A Novel Method for Classifying Hearing Impairment in Epidemiological Studies of Aging: The Wisconsin Age-Related Hearing Impairment Classification Scale.

Purpose Longitudinal population-based cohort data were used to develop a standardized classification system for age-related hearing impairment using thresholds for frequencies (0.5-8 kHz) typically measured in cohort studies. Method Audiometric testing data collected in the Epidemiology of Hearing Loss Study from participants (n = 1,369) with four visits (1993-1995, 1998-2000, 2003-2005, and 2009-2010) were included (10,952 audiograms). Cluster analyses (Wald's method) were used to identify audiometric patterns. Maximum allowable threshold values were defined for each cluster to create an ordered scale. Progression was defined as a two-step change. Results An eight-step scale was developed to capture audiogram shape and severity of hearing impairment. Of the 1,094 participants classified as having normal hearing based on a pure-tone average, only 25% (n = 277) were classified as Level 1 (all thresholds ≤ 20 dB HL) on the new scale, whereas 17% (n = 182) were Levels 4-6. During the 16-year follow-up, 64.9% of those at Level 1 progressed. There was little regression using this scale. Conclusions This is the first scale developed from population-based longitudinal cohort data to capture audiogram shape across time. This simple, standardized scale is easy to apply, reduces misclassification of normal hearing, and may be a useful method for identifying risk factors for early, preclinical, age-related changes in hearing.

An Epidemiologic Study of the Association between Free Recall Dichotic Digits Test Performance and Vascular Health.

BACKGROUND: Associations between vascular health-related factors and hearing loss defined using audiometric pure-tone thresholds have been found. Studies have not focused on a potential relationship between vascular health-related factors and central auditory processing. PURPOSE: The aim of this study was to evaluate, on a population level, the relationship of vascular health-related factors with central auditory function. RESEARCH DESIGN: A cross-sectional, population study. STUDY SAMPLE: Subjects were participants in the Epidemiology of Hearing Loss Study (EHLS) or the Beaver Dam Offspring Study (BOSS)-prospective studies of aging and sensory loss. BOSS participants were the adult offspring of participants in the EHLS. Participants who completed the Dichotic Digits Test (DDT) during the fourth examination period of the EHLS (2008-2010) or the second examination period of the BOSS (2010-2013) were included (n = 3,655, mean age = 61.1 years). DATA COLLECTION AND ANALYSIS: The DDT-free recall test was conducted using 25 sets of triple-digit pairs at a 70 dB HL presentation level. The total number of correctly repeated digits from the right and left ears was converted to a percentage correct and used as an outcome. The percentage correct in the left ear was subtracted from the percentage correct in the right ear and used as an outcome. Vascular health-related measures obtained during the examination included blood pressure, mean carotid intima-media thickness, femoral pulse wave velocity (PWV), hemoglobin A1C, and non-high-density lipoprotein (HDL) cholesterol, and, in the EHLS participants, C-reactive protein and interleukin-6. Information on vascular health-related history and behaviors was self-reported. General linear modeling produced estimates of the age- and sex-adjusted least squares means for each vascular factor, and multiple linear regression was used for multivariable modeling of each outcome. RESULTS: After multivariable adjustment, participants with diabetes had a significantly lower (worse) mean DDT-free recall total score (-2.08 percentage points, p < 0.001) than those without diabetes. Participants who exercised at least once per week had a significantly higher (better) mean DDT-free recall total score (+1.07 percentage points, p < 0.01) than those who did not exercise at least once per week. Alcohol consumption was associated with a higher DDT-free recall total score (+0.15 percentage points per +25 g ethanol, p < 0.01). In multivariable modeling of the right-left ear difference in DDT-free recall scores, participants with a history of cardiovascular disease (CVD) or higher PWV demonstrated significantly larger differences (CVD: +3.11 percentage points, p = 0.02; PWV: +0.36 percentage points per 1 m/sec, p < 0.01). Higher levels of non-HDL cholesterol were associated with smaller right-left ear differences (-0.22 percentage points per 10 mg/dL, p = 0.01). Adjustment for handedness did not affect the results. CONCLUSIONS: Vascular health-related factors may play a role in central auditory function.

Association Between Cystatin C and 20-Year Cumulative Incidence of Hearing Impairment in the Epidemiology of Hearing Loss Study.

