History and Lingering Impact of the Arbitrary 25-dB Cutoff for Normal Hearing

Gatlin, Andrea E.; Dhar, Sumitrajit

doi:10.1044/2020_aja-20-00181

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…There were divided into normal (NH) and hearing-impaired (HL) groups based on their pure-tone audiometry hearing thresholds. We used 25 dB HL as the cutoff to define normal hearing per standard clinical conventions ( Gatlin and Dhar, 2021 ). NH listeners ( n = 13) had average thresholds (250–8,000 Hz) better than 25 dB HL across both ears whereas HL listeners ( n = 19) had average thresholds poorer than 25 dB HL.…”

Section: Methodsmentioning

confidence: 99%

Cortical-brainstem interplay during speech perception in older adults with and without hearing loss

2023

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IntroductionReal time modulation of brainstem frequency-following responses (FFRs) by online changes in cortical arousal state via the corticofugal (top-down) pathway has been demonstrated previously in young adults and is more prominent in the presence of background noise. FFRs during high cortical arousal states also have a stronger relationship with speech perception. Aging is associated with increased auditory brain responses, which might reflect degraded inhibitory processing within the peripheral and ascending pathways, or changes in attentional control regulation via descending auditory pathways. Here, we tested the hypothesis that online corticofugal interplay is impacted by age-related hearing loss.MethodsWe measured EEG in older adults with normal-hearing (NH) and mild to moderate hearing-loss (HL) while they performed speech identification tasks in different noise backgrounds. We measured α power to index online cortical arousal states during task engagement. Subsequently, we split brainstem speech-FFRs, on a trial-by-trial basis, according to fluctuations in concomitant cortical α power into low or high α FFRs to index cortical-brainstem modulation.ResultsWe found cortical α power was smaller in the HL than the NH group. In NH listeners, α-FFRs modulation for clear speech (i.e., without noise) also resembled that previously observed in younger adults for speech in noise. Cortical-brainstem modulation was further diminished in HL older adults in the clear condition and by noise in NH older adults. Machine learning classification showed low α FFR frequency spectra yielded higher accuracy for classifying listeners’ perceptual performance in both NH and HL participants. Moreover, low α FFRs decreased with increased hearing thresholds at 0.5–2 kHz for clear speech but noise generally reduced low α FFRs in the HL group.DiscussionCollectively, our study reveals cortical arousal state actively shapes brainstem speech representations and provides a potential new mechanism for older listeners’ difficulties perceiving speech in cocktail party-like listening situations in the form of a miss-coordination between cortical and subcortical levels of auditory processing.

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Section: Methodsmentioning

confidence: 99%

Cortical-brainstem interplay during speech perception in older adults with and without hearing loss

2023

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“… 36 , 37 Further, studies have suggested that the presence of normal hearing (defined using the standard clinical cutoff of 25 dB HL for frequencies ≤8 kHz) is not a sufficient indicator of cochlear health. 38 , 39 Because this study was concerned with outer hair cell health, our strict definition of normal hearing was fitting.…”

Section: Discussionmentioning

confidence: 99%

“…Our decision to use a more conservative definition of hearing loss was motivated in part by recent evidence linking subclinical hearing loss to decreased cognition and symptoms of depression 36,37 . Further, studies have suggested that the presence of normal hearing (defined using the standard clinical cutoff of 25 dB HL for frequencies ≤8 kHz) is not a sufficient indicator of cochlear health 38,39 . Because this study was concerned with outer hair cell health, our strict definition of normal hearing was fitting.…”

