Hearing Loss and Associated 7-Year Cognitive Outcomes Among Hispanic and Latino Adults.

Importance: Hearing loss appears to have adverse effects on cognition and increases risk for cognitive impairment. These associations have not been thoroughly investigated in the Hispanic and Latino population, which faces hearing health disparities. Objective: To examine associations between hearing loss with 7-year cognitive change and mild cognitive impairment (MCI) prevalence among a diverse cohort of Hispanic/Latino adults. Design, Setting, and Participants: This cohort study used data from a large community health survey of Hispanic Latino adults in 4 major US cities. Eligible participants were aged 50 years or older at their second visit to study field centers. Cognitive data were collected at visit 1 and visit 2, an average of 7 years later. Data were last analyzed between September 2023 and January 2024. Exposure: Hearing loss at visit 1 was defined as a pure-tone average (500, 1000, 2000, and 4000 Hz) greater than 25 dB hearing loss in the better ear. Main outcomes and measures: Cognitive data were collected at visit 1 and visit 2, an average of 7 years later and included measures of episodic learning and memory (the Brief-Spanish English Verbal Learning Test Sum of Trials and Delayed Recall), verbal fluency (word fluency-phonemic fluency), executive functioning (Trails Making Test-Trail B), and processing speed (Digit-Symbol Substitution, Trails Making Test-Trail A). MCI at visit 2 was defined using the National Institute on Aging-Alzheimer Association criteria. Results: A total of 6113 Hispanic Latino adults were included (mean [SD] age, 56.4 [8.1] years; 3919 women [64.1%]). Hearing loss at visit 1 was associated with worse cognitive performance at 7-year follow-up (global cognition: ß = -0.11 [95% CI, -0.18 to -0.05]), equivalent to 4.6 years of aging and greater adverse change (slowing) in processing speed (ß = -0.12 [95% CI, -0.23 to -0.003]) equivalent to 5.4 years of cognitive change due to aging. There were no associations with MCI. Conclusions and relevance: The findings of this cohort study suggest that hearing loss decreases cognitive performance and increases rate of adverse change in processing speed. These findings underscore the need to prevent, assess, and treat hearing loss in the Hispanic and Latino community.

Attentional Resources Are Needed for Auditory Stream Segregation in Aging.

The ability to select sound streams from background noise becomes challenging with age, even with normal peripheral auditory functioning. Reduced stream segregation ability has been reported in older compared to younger adults. However, the reason why there is a difference is still unknown. The current study investigated the hypothesis that automatic sound processing is impaired with aging, which then contributes to difficulty actively selecting subsets of sounds in noisy environments. We presented a simple intensity oddball sequence in various conditions with irrelevant background sounds while recording EEG. The ability to detect the oddball tones was dependent on the ability to automatically or actively segregate the sounds to frequency streams. Listeners were able to actively segregate sounds to perform the loudness detection task, but there was no indication of automatic segregation of background sounds while watching a movie. Thus, our results indicate impaired automatic processes in aging that may explain more effortful listening, and that tax attentional systems when selecting sound streams in noisy environments.

Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study/Study of Latinos.

STUDY OBJECTIVE: 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. METHODS: We used data from the HCHS/SOL, a multicenter population-based study of self- identifying Hispanic/Latinos 18- to 74-y-old adults from four US urban communities. We performed home SA testing and in-clinic audiometry testing in all participants. SA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. HI was defined as a mean hearing threshold > 25 dB hearing level in either ear at the frequencies: 3,000 to 8,000 Hz for high-frequency HI (HF-HI) and 500 to 2,000 Hz for low-frequency HI (LF-HI). Combined-frequency HI (CF-HI) was defined as both conditions present, and Any-HI was considered as HI in either low or high frequencies. RESULTS: Of 13,967 participants, 9.9% had SA and 32.3% had Any-HI. Adjusted for risk factors for HI, those with SA had a 30% higher odds of Any-HI (95% confidence interval [CI] = 8% to 57%), 26% higher odds of HF-HI (CI = 3% to 55%), 127% higher odds of LF-HI (CI = 21% to 326%), and 29% higher odds of CF-HI (CI = 0% to 65%). A dose-response association was observed between AHI severity and Any-HI (versus no SA, OR for AHI ≥ 15 and < 30 = 1.22, CI = 0.96 to 1.54, and OR for AHI ≥ 30 = 1.46, CI = 1.11 to 1.91, p = 0.002). CONCLUSION: SA is associated with HF-HI and LF-HI, independent of snoring and other confounders. COMMENTARY: A commentary on this article appears in this issue on page 641.

Risk Factors for Hearing Impairment among Adults with Diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

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/1.73m2 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.

Hearing Impairment Prevalence and Associated Risk Factors in the Hispanic Community Health Study/Study of Latinos.

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.

Effects of acoustic complexity on processing sound intensity in 10- to 11-year-old children: evidence from cortical auditory evoked potentials.

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.

Behavioral and electrophysiological measures of auditory change detection in children following late cochlear implantation: a preliminary study.

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.

Processing intensity at rapid rates: evidence from auditory evoked potentials in 9-11-year-old children.

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 86dB SPL) and five different stimulus frequencies were presented at a stimulus rate of 10Hz. 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.