Importance: Hearing impairment (HI) is one of the most common conditions affecting older adults. Identification of factors associated with the development of HI may lead to ways to reduce the incidence of this condition. Objective: To investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of HI. Design, Setting, and Participants: Data were obtained from the Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study in Beaver Dam, Wisconsin. Baseline examinations began in 1993 and continued through 1995, and participants were examined approximately every 5 years, with the most recent examination phase completed in 2015. The EHLS participants with serum cystatin C concentration data and without HI at the baseline examination were included in this study. Main Outcomes and Measures: Participants without HI were followed up for incident HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz >25 dB hearing level in either ear) for 20 years. Cystatin C was analyzed as a biomarker (concentration) and used to determine estimated glomerular filtration rate (eGFRCysC). Discrete-time Cox proportional hazards regression models were used to analyze the association between cystatin C concentration and eGFRCysC and the 20-year cumulative incidence of HI. Results: There were 863 participants aged 48 to 86 years with cystatin C data and without HI at baseline. Of these, 599 (69.4%) were women. In models adjusted for age and sex, cystatin C was associated with an increased risk of developing HI (hazard ratio [HR], 1.20; 95% CI, 1.07-1.34 per 0.2-mg/L increase in cystatin C concentration), but the estimate was attenuated after further adjusting for educational level, current smoking, waist circumference, and glycated hemoglobin (HR, 1.11; 95% CI, 0.98-1.27 per 0.2-mg/L increase in cystatin C concentration). Low eGFRCysC was significantly associated with the 20-year cumulative incidence of HI in both the age- and sex-adjusted model (HR, 1.70; 95% CI, 1.16-2.48; <60 vs ≥60 mL/min/1.73 m2) and the multivariable-adjusted model (HR, 1.50; 95% CI, 1.02-2.22; <60 vs ≥60 mL/min/1.73 m2). Conclusions and Relevance: Reduced kidney function as estimated using cystatin C, but not cystatin C alone, was associated with the 20-year cumulative incidence of HI, suggesting that some age-related HI may occur in conjunction with or as the result of reduced kidney function.

Generational Differences in the 5-Year Incidence of Age-Related Macular Degeneration.

Importance: Whether a reported decline in the risk of developing age-related macular degeneration (AMD) continued for people born during the Baby Boom years (1946-1964) or later is unknown. These data are important to plan for ocular health care needs in the 21st century. Objectives: To determine whether the 5-year risk for AMD declined by generation and to identify factors that contributed to improvement in risk. Design, Setting, and Participants: Data came from the longitudinal cohort Beaver Dam Eye Study (March 1, 1988, through September 15, 1990, and March 1, 1993, through June 15, 1995) and the Beaver Dam Offspring Study (June 8, 2005, through August 4, 2008, and July 12, 2010, through March 21, 2013). These population-based studies examined residents of Beaver Dam, Wisconsin, aged 43 to 84 years in 1987 through 1988 and their adult offspring aged 21 to 84 years in 2005 through 2008. A total of 4819 participants were at risk for developing AMD based on fundus images obtained at baseline visits. Data were analyzed from February 18, 2016, through June 22, 2017, with additional analyses ending September 22, 2017. Main Outcomes and Measures: Fundus images were graded for AMD using the Wisconsin Age-related Maculopathy Grading System. The incidence of AMD was defined as the presence at the 5-year follow-up examination of pure geographic atrophy or exudative macular degeneration, any type of drusen with pigmentary abnormalities, or soft indistinct drusen without pigmentary abnormalities. Results: Among the 4819 participants, the mean (SD) baseline age of the cohort was 54 (11) years; 2117 were men (43.9%) and 2702 were women (56.1%). The 5-year age- and sex-adjusted incidence of AMD was 8.8% in the Greatest Generation (born during 1901-1924), 3.0% in the Silent Generation (born during 1925-1945), 1.0% in the Baby Boom Generation (born during 1946-1964), and 0.3% in Generation X (born during 1965-1984). Adjusting for age and sex, each generation was more than 60% less likely to develop AMD than the previous generation (relative risk, 0.34; 95% CI, 0.24-0.46). The generational association (relative risk, 0.40; 95% CI, 0.28 to 0.57) remained significant after adjusting for age, sex, smoking, educational attainment, exercise, levels of non­high-density lipoprotein cholesterol and high-sensitivity C-reactive protein, and use of nonsteroidal anti-inflammatory drugs, statins, and multivitamins. Conclusions and Relevance: The 5-year risk for AMD declined by birth cohorts throughout the 20th century. Factors that explain this decline in risk are not known. However, this pattern is consistent with reported declines in risks for cardiovascular disease and dementia, suggesting that aging Baby Boomers may experience better retinal health at older ages than did previous generations.

