Latino persons aged 18 to 74 years recruited from randomly selected households using a stratified 2-stage area probability sample design based on census block groups and households within block groups. Main Outcomes and Measures Hearing thresholds were measured by pure-tone audiometry. Hearing impairment was defined as a pure-tone average (PTA) of thresholds at 0.5, 1, 2, and 4 kHz greater than 25 dB hearing level. Bilateral hearing impairment required a PTA greater than 25 dB hearing level in both ears. Multivariable analyses included adjustments for sociodemographic and lifestyle variables, body mass index, and medical conditions. Results The prevalence of hearing impairment was 15.06% (SE, 0.44%) overall, and 8.24% (SE, 0.33%) had bilateral hearing impairment. The prevalence of hearing impairment was higher among people 45 years and older, ranging by Hispanic/Latino background from 29.35% to 41.20% among men and 17.89% to 32.11% among women. The multivariable-adjusted odds of hearing impairment was greater for participants of Puerto Rican background compared with Mexican background (odds ratio [OR], 1.57 [95% CI, 1.10-2.25]). The odds of hearing impairment were lower with more education (OR, 0.71 [95% CI, 0.59-0.86] for at least high school) and higher income (OR, 0.58 [95% CI, 0.36-0.92] for >$75 000 vs ≤$10 000). Noise exposure (OR, 1.35 [95% CI, 1.07-1.70]), diabetes (OR, 1.57 [95% CI, 1.27-1.94]), and prediabetes (OR, 1.37 [95% CI, 1.12-1.67]) were associated with hearing impairment. Conclusions and Relevance Hearing impairment is a common problem for older Hispanics/Latinos in these communities and is associated with socioeconomic factors, noise exposure, and abnormal glucose metabolism. Longitudinal studies are needed to determine whether these factors are involved in the etiology of hearing impairment and to identify ways to prevent or delay age-related changes in hearing.

Objective To evaluate the efficacy of esterified hyaluronic acid (MeroGel) as a middle ear (ME)–packing material. Design Randomized controlled trial. Material Twenty-four guinea pigs. Intervention Group 1, MeroGel-treated animals (n = 10), bilateral wounding of ME mucosa with 5 of the animals receiving the MeroGel packing in the left ME and 5 of the animals receiving MeroGel in the right ME; group 2, absorbable gelatin sponge–treated animals (n = 10), with the same experimental protocol as in group 1 except that the absorbable gelatin sponge was the packing material; group 3, untreated animals (n = 4), unilateral wounding of the left ME mucosa in 2 animals and in 2 animals in the right ME, with no packing material. Auditory brainstem recordings were performed for all groups before the ME operation and 5 days and 6 weeks after the operation. Results Auditory brainstem response recordings at postoperative day 5 showed that all ears with ME packing had hearing losses in the frequency range of 500 to 4000 Hz. The recovery of hearing acuity at postoperative week 6 was significantly better in group 1 (MeroGel-treated) guinea pigs compared with group 2 (the absorbable gelatin sponge–treated) animals. In group 2 animals, 20% of the packing material remained in the ME cavities and new bone formation was observed, while in group 1 animals, there was less packing material in the ME and no formation of new bone. Conclusions MeroGel is a nonototoxic packing material with a high level of biocompatibility for ME mucosa; it is an effective supportive material following ME surgery and is easily expelled from the ME cavity.

Highlights • Hearing impairment was experienced by 59% of adults with diabetes. • Modifiable risk factors were smoking, high alcohol use and high triglycerides. • Lesser education and lower income were associated with hearing impairment. • Suboptimal glycemic control was not associated with hearing impairment., Aim The aim was to examine risk factors for hearing impairment among Hispanic/Latino adults with diabetes. Methods Findings are based on 3384 participants aged 18–76 years with diagnosed or previously undetected diabetes who completed audiometric testing as part of the Hispanic Community Health Study/Study of Latinos. We defined hearing impairment as the pure-tone average (PTA) >25 decibels hearing level [dB HL] of pure-tone thresholds at high frequencies (3000, 4000, 6000, and 8000 Hz) in the worse ear and defined a second hearing impairment outcome with the additional requirement of PTA >25 dB HL of low/mid-frequency (500, 1000, and 2000 Hz) thresholds in the worse ear. We identified independent associations using logistic regression. Results Controlling for age and Hispanic/Latino background, prevalence ratios for hearing impairment in the high plus low/mid frequencies were 1.35 (95% CI 1.07, 1.71) for current smoking, 1.64 (1.14, 2.38) for alcohol consumption (≥14 drinks/week for men or ≥ 7 drinks/week for women), and 1.29 (1.06, 1.56) for triglycerides ≥ 150 mg/dL. For high-frequency only hearing impairment, the prevalence ratio for estimated glomerular filtration rate 30–59 mL/min/1.73 m2 was 1.23 (1.03, 1.47) adjusted for age and sex. People with family income less than $20,000 had almost twice the prevalence of hearing impairment (PR = 1.93 (1.34, 2.78)) as people with income over $40,000. Conclusions Current smoking, alcohol consumption, high triglycerides, and chronic kidney disease are potentially preventable correlates of hearing impairment for persons with diabetes. Low income is a marker of increased likelihood of hearing impairment.