Section: Discussionmentioning

confidence: 99%

Jackson Heart Study: Aggregate cardiovascular disease risk and auditory profiles

Baiduc

Spankovich

et al. 2023

Laryngoscope Investig Oto

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Objectives Evaluate the relationship between cardiovascular disease (CVD) risk factors and cochlear function in African Americans. Methods Relationships between hearing loss, cochlear function, and CVD risk factors were assessed in a cross‐sectional analysis of 1106 Jackson Heart Study participants. Hearing loss was defined as puretone average (PTA 0.5,1,2,4 ) > 15 dB HL. Distortion product otoacoustic emissions (DPOAEs) were collected for f 2 = 1.0–8.0 kHz. Two amplitude averages were computed: DPOAE low ( f 2 ≤ 4 kHz) and DPOAE high ( f 2 ≥ 6 kHz). Based on major CVD risk factors (diabetes, current smoking, total cholesterol ≥240 mg/dL or treatment, and systolic blood pressure [BP]/diastolic BP ≥ 140/≥90 mmHg or treatment), four risk groups were created: 0, 1, 2, and ≥3 risk factors. Logistic regression estimated the odds of hearing loss and absent/reduced DPOAE low and DPOAE high by CVD risk status adjusting for age, sex, education, BMI, vertigo, and noise exposure. Results With multivariable adjustment, diabetes was associated with hearing loss (OR = 1.48 [95% CI: 1.04–2.10]). However, there was not a statistically significant relationship between CVD risk factors (individually or for overall risk) and DPOAEs. Conclusion Diabetes was associated with hearing loss. Neither individual CVD risk factors nor overall risk showed a relationship to cochlear dysfunction. Level of Evidence 2b.

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“…Another potential future direction is to revisit the cutoff of what constitutes adult HL. The commonly used 25 dB threshold for defining adult HL is arbitrary ( Gatlin and Dhar, 2021 ). The WHO now recommends 20 dB ( World Health Organization, 2021a ).…”

Section: Discussionmentioning

confidence: 99%

The Longitudinal Association of Subclinical Hearing Loss With Cognition in the Health, Aging and Body Composition Study

Chern

Irace

Sharma

et al. 2022

Front. Aging Neurosci.

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ObjectivesTo examine the longitudinal association between subclinical hearing loss (SCHL) and neurocognitive performance.DesignLongitudinal analyses were conducted among 2,110 subjects who underwent audiometric testing in a US multi-centered epidemiologic cohort study. The primary exposure was better ear hearing (pure tone average). SCHL was defined as hearing ≤ 25 dB. The primary outcome was neurocognitive performance, measured by Digit Symbol Substitution Test (DSST), Modified Mini Mental State Examination (3MS), and CLOX1. Linear mixed models were performed to assess the longitudinal association between hearing and cognitive performance, adjusting for covariates. Models were fit among all individuals and among individuals with SCHL only.ResultsAmong 2,110 participants, mean (SD) age was 73.5 (2.9) years; 52.3% were women. Mean (SD) better ear pure tone average was 30.0 (13.1) dB. Mean follow-up was 9.1 years (range 3–16). Among all participants, worse hearing was associated with significantly steeper cognitive decline measured by the DSST [0.054-point/year steeper decrease per 10 dB worse hearing, 95% confidence interval (CI): 0.026–0.082] and 3MS (0.044-point/year steeper decrease per 10 dB worse hearing, CI: 0.026–0.062), but not CLOX1. Among those with SCHL, worse hearing was associated with significantly steeper cognitive performance decline as measured by DSST (0.121-point/year steeper decrease per 10 dB worse hearing, CI: 0.013–0.228), but not CLOX1 or 3MS.ConclusionAmong those with SCHL, worse hearing was associated with steeper cognitive performance declines over time as measured by DSST. The relationship between hearing loss and cognition may begin at earlier levels of hearing loss than previously recognized.

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History and Lingering Impact of the Arbitrary 25-dB Cutoff for Normal Hearing

Cited by 8 publications

References 17 publications

Cortical-brainstem interplay during speech perception in older adults with and without hearing loss

Cortical-brainstem interplay during speech perception in older adults with and without hearing loss

Jackson Heart Study: Aggregate cardiovascular disease risk and auditory profiles

The Longitudinal Association of Subclinical Hearing Loss With Cognition in the Health, Aging and Body Composition Study

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