A longitudinal population study of the impact of cataract extraction on sleep quality.

PURPOSE: To investigate the longitudinal effects of cataract extraction on sleep quality in two discrete population cohorts. METHODS: 301 participants who had senile cataract in both eyes at the baseline examination were selected from two large longitudinal epidemiologic studies of age-related eye disease, hearing, olfaction, and cognition. The participants were divided into two groups: one had cataract surgery (CS) in both eyes, and the other had no cataract surgery (NCS) in either eye by the follow up examination. Cataract was graded from photos or digital images using a standardized protocol. The quality of sleep was assessed using a modified Wisconsin Sleep Cohort Study Questionnaire. The NCS and CS groups were compared as to the change in the number of sleep problems reported from the baseline to the follow-up examination. Systemic co-morbidity data were included as potential confounders, including diabetes mellitus, obesity, hypertension, cerebrovascular disease, thyroid disease, tobacco and alcohol use, and the SF-12 physical component and mental component summary scores. RESULTS: The average (mean±SD) age was 71.0±8.8 years in the NCS (n=237) group and 73.4±9.1 years (n=64) in the CS group. There was no statistically significant difference in the change in the number of sleep problems reported between the NCS and CS groups (mean: -0.068 for NCS and 0.016 for CS, p=0.57). The multivariable linear regression models, when adjusted for confounders, yielded similar results. CONCLUSION: In this longitudinal, community-based population study, we found no significant impact of cataract extraction on sleep quality. Studies of the effect of cataract extraction on sleep should allow a longer follow up to demonstrate sustainability.

The Relation between Sleep Disruption and Cataract in a Large Population-Based Study.

PURPOSE: To investigate the relation between sleep disruption and nuclear cataract, as well as the impact of cataract removal on sleep, in two discrete population-based cohorts. METHODS: This is a cross-sectional study of 5070 participants from three large longitudinal epidemiologic studies of age-related eye disease, hearing, olfaction, and cognition. Slit-lamp photos of the lens were obtained to grade nuclear cataract using a standardized protocol. The quality of sleep was assessed using a modified Wisconsin Sleep Cohort Study questionnaire. Multiple linear regression analyses were used to assess the associations between levels of nuclear cataract/cataract extraction and the number of sleep problems. Systemic co-morbidity data were included as potential confounders, including diabetes mellitus, obesity, hypertension, cerebrovascular disease, thyroid disease, tobacco and alcohol use, and physical component summary score and mental component summary score. RESULTS: The mean age of the cohort was 57.6 years (range 22-95 years). The majority of the cohort demonstrated nuclear cataract levels 2 or 3 (36.8% and 30.1%, respectively). A total of 8% of the cohort had an intraocular lens (IOL) in at least one eye. There was no statistically significant correlation between sleep problems with presence of either nuclear cataract or IOL implant (p > 0.05). CONCLUSION: In this cross-sectional, population-based study, we found no significant association between nuclear cataract or presence of IOL with poor sleep quality after adjusting for potential confounders. Studies of the longitudinal impact of nuclear cataract and cataract removal on sleep are needed to elucidate the role of nuclear cataract and cataract removal on sleep.

Dichotic Digits Test Performance Across the Ages: Results From Two Large Epidemiologic Cohort Studies.

