The Nord-Trøndelag Norway Audiometric Survey 1996-98: unscreened thresholds and prevalence of hearing impairment for adults > 20 years.

As supplement to a general health screening examination (HUNT-II), we conducted a puretone audiometry study in 1996-98 on adults (>20 years) in 17 of 23 municipalities in Nord-Trøndelag, Norway, including questionnaires on occupational and leisure noise exposure, medical history, and symptoms of hearing impairment. The study aims to contribute to updated normative hearing thresholds for age and gender, while evaluating the effects of noise exposure, medical history, and familial or genetic influences on hearing. This paper presents the unscreened hearing threshold data and prevalence of hearing impairment for different age groups and by gender. Valid audiometric data were collected from 62% (n=50,723) of 82,141 unscreened invited subjects (age-range 20-101 years, mean=50.2 years, SD=17.0 years). Two ambulant audiometric teams each conducted 5 parallel self-administered, pure-tone hearing threshold examinations with the standard test frequencies 0.25-0.5-1-2-3-4-6-8 kHz (manual procedure when needed). Tracking audiometers were used in dismountable booths with in-booth noise levels well within ISO criteria, except being at the criterion around 200 Hz. The data were electronically transferred to a personal computer. Test-retest correlations for 99 randomly drawn subjects examined twice were high. The mean thresholds recorded were some dB elevated from "audiometric zero" even for age group 20-24 years. As also found in other studies, this might indicate too restrictive audiometric reference thresholds. Males had slightly better hearing < or =0.5 kHz for all age groups. Mean thresholds were poorer in males > or = 30 years from > or =2 kHz, with maximal gender differences of approximately 20 dB at 3-4 kHz for subjects aged 55-74 years. Weighted prevalence data averaged over 0.5-1-2-4 kHz showed hearing impairment >25 dB hearing threshold level of 18.8% (better ear) and 27.2% (worse ear) for the total population--for males 22.2% and 32.0%, for females 15.9% and 23.0%, respectively. Mean hearing loss > or =10 dB at 6 kHz registered for both genders even in age groups 20-24 years may be partly due to calibration artefacts, but might possibly also reflect noise-related socio-acusis.

Does health promotion work in relation to noise?

Noise is a health risk. The only scientifically established adverse health effect of noise is noise-induced hearing loss (NIHL). Besides noise may affect quality of life and cause annoyance and sleep disturbance. The present scientific evidence of potential non-auditory effects of noise on health is quite weak. Whether health promotion works in relation to noise may be reflected by permanent hearing threshold shift development in population studies. Hearing impairment continues to be the most prevalent disability in Western societies. The National Institute of Occupational Safety and Health (NIOSH) still rates noise induced hearing loss among the top ten work-related problems. Recent studies report that employees continue to develop noise induced hearing loss although to a lesser extent than before, in spite of occupational hearing conservation programmes. Besides socio-acusis and leisure noise seem to be an increasing hazard to hearing, also in young children and adolescents. This seems partly related to acute leisure noise exposure (e.g. toy pistols, amplified music). However, population studies increasingly find non-normal high-frequency hearing including the characteristic NIHL-"notch" around 6 kHz also in subjects who do not report noise exposure incidents or activities. Today 12.5% of US children 6-19 years show a noise-"notch" in one or both ears (n= 5249, Niskar et al 2001). A Norwegian county audiometry survey on adults >/= 20 years n=51.975) showed mean unscreened thresholds +10 dB at 6 kHz for both genders even or the youngest age group 20-24 years (Borchgrevink et al 2001). Accordingly, the present health promotion initiatives seem insufficient in relation to noise and noise-induced hearing loss.