Time From Hearing Aid Candidacy to Hearing Aid Adoption: A Longitudinal Cohort Study

Objectives: Although many individuals with hearing loss could benefit from intervention with hearing aids, many do not seek or delay seeking timely treatment after the onset of hearing loss. There is limited data-based evidence estimating the delay in adoption of hearing aids with anecdotal estimates ranging from 5 to 20 years. The present longitudinal study is the first to assess time from hearing aid candidacy to adoption in a 28-year ongoing prospective cohort of older adults, with the additional goal of determining factors influencing delays in hearing aid adoption, and self-reported successful use of hearing aids. Design: As part of a longitudinal study of age-related hearing loss, a wide range of demographic, biologic, and auditory measures are obtained yearly or every 2 to 3 years from a large sample of adults, along with family, medical, hearing, noise exposure, and hearing aid use histories. From all eligible participants (age ≥18; N = 1530), 857 were identified as hearing aid candidates either at baseline or during their participation, using audiometric criteria. Longitudinal data were used to track transition to hearing aid candidacy and hearing aid adoption. Demographic and hearing-related characteristics were compared between hearing aid adopters and nonadopters. Unadjusted estimated overall time (in years) to hearing aid adoption and estimated delay times were stratified by demographic and hearing-related factors and were determined using a time-to-event analysis (survival analysis). Factors influencing rate of adoption in any given time period were examined along with factors influencing successful hearing aid adoption. Results: Age, number of chronic health conditions, sex, retirement status, and education level did not differ significantly between hearing aid adopters and nonadopters. In contrast, adopters were more likely than nonadopters to be married, of white race, have higher socioeconomic status, have significantly poorer higher frequency (2.0, 3.0, 4.0, 6.0, and 8.0 kHz) pure-tone averages, poorer word recognition in quiet and competing multi-talker babble, and reported more hearing handicap on the Hearing Handicap Inventory for the Elderly/Adults emotional and social subscales. Unadjusted estimation of time from hearing aid candidacy to adoption in the full participant cohort was 8.9 years (SE ± 0.37; interquartile range = 3.2–14.9 years) with statistically significant stratification for race, hearing as measured by low- and high-frequency pure-tone averages, keyword recognition in low-context sentences in babble, and the Hearing Handicap Inventory for the Elderly/Adults social score. In a subgroup analysis of the 213 individuals who adopted hearing aids and were assigned a success classification, 78.4% were successful. No significant predictors of success were found. Conclusions: The average delay in adopting hearing aids after hearing aid candidacy was 8.9 years. Nonwhite race and better speech recognition (in a more difficult task) significantly increased the delay to treatment. Poorer hearing and more self-assessed hearing handicap in social situations significantly decreased the delay to treatment. These results confirm the assumption that adults with hearing loss significantly delay seeking treatment with hearing aids. ACKNOWLEDGMENTS: The authors thank Jayne Ahlstrom for editorial assistance. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06 RR14516 from the National Center for Research Resources (NCRR), National Institutes of Health (NIH). This work was supported (in part) by research grant P50 DC000422 from NIH, National Institute on Deafness and Other Communication Disorders (NIDCD) and by the South Carolina Clinical and Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, NIH/NCRR Grant number UL1 RR029882. The authors have no conflicts of interest to disclose. Address for correspondence: Annie N. Simpson, Medical University of South Carolina, Charleston, SC 29425, USA. E-mail: simpsona@musc.edu Received November 7, 2017; accepted June 8, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Time From Hearing Aid Candidacy to Hearing Aid Adoption: A Longitudinal Cohort Study

