I Hear Fine, Others Need to Just Stop Mumbling

As audiologists, it is common to come across patients who deny hearing difficulty or rationalize those difficulties to external variables. This brings up the question, how prevalent is report of self-perceived good hearing despite audiometric evidence of hearing loss?

Using data from the National Health and Nutrition Examination Survey (NHANES), Curti et al (2019) reported on the prevalence and variables related to self-reported good hearing despite audiometric evidence of hearing loss applying several definitions (at least one frequency >25 dBHL in either ear; pure-tone average (PTA4) of 500, 1000, 2000, and 4000 Hz > 25 dBHL; and PTA > 40 dBHL). Self-reported good hearing status was based on a question of general hearing condition, which read “Which statement best describes your hearing (without a hearing aid)? Would you say your hearing is good, that you have a little trouble, a lot of trouble, or are you deaf?”

Audiometric data were collected in 3,853 participants from two NHANES cycles. After excluding for missing data or evidence of conductive pathology, 2,681 participants remained. This group was then limited to those with hearing loss based on the three definitions. Based on the any frequency >25dBHL definition 68.5% of the participants self-reported good hearing. Applying the PTA4 criteria >25dBHL, 43 percent self-reported good hearing. When limited to participants with a moderate hearing loss or greater (PTA4 > 40 dBHL), the report of good hearing was limited to 22 percent. Variables that increased the odds of reporting good hearing despite audiometric evidence of hearing loss included self-reported good general health and better diet quality. Variables that decreased the odds of self-reported good hearing included presence of tinnitus, history of noise exposure, and other health comorbidities (e.g., being overweight, balance issues). Curti et al also examined the relationship of self-reported hearing status to reported use of hearing aids. Participants with audiometric evidence of hearing loss that self-reported hearing difficulty were 16 times more likely to report use of hearing aids.

Overall, the findings suggest that self-reported hearing status is clearly related to severity of hearing loss based on audiometry, i.e., the greater the thresholds the lower the self-report of good hearing. Nonetheless, a high number of individuals with hearing loss (43 percent) will self-report good hearing. This is likely because the majority of the individuals in the dataset had what would be considered a mild hearing loss (75 percent). This high prevalence of mild hearing loss is consistent with other NHANES analyses using different cycles (Goman et al, 2015). The authors report that the high prevalence of mild hearing loss and lack of perceived hearing difficulty as a contributing factor to low utilization of hearing aids. In the absence of significant communication setbacks or presence of related comorbidities (e.g., tinnitus), those with mild hearing loss may dismiss subtle communication difficulties, a negative consequence is potential delay in identification and management.

Reference

Curti et al. (2019) Prevalence of and characteristics associated with self-reported good hearing in a population with elevated audiometric thresholds, JAMA-Oto Head & Neck. June 6.