JAMA Study Examines Relationship Between Self-Reported Hearing and Audiogram Thresholds

By Brian Taylor, AuD, Editor-at-Large

Brian Taylor, AuD

Clinicians know a substantial number of individuals presenting to the clinic for a routine hearing assessment have hearing loss on their audiogram but self-report good hearing. Just how sizeable is this group? That was a question addressed recently by researchers at the University of Mississippi Medical Center.

A JAMA-Otolaryngology article, published on-line June 6 and co-authored by audiologist Christopher Spankovich, analyzed US National Health and Nutrition Examination Survey (NHANES) data from more than 1300 adults, aged 20 to 69 years. In the study, hearing loss was defined by at least one frequency >25 dB HL in at least one ear. Of the 1373 participants that met that criteria for hearing loss, 68.5% of that group self-reported good hearing.

The researchers also examined several factors associated with self-reports of good hearing. Among their findings was diet quality and better self-reported general health significantly increased the odds of self-reported good hearing, while tinnitus, history of noise exposure, vision difficulty and prescription drug use were some of the factors associated with decreased odds of self-reporting good hearing. 

Interestingly, the researchers narrowed the definition of hearing loss and re-evaluated its relationship to self-reported hearing and hearing aid use. When mild hearing loss was defined as a pure tone average across speech frequencies (PTA4) of > 25 dB HL, 43% of the participants reported good hearing. And, when hearing loss was defined as a PTA4 greater than 40 dB HL, 22% reported good hearing. 

Thus, even when a relatively substantial hearing loss is present on the audiogram (PTA >40 dB HL), clinicians can surmise, using this study as a reference point, that about 1 in 5 individuals will report good hearing. 

Of the 94 individuals with a PTA4 greater than 40 dB HL, 78% did self-report some degree of hearing difficulty, with 46.8% of this group reporting “little trouble” and 31.2% reporting “greater than a little trouble” or worse. The study also examined hearing aid use among this group and found that only 26.6% of the participants reported they wore hearing aids. Factors associated with the odds of having hearing loss and wearing hearing aids are detailed in the article


Implications for the Audiology Clinic


There are a few clinical applications to findings of this study. First, according to the researchers, participants who perceived hearing difficulties were more than 16 times as likely to report wearing a hearing aid. This finding suggests that hearing aid use is more related to an individual’s perceived perception of their hearing status, rather than their hearing thresholds recorded on the audiogram.

For clinicians, this is evidence indicating an individual’s perception of hearing difficulty must be explored by clinicians in relation to their hearing thresholds. Self-perception of hearing difficulty is likely to trump test results, especially for more prevalent mild and high frequency moderate hearing losses. 

Second, a relatively large number (22%) of individuals with a sizeable hearing loss (PTA4 >40 dB HL) reported good hearing, and even those that do self-report hearing difficulty are likely to perceive that difficulty as mild in nature. As the authors suggest, there are several explanations for this including, the gradual nature of hearing loss, stigma related to aging, as well as the painless nature of hearing loss.

For the clinician, these findings underscore the importance of employing personal adjustment counseling strategies that enable individuals with hearing loss to explore some of the ambiguity and uncertainty related to an insidious condition of gradual onset. Third, these findings suggest that public awareness campaigns are needed to raise attention on the insidious nature of hearing loss – all adults, regardless of health status should receive a periodic check of their hearing. 


*featured image courtesy flckr