Objectives: Although many individuals with hearing loss could benefit from intervention with hearing aids, many do not seek or delay seeking timely treatment after the onset of hearing loss. There is limited data-based evidence estimating the delay in adoption of hearing aids with anecdotal estimates ranging from 5 to 20 years. The present longitudinal study is the first to assess time from hearing aid candidacy to adoption in a 28-year ongoing prospective cohort of older adults, with the additional goal of determining factors influencing delays in hearing aid adoption, and self-reported successful use of hearing aids. Design: As part of a longitudinal study of age-related hearing loss, a wide range of demographic, biologic, and auditory measures are obtained yearly or every 2 to 3 years from a large sample of adults, along with family, medical, hearing, noise exposure, and hearing aid use histories. From all eligible participants (age ≥18; N = 1530), 857 were identified as hearing aid candidates either at baseline or during their participation, using audiometric criteria. Longitudinal data were used to track transition to hearing aid candidacy and hearing aid adoption. Demographic and hearing-related characteristics were compared between hearing aid adopters and nonadopters. Unadjusted estimated overall time (in years) to hearing aid adoption and estimated delay times were stratified by demographic and hearing-related factors and were determined using a time-to-event analysis (survival analysis). Factors influencing rate of adoption in any given time period were examined along with factors influencing successful hearing aid adoption. Results: Age, number of chronic health conditions, sex, retirement status, and education level did not differ significantly between hearing aid adopters and nonadopters. In contrast, adopters were more likely than nonadopters to be married, of white race, have higher socioeconomic status, have significantly poorer higher frequency (2.0, 3.0, 4.0, 6.0, and 8.0 kHz) pure-tone averages, poorer word recognition in quiet and competing multi-talker babble, and reported more hearing handicap on the Hearing Handicap Inventory for the Elderly/Adults emotional and social subscales. Unadjusted estimation of time from hearing aid candidacy to adoption in the full participant cohort was 8.9 years (SE ± 0.37; interquartile range = 3.2–14.9 years) with statistically significant stratification for race, hearing as measured by low- and high-frequency pure-tone averages, keyword recognition in low-context sentences in babble, and the Hearing Handicap Inventory for the Elderly/Adults social score. In a subgroup analysis of the 213 individuals who adopted hearing aids and were assigned a success classification, 78.4% were successful. No significant predictors of success were found. Conclusions: The average delay in adopting hearing aids after hearing aid candidacy was 8.9 years. Nonwhite race and better speech recognition (in a more difficult task) significantly increased the delay to treatment. Poorer hearing and more self-assessed hearing handicap in social situations significantly decreased the delay to treatment. These results confirm the assumption that adults with hearing loss significantly delay seeking treatment with hearing aids. ACKNOWLEDGMENTS: The authors thank Jayne Ahlstrom for editorial assistance. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06 RR14516 from the National Center for Research Resources (NCRR), National Institutes of Health (NIH). This work was supported (in part) by research grant P50 DC000422 from NIH, National Institute on Deafness and Other Communication Disorders (NIDCD) and by the South Carolina Clinical and Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, NIH/NCRR Grant number UL1 RR029882. The authors have no conflicts of interest to disclose. Address for correspondence: Annie N. Simpson, Medical University of South Carolina, Charleston, SC 29425, USA. E-mail: simpsona@musc.edu Received November 7, 2017; accepted June 8, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Compartmentalization of antagonistic Ca2+ signals in developing cochlear hair cells.

Related Articles

Compartmentalization of antagonistic Ca2+ signals in developing cochlear hair cells.

Proc Natl Acad Sci U S A. 2018 02 27;115(9):E2095-E2104

Authors: Moglie MJ, Fuchs PA, Elgoyhen AB, Goutman JD

Abstract
During a critical developmental period, cochlear inner hair cells (IHCs) exhibit sensory-independent activity, featuring action potentials in which Ca2+ ions play a fundamental role in driving both spiking and glutamate release onto synapses with afferent auditory neurons. This spontaneous activity is controlled by a cholinergic input to the IHC, activating a specialized nicotinic receptor with high Ca2+ permeability, and coupled to the activation of hyperpolarizing SK channels. The mechanisms underlying distinct excitatory and inhibitory Ca2+ roles within a small, compact IHC are unknown. Making use of Ca2+ imaging, afferent auditory bouton recordings, and electron microscopy, the present work shows that unusually high intracellular Ca2+ buffering and "subsynaptic" cisterns provide efficient compartmentalization and tight control of cholinergic Ca2+ signals. Thus, synaptic efferent Ca2+ spillover and cross-talk are prevented, and the cholinergic input preserves its inhibitory signature to ensure normal development of the auditory system.

PMID: 29439202 [PubMed - indexed for MEDLINE]

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Compartmentalization of antagonistic Ca2+ signals in developing cochlear hair cells.

Related Articles

Compartmentalization of antagonistic Ca2+ signals in developing cochlear hair cells.

Proc Natl Acad Sci U S A. 2018 02 27;115(9):E2095-E2104

Authors: Moglie MJ, Fuchs PA, Elgoyhen AB, Goutman JD

Abstract
During a critical developmental period, cochlear inner hair cells (IHCs) exhibit sensory-independent activity, featuring action potentials in which Ca2+ ions play a fundamental role in driving both spiking and glutamate release onto synapses with afferent auditory neurons. This spontaneous activity is controlled by a cholinergic input to the IHC, activating a specialized nicotinic receptor with high Ca2+ permeability, and coupled to the activation of hyperpolarizing SK channels. The mechanisms underlying distinct excitatory and inhibitory Ca2+ roles within a small, compact IHC are unknown. Making use of Ca2+ imaging, afferent auditory bouton recordings, and electron microscopy, the present work shows that unusually high intracellular Ca2+ buffering and "subsynaptic" cisterns provide efficient compartmentalization and tight control of cholinergic Ca2+ signals. Thus, synaptic efferent Ca2+ spillover and cross-talk are prevented, and the cholinergic input preserves its inhibitory signature to ensure normal development of the auditory system.