OBJECTIVES: The Dichotic Digits test (DDT) has been widely used to assess central auditory processing but there is limited information on observed DDT performance in a general population. The purpose of the study was to determine factors related to DDT performance in a large cohort spanning the adult age range. DESIGN: The study was cross-sectional and subjects were participants in the Epidemiology of Hearing Loss Study (EHLS), a population-based investigation of age-related hearing loss, or the Beaver Dam Offspring Study (BOSS), a study of aging in the adult offspring of the EHLS members. Subjects seen during the 4th EHLS (2008 to 2010) or the 2nd BOSS (2010 to 2013) examination were included (N = 3655 participants [1391 EHLS, 2264 BOSS]; mean age = 61.1 years, range = 21 to 100 years). The free and right ear-directed recall DDTs were administered using 25 sets of triple-digit pairs with a 70 dB HL presentation level. Pure-tone audiometric testing was conducted and the pure-tone threshold average (PTA) at 0.5, 1, 2, and 4 kHz was categorized using the worse ear: no loss = PTA ≤ 25 dB HL; mild loss = 25 < PTA ≤ 40 dB HL; moderate or marked loss = PTA > 40 dB HL. Cognitive impairment was defined as a Mini-Mental State Examination score < 24 (maximum = 30) or a self- or proxy-reported history of dementia or Alzheimer's disease. Demographic information was self-reported. General linear models were fit and multiple linear regression was performed. RESULTS: The mean total free recall DDT score was 76.7% (range = 21.3 to 100%). Less than 10% of the participants had a total free recall score below 60% correct. The mean right ear-directed recall score was 98.4% with 69% of the participants scoring 100% and another 15.5% scoring 98.7% (1 incorrect digit). In multivariable modeling of the total free recall scores, the predicted mean free recall score was 1 percentage point lower for every 5-year increase in age, 2.3 percentage points lower in males than females, 8.7 percentage points lower in participants with less than a high school degree than in those with college degrees, 6.8 percentage points lower in participants with a moderate or marked hearing loss compared with no hearing loss, and 8.3 percentage points lower in participants with cognitive impairment compared with those without cognitive impairment. These 5 factors were independently and significantly related to performance and accounted for 22.7% of the total variability in free recall scores. CONCLUSIONS: Substantial variation in the total free recall DDT scores but very little variation in the right ear-directed recall DDT scores was observed. Age, sex, education, hearing loss severity, and cognitive impairment were found to be significantly related to DDT scores but explained less than 25% of the total variability in total free recall scores. The right ear-directed recall DDT by itself may not be of benefit in assessing central auditory processing in a general population because of its limited variability but further evaluation of factors potentially related to free recall DDT variability may prove useful.

Hearing-aid use and long-term health outcomes: Hearing handicap, mental health, social engagement, cognitive function, physical health, and mortality.

OBJECTIVE: To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. DESIGN: We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. STUDY SAMPLE: Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. RESULTS: There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significantly better than unaided HHIE-S. At 11 years hearing-aid users had significantly better SF-12 physical health scores (46.2 versus 41.2; p = 0.03). There was no difference in incidence of cognitive impairment or mortality. CONCLUSION: There was no evidence that hearing aids promote cognitive function, mental health, or social engagement. Hearing aids may reduce hearing handicap and promote better physical health.

Smoking, central adiposity, and poor glycemic control increase risk of hearing impairment.

OBJECTIVES: To determine associations between smoking, adiposity, diabetes mellitus, and other risk factors for cardiovascular disease (CVD) and the 15-year incidence of hearing impairment (HI). DESIGN: A longitudinal population-based cohort study (1993-95 to 2009-10), the Epidemiology of Hearing Loss Study (EHLS). SETTING: Beaver Dam, Wisconsin. PARTICIPANTS: Participants in the Beaver Dam Eye Study (1988-90; residents of Beaver Dam, WI, aged 43-84 in 1987-88) were eligible for the EHLS. There were 1,925 participants with normal hearing at baseline. MEASUREMENTS: Fifteen-year cumulative incidence of HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz greater than 25 decibels hearing level in either ear). Cigarette smoking, exercise, and other factors were ascertained according to questionnaire. Blood pressure, waist circumference, body mass index, and glycosylated hemoglobin were measured. RESULTS: Follow-up examinations (≥1) were obtained from 87.2% (n=1,678; mean baseline age 61). The 15-year cumulative incidence of HI was 56.8%. Adjusting for age and sex, current smoking (hazard ratio (HR)=1.31, P=.048), education (<16 years; HR=1.35, P=.01), waist circumference (HR=1.08 per 10 cm, P=.02), and poorly controlled diabetes mellitus (HR=2.03, P=.048) were associated with greater risk of HI. Former smokers and people with better-controlled diabetes mellitus were not at greater risk. CONCLUSION: Smoking, central adiposity, and poorly controlled diabetes mellitus predicted incident HI. These well-known risk factors for CVD suggest that vascular changes may contribute to HI in aging. Interventions targeting reductions in smoking and adiposity and better glycemic control in people with diabetes mellitus may help prevent or delay the onset of HI.

