Severe hearing impairment and risk of depression: A national cohort study

<div><p>Objective</p><p>Hearing impairment is suggested to be associated with depression in the elderly. The present study evaluated the risk of depression after hearing impairment in all age groups matched by age, sex, income, and region of residence.</p><p>Methods</p><p>The Korean Health Insurance Review and Assessment Service—National Patient Samples were collected for a period from 2002 to 2013. Hearing impairment was defined as a hearing threshold ≥ 60 dB in both ears or as ≥ 80 dB in one ear and ≥ 40 dB in one ear. Hearing-impaired participants performed a pure tone audiometry test 3 times and an auditory brainstem response threshold test once. The 6,136 hearing-impaired participants were matched 1:4 with 24,544 controls with no reported hearing impairment for age, sex, income, and region of residence. Depression was investigated based on the International Classification of Disease-10 codes F31 (bipolar affective disorder) through F39 (unspecified mood disorder) by a psychiatrist from 2002 through 2013. The crude (simple) and adjusted (age, sex, income, region of residence, dementia, hypertension, diabetes, and dyslipidemia) hazard ratio (HR) of hearing impairment on depression were analyzed using Cox-proportional hazard model.</p><p>Results</p><p>The rate of depression was significantly higher in the severe hearing-impaired group than in the control group (7.9% vs. 5.7%, P < 0.001). Severe hearing impairment increased the risk of depression (adjusted HR = 1.37, 95% confidence interval [CI] = 1.24–1.52, P < 0.001). In a subgroup analysis, young (0–29 years old), middle-aged (30–59 years old), and old (≥ 60 years old) severe hearing-impaired groups showed significantly increased risk of depression compared to controls with no reported hearing impairment. In accordance with income level, severe hearing impairment elevated depression in the low and high income groups, but not in the middle income group.</p><p>Conclusion</p><p>Severe hearing impairment increased the risk of depression independently of age, sex, region, past medical histories, and income (in low and high income persons but not in middle income persons).</p></div

Discrepancy between self-assessed hearing status and measured audiometric evaluation

<div><p>Objective</p><p>The purpose of this study was to examine the difference between self-reported hearing status and hearing impairment assessed using conventional audiometry. The associated factors were examined when a concordance between self-reported hearing and audiometric measures was lacking.</p><p>Methods</p><p>In total, 19,642 individuals ≥20 years of age who participated in the Korea National Health and Nutrition Examination Surveys conducted from 2009 through 2012 were enrolled. Pure-tone hearing threshold audiometry (PTA) was measured and classified into three levels: <25 dB (normal hearing); ≥25 dB <40 dB (mild hearing impairment); and ≥40 dB (moderate-to-severe hearing impairment). The self-reported hearing loss was categorized into 3 categories. The participants were categorized into three groups: the concordance (matched between self-reported hearing loss and audiometric PTA), overestimation (higher self-reported hearing loss compared to audiometric PTA), and underestimation groups (lower self-reported hearing loss compared to audiometric PTA). The associations of age, sex, education level, stress level, anxiety/depression, tympanic membrane (TM) status, hearing aid use, and tinnitus with the discrepancy between the hearing self-reported hearing loss and audiometric pure tone threshold results were analyzed using multinomial logistic regression analysis with complex sampling.</p><p>Results</p><p>Overall, 80.1%, 7.1%, and 12.8% of the participants were assigned to the concordance, overestimation, and underestimation groups, respectively. Older age (adjusted odds ratios [AORs] = 1.28 [95% confidence interval = 1.19–1.37] and 2.80 [2.62–2.99] for the overestimation and the underestimation groups, respectively), abnormal TM (2.17 [1.46–3.23] and 1.59 [1.17–2.15]), and tinnitus (2.44 [2.10–2.83] and 1.61 [1.38–1.87]) were positively correlated with both the overestimation and underestimation groups. Compared with specialized workers, service workers, manual workers, and the unemployed were more likely to be in the overestimation group (1.48 [1.11–1.98], 1.39 [1.04–1.86], and 1.50 [1.18–1.90], respectively), and service workers were more likely to be in the underestimation group (AOR = 1.42 [1.01–1.99]). Higher education level (0.77 [0.59–1.01] and 0.43 [0.33–0.57]) and hearing aid use (0.36 [0.17–0.77] and 0.23 [0.13–0.43]) were negatively associated with being in the underestimation group (0.43 [0.37–0.50]). Compared with males, females were less likely to be assigned to the underestimation group (0.43 [0.37–0.50]). Stress (1.98 [1.32–2.98]) and anxiety/depression (1.30 [1.06–1.59]) were associated with overestimation group.</p><p>Conclusion</p><p>Older age, lower education level, occupation, abnormal TM, non-hearing aid use, and tinnitus were related to both overestimation and underestimation groups. Male gender was related to underestimation, and stress and anxiety/depression were correlated with overestimation group. An understanding of these factors associated with the self-reported hearing loss will be instrumental to identifying and managing hearing-impaired individuals.</p></div

