Incidence, persistence, and progression of tinnitus symptoms in older adults : the Blue Mountains hearing study

Objective: Temporal population-based data on tinnitus are lacking. We used a representative older population-based cohort to establish 5-yr incidence, persistence, and progression of tinnitus symptoms. Design: Two thousand six participants of the Blue Mountains Hearing Study (1997-1999) had complete tinnitus data, and of these, 1214 participants were followed up at 5-yr examinations in 2002-2004. Presence of prolonged tinnitus was assessed by a positive response to a single question administered by an audiologist. Incident tinnitus was defined in participants who were free of tinnitus symptoms at the baseline study in 1997-1999 but who reported tinnitus symptoms at the 5-yr follow-up in 2002-2004. Progression of tinnitus was defined as the increase in annoyance of tinnitus symptoms from baseline to the 5-yr follow-up study. Persistence of tinnitus symptoms was defined as the presence of tinnitus symptoms at both the baseline and follow-up examinations. Hearing impairment was measured as the pure-tone average (PTA) of audiometric hearing thresholds at 500, 1000, 2000, and 4000 Hz (PTA0.5-4 kHz), defining bilateral hearing loss as PTA0.5-4 kHz >25 dB HL. Results: Five-year incidence of tinnitus was 18.0%. A significant age trend was observed for the 5-yr incidence (p = 0.005), with incident tinnitus decreasing with age. Hearing loss increased the risk of developing incident tinnitus, age-sex adjusted odds ratio 2.13 (95% confidence interval, 1.40 to 3.24). Most (55.5%) incident tinnitus cases reported symptoms that were only mildly annoying. Tinnitus at baseline persisted in 81.6% of participants. Of those reporting mildly annoying tinnitus at baseline, 39.6% progressed to moderately annoying and 5.9% to severely annoying tinnitus. At the follow-up, a higher frequency of participants with persistent tinnitus (old cases) reported their symptoms as very/extremely annoying compared with the new (incident) cases of tinnitus (p = 0.01). A high proportion (85.2%) of subjects receiving tinnitus treatment (mainly medications and hearing aid) at baseline still reported tinnitus at 5-yr examinations. Conclusions: Incident tinnitus was frequent, with nearly one in five older adults suffering from this condition after 5 yrs. Tinnitus symptoms persisted in more than three-quarters of the cohort, during the 5 yrs. Longitudinal data are an important contribution to the research evidence base to support timely intervention and effective management of this frequent symptom.6 page(s

Risk factors and impacts of incident tinnitus in older adults

Purpose: We used a representative older population-based cohort to establish the predictors and impacts of tinnitus. Methods: A total of 1,214 participants of the Blue Mountains Hearing Study were followed for 5 years (1997 − 1999 to 2002 − 2004). The presence of tinnitus was assessed by an audiologist-administered questionnaire. Hearing impairment was defined as the pure tone average (PTA)0.5–4KHz > 25 dB HL, in the better ear. Quality of life was measured by use of the Short Form 36-item Health Survey (SF-36). Depression was assessed using either the SF-36 (Mental Health Index, subscale) and the Center for Epidemiologic Studies Depression Scale. Results: Symptomatic dizziness and hearing loss were significant risk factors for incident tinnitus, multivariable-adjusted odds ratio, 2.41 (95% confidence interval, 1.62–3.58) and odds ratio 2.31 (95% confidence interval, 1.46–3.66), respectively. Incident tinnitus cases demonstrated significantly lower mean SF-36 scores compared with subjects without tinnitus and were more likely to be depressed as assessed by both the Mental Health Index and Center for Epidemiologic Studies Depression Scale. Conclusions: Incident tinnitus was predicted by two otological risk factors, dizziness and hearing loss. Temporal data documented diminished quality of life and psychological well-being in those subjects experiencing tinnitus. This finding highlights the importance of effective intervention strategies to prevent potentially debilitating morbidity associated with tinnitus.7 page(s

Direct and indirect effects of visual impairment on mortality risk in older persons : the Blue Mountains eye study

Objective: To investigate pathways from visual impairment to increased all-cause mortality in older persons. Methods: The Blue Mountains Eye Study examined 3654 persons 49 years and older (82.4% response) during 1992-1994 and after 5 and 10 years. Australian National Death Index data confirmed deaths until 2005. Visual impairment was defined as presenting, correctable, and noncorrectable, using better-eye visual acuity. Associations between visual impairment and mortality risk were estimated using Cox regression and structural equation modeling. Results: After 13 years, 1273 participants had died. Adjusting for mortality risk markers, higher mortality was associated with noncorrectable visual impairment (hazardratio [HR], 1.35; 95% confidence interval [CI], 1.04-1.75). This association was stronger for ages younger than 75 years (HR, 2.58; 95% CI, 1.42-4.69). Structural equation modeling revealed greater effects of noncorrectable visual impairment on mortality risk (HR, 5.25; 95% CI, 1.97-14.01 for baseline ages _75 years), with both direct (HR, 2.16; 95% CI, 1.11-4.23) and indirect (HR, 2.43; 95% CI, 1.17-5.03) effects. Of mortality risk markers examined, only disability in walking demonstrated a significant indirect pathway for the link between visual impairment and mortality. Conclusions: Visual impairment predicted mortality by both direct and indirect pathways, particularly for persons younger than 75 years with noncorrectable visual impairment. Disability in walking, which can substantially influence general health, represented a major indirect pathway.7 page(s

