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Original Investigation |

Increases in the Rate of Age-Related Hearing Loss in the Older Old ONLINE FIRST

Kapil Wattamwar, BS1,2; Z. Jason Qian, MD3,4; Jenna Otter, MD3,5; Matthew J. Leskowitz, MD3,6; Francesco F. Caruana1; Barbara Siedlecki, RN1; Jaclyn B. Spitzer, PhD1; Anil K. Lalwani, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
2Robert Wood Johnson Medical School, New Brunswick, New York
3Columbia University College of Physicians and Surgeons, New York, New York
4Department of Otolaryngology–Head & Neck Surgery, Stanford University, Stanford, California
5Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania
6Boston Consulting Group, New York, New York
JAMA Otolaryngol Head Neck Surg. Published online September 15, 2016. doi:10.1001/jamaoto.2016.2661
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Importance  There is a critical disparity in knowledge regarding the rate and nature of hearing loss in the older old (80 years and older).

Objective  To determine if the rate of age-related hearing loss is constant in the older old.

Design, Setting, and Participants  We performed a retrospective review that began on August 1, 2014, with audiometric evaluations at an academic medical center of 647 patients aged between 80 and 106 years, of whom 141 had multiple audiograms.

Main Outcomes and Measures  From a population perspective, the degree of hearing loss was compared across the following age brackets: 80 to 84 years, 85 to 89 years, 90 to 94 years, and 95 years and older. From an individual perspective, the rate of hearing decrease between 2 audiograms was compared with age.

Results  Changes in hearing among age brackets were higher during the 10th decade of life than the 9th decade at all frequencies (5.4-11.9 dB hearing level [dB HL]) for the 647 patients (mean [SD] age, 90 [5.5] years). Correspondingly, the annual rate of low-frequency hearing loss was faster during the 10th decade by the 3.8 dB HL per year at 0.25 kHz, 3.8 dB HL per year at 0.5 kHz, and 3.2 dB HL per year at 1 kHz. Despite the universal presence of hearing loss in our sample, 382 patients (59%) used hearing aids.

Conclusions and Relevance  There is a significant increase in the rate of hearing loss in patients during the 10th decade of life compared with the 9th decade that represents a fundamental change in the mechanistic process of presbycusis. Despite the potential benefit of hearing aids, they remain underused in the older old. Use may be improved by changing the method of hearing rehabilitation counseling from a patient-initiated model to a chronic disease example.

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Figure 1.
Average Thresholds of 647 Patients by Age Bracket in Better Hearing Ears

Thresholds at each frequency increase with age (analysis of variance, P < .05 for each frequency). The 95 years and older bracket has significantly worse hearing than all other groups (t tests, P < .05 for each frequency). Error bars represent 95% CI.

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Figure 2.
Threshold Differences Among Age Brackets in 647 Patients

The 4 age brackets were 80 to 84 years, 85 to 89 years, 90 to 94 years, and 95 years and older. There was a significant difference in thresholds among consecutive age brackets at all frequencies (analysis of variance, P < .05 for each frequency). The highest hearing loss occurred between the 90 to 94 and 95 years and older brackets. Error bars represent 95% CI.

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Figure 3.
Rate of Threshold Change Between 2 Audiograms in 141 Patients

Audiogram pairs were categorized by the decade of life during which they were obtained. The rates of low-frequency (0.25, 0.5, and 1 kHz) threshold change were significantly higher between 2 audiograms taken in the 10th decade (analysis of variance and t tests, P < .05 for specified frequencies). Error bars represent 95% CI.

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