Subclinical atherosclerosis and increased risk of hearing impairment.

OBJECTIVE: The study's purpose was to test if subclinical atherosclerosis was associated with the risk of developing HI in a large cohort of middle-aged participants. METHODS: Study subjects were members of the Beaver Dam Offspring Study (BOSS), a longitudinal study of adult children of participants in the population-based Epidemiology of Hearing Loss Study (1993-present). BOSS examinations took place in 2005-2008 (baseline) and 2010-2013 (5-year follow-up). The 5-year incidence of hearing impairment was defined as a pure-tone average (PTA) of thresholds at 0.5, 1, 2 and 4 kHz > 25 dB Hearing Level (dB HL) in either ear at follow-up among participants at risk (baseline PTA in both ears < = 25 dB HL; n = 2436, mean age = 47.7 years). Atherosclerosis was measured as the mean carotid intima-media thickness and the presence of carotid artery plaque. RESULTS: Among the 1984 participants at-risk with a follow-up audiometric examination, the 5-year incidence of hearing impairment was 8.3% (95% Confidence Interval (C.I.) 7.1, 9.5). With multivariable adjustment, carotid intima-media thickness was positively associated with hearing impairment incidence (Relative Risk (RR) = 1.14 per 0.1 mm, 95% C.I. 1.04, 1.24). The number of sites (0-6) with plaque was also positively associated with the incidence of impairment (RR = 1.16 per site, 95% C.I. 1.01, 1.32). CONCLUSION: Atherosclerosis was associated with the 5-year incidence of hearing impairment in this predominantly middle-aged cohort. Interventions targeting atherosclerosis prevention may help to prevent or delay the onset of hearing impairment.

Association of exercise with lower long-term risk of olfactory impairment in older adults.

IMPORTANCE: The prevalence of olfactory impairment is high in older adults, and this decline in olfactory ability may pose health and safety risks, affect nutrition, and decrease quality of life. It is important to identify modifiable risk factors to reduce the burden of olfactory impairment in aging populations. OBJECTIVE: To determine if exercise is associated with the 10-year cumulative incidence of olfactory impairment. DESIGN, SETTING, AND PARTICIPANTS: Observational longitudinal population-based Epidemiology of Hearing Loss Study. Participants without olfactory impairment (n = 1611) were ages 53 to 97 years at baseline and were followed for up to 10 years (1998-2010). MAIN OUTCOMES AND MEASURES: Olfaction was measured with the San Diego Odor Identification Test at 3 examinations (1998-2000, 2003-2005, and 2009-2010) of the Epidemiology of Hearing Loss Study. The main outcome was the incidence of olfactory impairment 5 (2003-2005) or 10 (2009-2010) years later and the association of baseline exercise with the long-term risk of developing olfactory impairment. RESULTS: The 10-year cumulative incidence of olfactory impairment was 27.6% (95% CI, 25.3%-29.9%) and rates varied by age and sex; those who were older (hazard ratio [HR], 1.88 [95% CI, 1.74-2.03], for every 5 years) or male (HR, 1.27 [95% CI, 1.00-1.61]) had an increased risk of olfactory impairment. Participants who reported exercising at least once a week long enough to work up a sweat had a decreased risk of olfactory impairment (age- and sex-adjusted HR, 0.76 [95% CI, 0.60-0.97]). Increasing frequency of exercise was associated with decreasing risk of developing olfactory impairment (P value for trend = .02). CONCLUSIONS AND RELEVANCE: Regular exercise was associated with lower 10-year cumulative incidence of olfactory impairment. Older adults who exercise may be able to retain olfactory function with age.

Sixteen-year change in acoustic-admittance measures among older adults: data from a population-based study.

PURPOSE: The primary purpose of this study was to measure the 16-year change in peak compensated static acoustic admittance (Peak Y(tm)) in a population-based cohort of older adults, and to determine whether age was associated with any observed change in Peak Y(tm). Other tympanometric measures also were taken and analyzed. METHOD: Data from two examinations (1993-1995 and 2009-2010) of the population-based Epidemiology of Hearing Loss Study (n = 1,439 with data at both examinations, ages 48-84 years at baseline) were utilized to assess 16-year change. Tympanometric measures were taken using a 226-Hz probe tone, a positive-to-negative direction of pressure change, and a measured pump speed of 600/200 daPa/s. RESULTS: During the 16-year period, Peak Y(tm) declined an average of 0.009 mmho/year (0.009/year for women, 0.007/year for men). Among women, older baseline age was associated with greater decline in Peak Y(tm). Among men, baseline age was associated with change in Peak Y(tm), but in a nonlinear pattern. Other tympanometric measures demonstrated little change after 16 years. CONCLUSIONS: These results demonstrate a small degree of middle-ear stiffening after 16 years among these older adults, but not enough to affect function in a manner that would influence clinical decisions.