Associations between hearing impairment and mortality risk in older persons : the Blue Mountains hearing study

Purpose: To assess whether hearing loss predicts an increased risk of mortality. Methods: The Blue Mountains Hearing Study examined 2956 persons (49+ years) during 1997 to 2000. The Australian National Death Index was used to identify deaths until 2005. Hearing loss was defined as the pure-tone average (0.5−4 kHz) of air-conduction hearing thresholds greater than 25 dB HL. Associations between hearing loss and mortality risk were estimated using Cox regression and structural equation modeling (SEM). Results: When we used Cox regression, we discovered that hearing loss was associated with increased risk of cardiovascular (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08−1.84) and all-cause (AC) mortality (HR 1.39, 95% CI 1.11−1.79) after adjustment for age and sex but not after multivariable adjustment. SEM pathway analysis, however, revealed a greater AC mortality risk (HR 2.58, 95% CI 1.64−4.05) in persons with hearing loss, which was mediated: cognitive impairment (HR 1.45, 95% CI 1.08−1.94) and walking disability (HR 1.63, 95% CI 1.24−2.15). These variables increased mortality both directly and indirectly through effects on self-rated health. Conclusions: Hearing loss was associated with increased AC mortality via three mediating variables: disability in walking, cognitive impairment, and self-rated health. It is important to recognize that persons with combined disabilities are at increased risk of cardiovascular and AC mortality.8 page(s

Hearing loss impacts on the use of community and informal supports

Objective: the aim of this study is to estimate the cross-sectional and longitudinal impact of hearing loss on use of community support services and reliance on non-spouse family/friends among older people. Methods: Blue Mountains Hearing Study participants (n = 2,956) were assessed for hearing impairment by audiologists in sound-treated booths. Participants were classified as hearing impaired if PTA0.5–4 kHz >25 dB HL. Use of services and non-spouse family/friend support was assessed cross-sectionally. Incident use was assessed among survivors at the 5-year follow-up (n = 1,457). Results: a significant cross-sectional association between hearing loss (>25 dB HL) and use of community support services was observed after adjusting for age, sex, living status, self-rated poor health, self-reported hospital admissions, disability in walking and best-corrected visual impairment [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.15–3.90]. Participants with hearing loss who never used a hearing aid were twice as likely to use formal supports as participants without hearing loss (multivariate-adjusted OR 2.25, 95% CI 1.19–4.24). Hearing loss increased the incident need for non-spouse family/friend support or community services (multivariate-adjusted OR 1.49, 95% CI 1.02–2.18). Conclusions: after adjusting for confounding factors, hearing impairment negatively impacted on the independence of older persons by increasing reliance on community or family support.7 page(s

NK Cell–Mediated Antitumor Effects of a Folate-Conjugated Immunoglobulin Are Enhanced by Cytokines

Optimally effective antitumor therapies would not only activate immune effector cells, but engage them at the tumor. Folate-conjugated to immunoglobulin (F-IgG) could direct innate immune cells with Fc receptors to folate receptor–expressing cancer cells. F-IgG bound to human KB and HeLa cells, as well as murine L1210JF, a folate receptor (FR) overexpressing cancer cell line, as determined by flow cytometry. Recognition of F-IgG by NK cell Fc receptors led to phosphorylation of the ERK transcription factor and increased NK cell expression of CD69. Lysis of KB tumor cells by NK cells increased about 5-fold after treatment with F-IgG, an effect synergistically enhanced by treatment with IL2, IL12, IL15, or IL21 (P < 0.001). F-IgG also enhanced the lysis of chronic lymphocytic leukemia cells by autologous NK cells. NK cells significantly increased production of IFNγ, MIP-1α, and RANTES in response to F-IgG–coated KB target cells in the presence of the NK cell–activating cytokine IL12, and these coculture supernatants induced significant T cell chemotaxis P < 0.001). F-IgG–coated targets also stimulated FcR-mediated monocyte effector functions. Studies in a murine leukemia model confirmed the intratumoral localization and antitumor activity of F-IgG, as well as enhancement of its effects by IL12 (P = 0.05). The antitumor effect of this combination was dependent on NK cells and led to decreased tumor cell proliferation in vivo. Thus, F-IgG can induce an immune response against FR-positive tumor cells that is mediated by NK cells and can be augmented by cytokine therapy

Beiträge zum 29. Darmstädter Geotechnik-Kolloquium am 7. März 2024

Themenschwerpunkte: 1. Klimawandelfolgen und Nachhaltigkeit 2. Digitalisierung und künstliche Intelligenz 3. Planung und Bemessung von Infrastrukturprojekten 4. Großprojekt