PMID: 29439202 [PubMed - indexed for MEDLINE]

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Preference for Infant-Directed Speech in Infants With Hearing Aids: Effects of Early Auditory Experience

Purpose

It is well established that (a) infants prefer listening to infant-directed speech (IDS) over adult-directed speech (ADS), and (b) IDS facilitates speech, language, and cognitive development, compared with ADS. The main purpose of this study was to determine whether infants with hearing aids (HAs), similar to their peers with normal hearing (NH), show a listening preference for IDS over ADS.

Method

A total of 42 infants participated in the study. In Experiment 1, 9 infants with hearing loss, who had approximately 12 months of experience (mean chronological age of 17.57 months) with HAs, and 9 infants with NH, who had similar chronological age (17.54 months), were tested. In Experiment 2, 10 infants with hearing loss, who had approximately 4 months of experience (mean chronological age of 9.86 months) with HAs, and 14 infants with NH, who had similar chronological age (9.09 months), were tested. Infants were tested on their listening preference in 3 randomized blocks: IDS versus silence, ADS versus silence, and IDS versus ADS blocks, using the central fixation preference procedure.

Results

Experiment 1 showed that infants with HAs, similar to their peers with NH, listened longer to both IDS and ADS relative to silence; however, neither infants with HAs nor infants with NH showed a listening preference for IDS over ADS. In Experiment 2, both infants with HAs and infants with NH showed a listening preference for IDS and ADS relative to silence; in addition, both groups preferred listening to IDS over ADS.

Conclusions

Infants with HAs appear to have sufficient access to the acoustic cues in the speech that allow them to develop an age-equivalent IDS preference. This may be attributed to a combination of being able to use the hearing they do have before receiving HAs and early device fitting. Given previously demonstrated positive associations between IDS preference and language development, this research encourages early interventions focusing on maximizing early auditory experience in infants with hearing loss.

Supplemental Material

https://doi.org/10.23641/asha.6906365

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Preference for Infant-Directed Speech in Infants With Hearing Aids: Effects of Early Auditory Experience

Purpose

It is well established that (a) infants prefer listening to infant-directed speech (IDS) over adult-directed speech (ADS), and (b) IDS facilitates speech, language, and cognitive development, compared with ADS. The main purpose of this study was to determine whether infants with hearing aids (HAs), similar to their peers with normal hearing (NH), show a listening preference for IDS over ADS.

Method

A total of 42 infants participated in the study. In Experiment 1, 9 infants with hearing loss, who had approximately 12 months of experience (mean chronological age of 17.57 months) with HAs, and 9 infants with NH, who had similar chronological age (17.54 months), were tested. In Experiment 2, 10 infants with hearing loss, who had approximately 4 months of experience (mean chronological age of 9.86 months) with HAs, and 14 infants with NH, who had similar chronological age (9.09 months), were tested. Infants were tested on their listening preference in 3 randomized blocks: IDS versus silence, ADS versus silence, and IDS versus ADS blocks, using the central fixation preference procedure.

Results

Experiment 1 showed that infants with HAs, similar to their peers with NH, listened longer to both IDS and ADS relative to silence; however, neither infants with HAs nor infants with NH showed a listening preference for IDS over ADS. In Experiment 2, both infants with HAs and infants with NH showed a listening preference for IDS and ADS relative to silence; in addition, both groups preferred listening to IDS over ADS.

Conclusions

Infants with HAs appear to have sufficient access to the acoustic cues in the speech that allow them to develop an age-equivalent IDS preference. This may be attributed to a combination of being able to use the hearing they do have before receiving HAs and early device fitting. Given previously demonstrated positive associations between IDS preference and language development, this research encourages early interventions focusing on maximizing early auditory experience in infants with hearing loss.

Supplemental Material

https://doi.org/10.23641/asha.6906365

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Intelligent Today, Smarter Tomorrow: Machine Learning in Widex Evoke

Discover how the world's first machine learning algorithm can enhance your hearing aid fittings and end user satisfaction.

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