Odor identification and cognitive function in the Beaver Dam Offspring Study.

Olfactory impairment is associated with cognitive impairment in older adults but less is known about the association of olfactory impairment and cognitive function in middle-aged adults. The association between olfactory impairment and cognitive function tests of attention, processing speed, and executive and psychomotor function was explored in 2837 participants (21-84 years; mean age 49 years) in the Beaver Dam Offspring Study. Among middle-aged participants (aged 35-64 years), those with impairment on an odor identification test took significantly longer to complete the Trail Making Test (TMT-A and TMT-B) and the Grooved Peg Board (GPB) test, than those without olfactory impairment in regression models adjusted for multiple factors. Similar results were found for the TMT-A and TMT-B, but not the GPB, in the whole cohort. Olfactory impairment was associated with poorer performance on cognitive function tests in a primarily middle-aged cohort.

Changes in environmental tobacco smoke exposure: the Beaver Dam experience.

OBJECTIVES: Environmental tobacco smoke (ETS) exposure has been associated with adverse health outcomes. Our goal was to determine if ETS exposure changed between 1998-2000 and 2003-2005 among participants in the population-based Epidemiology of Hearing Loss Study. METHODS: ETS exposure was ascertained using a cotinine-validated questionnaire at the 5-year (1998-2000) and 10-year follow-up examinations (2003-2005). Non-smoking participants with data from both visits were included (n=1898; ages 53-96 years at 5-yr follow-up). McNemar's test was used to test differences in ETS exposure overall and in 3 settings: home, work, and social settings. Generalized estimating equations (GEE) were used for multivariate logistic regression models of exposure. RESULTS: The proportion of nonsmokers with no or little ETS exposure increased from 80% to 88% (P< 0.0001). The percent living in a home with no indoor smokers increased from 94% to 97% (P<0.0001). The percent reporting no exposure at work increased from 91% to 95% (P<0.0001). The percent reporting the lowest frequency of social exposure increased from 65% to 77% (P<0.0001). In the GEE model, age was inversely associated with overall ETS exposure (Odds Ratio [OR] per 5 yr= 0.87, 95% CI= 0.81, 0.94), as was education (OR for college vs < high school=0.25, 95% CI=0.16, 0.37), female gender (ORI= 0.41, 95% CI= 0.33, 0.51), and later examination period (OR =0.62, 95% CI= 0.53, 0.73); current employment was positively associated with exposure (OR=1.44, 95% CI=1.14, 1.83). CONCLUSIONS: Between the late 1990s and the mid-2000s, ETS exposure in older adults decreased. Decreasing exposures suggest there may be future declines in ETS-related adverse health outcomes.

Generational differences in the reporting of tinnitus.