Hearing perception according to self-reported hearing loss and objective hearing difficulty.

<p>Hearing perception according to self-reported hearing loss and objective hearing difficulty.</p

General characteristics of the hearing estimation groups.

<p>General characteristics of the hearing estimation groups.</p

Multinomial logistic regression analysis with complex sampling (reference = relevance group).

<p>Multinomial logistic regression analysis with complex sampling (reference = relevance group).</p

Crude and adjusted hazard ratios (95% confidence interval) of hearing impairment for depression.

<p>Crude and adjusted hazard ratios (95% confidence interval) of hearing impairment for depression.</p

Subgroup analysis of crude and adjusted hazard ratios (95% confidence interval) of hearing impairment for depression according to age and sex.

<p>Subgroup analysis of crude and adjusted hazard ratios (95% confidence interval) of hearing impairment for depression according to age and sex.</p

A schematic illustration of participant selection in the present study.

<p>Among a total of 6,525 hearing impaired participants, participants who had a history of depression before hearing impairment (n = 294) and could not find enough matching participants (n = 95) were excluded. The data for the 6,136 of hearing impaired participants and 24,544 control participants were analyzed.</p

General characteristics of participants.

<p>General characteristics of participants.</p

Objective measurement of subjective tinnitus using the acoustic change complex

<div><p>At present, there is no objective method for diagnosing subjective sensorineural tinnitus. Recently, the acoustic change complex (ACC) has been used to evaluate neural detection of sounds. Thus, the present study aimed to examine whether the ACC can reflect cortical detection and discrimination of sounds matched with tinnitus frequencies. We hypothesized that the ACC to change stimuli matched with tinnitus frequencies would be decreased in tinnitus patients because the tinnitus interferes with the perception of acoustic changes. To test the hypothesis, 96 ears of normal-hearing (NH) tinnitus patients and controls were tested. Among the tinnitus patients, 33 ears with a tinnitus frequency of 8 kHz constituted the tinnitus group, and the remaining 63 ears with no experience of tinnitus were allocated to the control group. For the 4 kHz non-tinnitus matched frequency, a subset of tinnitus (n = 17) and NH (n = 47) subjects was tested. The acoustic stimuli were pure tones with a total duration of 500 ms consisting of a 1 kHz tone in the first 250 ms and a second tone of either 8 kHz or 4 kHz in the latter 250 ms. The normalized amplitude of the ACC (naACC) was calculated separately for the amplitude of the N1’-P2’ complex evoked by an 8 kHz or 4 kHz change stimulus and for the amplitude of the N1-P2 complex elicited by the initial 1 kHz background stimulus. Our results showed that the naACC to an 8 kHz stimulus in the tinnitus group was significantly smaller than those to 4 kHz and 8 kHz in normal controls. Additionally, in the tinnitus group, the naACC to 4 kHz was greater compared to 8 kHz. The receiver operating characteristic (ROC) curve analysis conducted for naACC to 8 kHz at UCL revealed a fair degree of diagnostic efficacy. Overall, our results indicated that the ACC to a change stimulus matched with the tinnitus frequency can provide an objective measure of frequency-specific tinnitus.</p></div