OBJECTIVES: Recent research suggests that hearing impairment is declining among older adults compared with earlier generations of the same age. Tinnitus is often associated with hearing impairment, so one might hypothesize that the prevalence of tinnitus is declining in a similar manner. The purpose of this study was to use multigenerational data with repeated measures to determine whether the prevalence of tinnitus is declining among more recent generations. DESIGN: Using data from the Epidemiology of Hearing Loss Study (1993-1995, 1998-2000, 2003-2005, and 2009-2010) and the Beaver Dam Offspring Study (2005-2008), the authors examined birth cohort patterns in the report of tinnitus for adults aged 45 years and older (n =12,689 observations from 5764 participants). Participants were classified as having tinnitus if they reported tinnitus in the past year of at least moderate severity or that caused difficulty falling asleep. A low-frequency (500, 1000, and 2000 Hz) and high-frequency (3000, 4000, 6000, and 8000 Hz) pure tone average from the worse ear was used to summarize hearing status. Other potential risk factors for tinnitus were also explored to determine if changes in the prevalence of these factors over time could explain any observed birth cohort differences in the prevalence of tinnitus. These included the following: education, history of head injury, history of doctor-diagnosed ear infections, history of cardiovascular disease (myocardial infarction, stroke, or angina), current noisy job, longest-held job, target shooting in the past year, number of concerts ever attended, alcohol use in the past year, doctor diagnosis of arthritis, current aspirin use, regular exercise, and consulting with a physician in the past year about any hearing/ear problem. Birth cohort effects were modeled with alternating logistic regression models which use generalized estimating equations to adjust for correlation among repeated measurements over time that are nested within families. RESULTS: The report of tinnitus tended to increase with more recent birth cohorts compared with earlier birth cohorts. For example, at ages 55 to 59 years, 7.6% of participants born between 1935 and 1939 reported tinnitus, compared with 11.0% of those born in 1940 to 1944, 13.6% of those born between 1945 and 1949, and 17.5% of those born between 1950 and 1954. Similarly, at ages 65 to 69 years, 7.9% of participants born between 1925 and 1929 reported tinnitus, compared with 10.0% of those born between 1930 and 1934, 11.9% of those born between 1935 and 1939, and 13.7% of those born between 1940 and 1944. Final alternating logistic regression model results indicated that, on average, after adjusting for age and other factors, participants in a given generation were significantly more likely to report tinnitus than participants from a generation 20 years earlier (odds ratio = 1.78, 95% confidence interval = 1.44, 2.21). CONCLUSIONS: Increased reports of tinnitus may reflect increased prevalence of symptoms, increased awareness of symptoms, or higher health expectations among more recent generations of adults. Regardless of the reasons, the increasing prevalence of tinnitus suggests that health care providers may see an increased number of patients bothered by this common but little understood symptom.

Aging and the 4-kHz air-bone gap.

PURPOSE: In this study, the authors assessed age- and sex-related patterns in the prevalence and 10-year incidence of 4-kHz air-bone gaps and associated factors. METHOD: Data were obtained as part of the longitudinal, population-based Epidemiology of Hearing Loss Study (Cruickshanks et al., 1998). An air-bone gap at 4 kHz was defined as an air-conduction threshold ≥ 15 dB higher than the bone-conduction threshold in the right ear. RESULTS: Among 3,553 participants ages 48-92 years at baseline (1993-1995), 3.4% had a 4-kHz air-bone gap in the right ear. The prevalence increased with age. Among the 120 participants with an air-bone gap, 60.0% did not have a flat tympanogram or an air-bone gap at 0.5 kHz. Ten years later, the authors assessed 2,093 participants who did not have a 4-kHz air-bone gap at baseline; 9.2% had developed a 4-kHz air-bone gap in the right ear. The incidence increased with age. Among the 192 participants who had developed an air-bone gap, 60.9% did not have a flat tympanogram or air-bone gaps at other frequencies. CONCLUSION: These results suggest that a finding of a 4-kHz air-bone gap may reflect a combination of aging and other factors and not necessarily exclusively abnormal middle-ear function.

Olfactory impairment in an adult population: the Beaver Dam Offspring Study.

The objective of this study was to determine the prevalence of olfactory impairment and associated risk factors and the effects of olfactory impairment on dietary choices and quality of life. Odor identification was measured in 2838 participants aged 21-84 years (mean 49 years) in the Beaver Dam Offspring Study. The overall prevalence of olfactory impairment was 3.8%, increased with age (from 0.6% in those<35 years to 13.9% among those≥65 years) and was more common in men than women. In a multivariate model age (odds ratio [OR]=1.48, 95% confidence interval [CI]=1.33, 1.64 for every 5-year increase), nasal polyps or deviated septum (OR=2.69, 95% CI=1.62, 4.48), ankle-brachial index<0.9 (OR=3.62, 95% CI=1.45, 9.01), and smoking (women only) (OR=2.43, 95% CI=1.19, 4.98 ever smoked vs. never) were associated with an increased odds of olfactory impairment, whereas higher household income, ≥$50,000 versus <$50,000 per year, was associated with a decreased odds of olfactory impairment (OR=0.48, 95% CI=0.31, 0.73). Participants with olfactory impairment were less likely to report that food tasted as good as it used to, or that they experienced food flavors the same. There was no association between olfactory impairment and general health-related quality of life, depressive symptoms, or dietary choices. The prevalence of olfactory impairment was low in this largely middle-aged cohort, and some factors associated with olfactory impairment are potentially modifiable.

Association of Biomarkers for Inflammation, Endothelial Dysfunction and Oxidative Stress with Cognitive Impairment. The Epidemiology of Hearing Loss Study (EHLS).

BACKGROUND: Individual biomarkers of inflammation, endothelial dysfunction and oxidative stress have been associated with cognitive impairment. This study explored whether a combination of biomarkers could prospectively identify those who developed cognitive decline. METHODS: Biomarkers were obtained during the baseline examination of the Beaver Dam Eye Study (1988-90), and cognitive status was assessed during the 5-year follow-up examination of the Epidemiology of Hearing Loss Study (1998-2000). Cognitive impairment was defined as a score of < 24 points on the Mini-Mental State Examination or self- or proxy report of Alzheimer Disease or dementia. Among those with cognitive data, interleukin-6, isoprostanes, protein carbonyl, soluble inter-cellular adhesion molecule-1 and vascular cell adhesion molecule-1 were available for 950 participants and 2,336 had high sensitivity C-reactive protein. RESULTS: Biomarkers of inflammation and endothelial dysfunction were not associated with cognitive impairment. There was a weak inverse association between higher levels of protein carbonyl content and cognitive impairment (OR, 0.8 per quartile of protein carbonyl content, p=0.045 unadjusted for multiple comparisons). This was not significant on multiple testing and may have been a chance finding. CONCLUSION: We found that many markers of inflammation and endothelial dysfunction were not associated with cognitive impairment. An inverse association with carbonyl protein, a marker of oxidative stress needs further confirmation.

Olfactory impairment in older adults: five-year incidence and risk factors.

OBJECTIVES/HYPOTHESIS: The objective of this study was to determine the five-year incidence of olfactory impairment and associated risk factors in a general population of older adults. STUDY DESIGN: Longitudinal population-based study. METHODS: Participants (n = 1,556) in the population-based Epidemiology of Hearing Loss Study had olfaction measured at the 5- and 10-year examinations (1998-2000 and 2003-2005, respectively). Olfactory ability was measured by the San Diego Odor Identification Test. RESULTS: The five-year incidence of olfactory impairment was 12.5%. Incidence rates increased with age for men and women. In a multivariate model, age (odds ratio [OR] = 1.79, 95% CI, 1.61-2.00; for every five-year increase), a history of nasal polyps (OR = 2.33, 95% CI, 1.13-4.59), a history of deviated septum (OR = 2.05, 95% CI, 1.14-3.56), and a history of heavy alcohol use (OR = 1.84, 95% CI, 1.13-2.93) were associated with an increased risk of olfactory impairment, whereas use of lipid-lowering agents (OR = 0.68, 95% CI, 0.46-0.99; yes vs. no), exercising at least once a week (OR = 0.69, 95% CI, 0.48-0.98), and oral steroid use (OR = 0.37, 95% CI, 0.11-0.94) were associated with a decreased risk. CONCLUSIONS: The five-year incidence of olfactory impairment is high in this population of older adults. Modifiable risk factors associated with impairment suggest some impairment could be amenable to prevention or treatment.

Tinnitus and its risk factors in the Beaver Dam offspring study.

OBJECTIVE: To assess the prevalence of tinnitus along with factors potentially associated with having tinnitus. DESIGN: Data were from the Beaver Dam Offspring Study, an epidemiological cohort study of aging. STUDY SAMPLE: After a personal interview and audiometric examination, participants (n = 3267, ages 21-84 years) were classified as having tinnitus if in the past year they reported having tinnitus of at least moderate severity or that caused difficulty in falling asleep. RESULTS: The prevalence of tinnitus was 10.6%. In a multivariable logistic regression model adjusting for age and sex, the following factors were associated with having tinnitus: hearing impairment (Odds Ratio (OR) = 3.20), currently having a loud job (OR = 1.90), history of head injury (OR = 1.84), depressive symptoms (OR = 1.82), history of ear infection (men, OR = 1.75), history of target shooting (OR = 1.56), arthritis (OR = 1.46), and use of NSAID medications (OR = 1.33). For women, ever drinking alcohol in the past year was associated with a decreased risk of having tinnitus (OR = 0.56). CONCLUSIONS: These results suggest that tinnitus is a common symptom in this cohort and may be associated with some modifiable risk factors.