年轻和年长吸烟者及非吸烟者的自我报告听力困难与听力筛查对比
Self-reported hearing difficulty versus audiometric screening in younger and older smokers and nonsmokers.
作者信息
Ramkissoon Ishara, Cole Margaret
机构信息
Ishara Ramkissoon, University of South Alabama 5721 Drive N., HAHN 1119 Mobile, AL 36688, USA.
出版信息
J Clin Med Res. 2011 Jul 26;3(4):183-90. doi: 10.4021/jocmr611w.
BACKGROUND
The high incidence of age-related hearing loss demands accessible, low cost hearing screenings for prevention and hearing health promotion. This study assessed performance of self report (SR) against audiometry, and prevalence of hearing difficulty when screening hearing in middle-aged and younger adults, including smokers and nonsmokers.
METHODS
Prospective participants (N = 219) completed a questionnaire providing biographical, health, and smoking information. Their Yes/No responses about hearing or communication difficulty provided data for self-reported hearing loss. Eligible (N = 170) participants received a hearing test including immittance, pure-tone, and speech audiometry. The binaural pure-tone average (PTA) hearing threshold was determined; PTA decibel (dB) level indicated degree (e.g., mild) of hearing loss. All hearing screening data were coded and initially analyzed in an Access database. Statistical analyses based on conditional probability included measures of prevalence, sensitivity, specificity, and predictive value of the SR versus audiometric measures. Participants provided a urine sample for biochemical analysis to confirm smoker/nonsmoker status.
RESULTS
Among all participants (N = 170), overall prevalence of self-reported hearing difficulty (15.9%) was in excellent agreement with measured, mild hearing loss (16.5%). However, factoring in age and smoking revealed that SR was incongruent with audiometry because hearing loss was overestimated by smokers and younger participants and underestimated by middle-aged individuals. The SR question yielded high specificity (80-90%) overall. Specificity was highest in nonsmokers (89-94%) and younger (90-91%) individuals with lower performance in smokers and middle-aged participants. SR sensitivity was high (86-100%) only when the hearing impairment cutoff was > 40 dB (moderate loss) and > 60 dB (severe loss). Sensitivity was highest in smokers (100%), supporting SR for screenings. High negative and low positive predictive value (PPV) occurred in smokers, younger, and middle-aged persons. This study reports new sensitivity and specificity data on self-reported hearing difficulty in smokers (N = 98), younger (N = 80), and middle-aged (N = 90) adults, indicating efficacy of SR as an adult hearing screening measure.
CONCLUSIONS
SR was effective as few normal-hearing persons were labeled hearing-impaired. However, audiometry should supplement SR to optimize detection of mild hearing loss for at-risk adults. Results may guide community health initiatives for hearing screenings, prevention, and health promotion.
KEYWORDS
Aging; Smoking; Self Report; Health Promotion; Hearing Screening.
背景
年龄相关性听力损失的高发病率要求进行可及、低成本的听力筛查，以预防听力损失并促进听力健康。本研究评估了自我报告（SR）相对于听力测定的表现，以及在中年和青年成年人（包括吸烟者和非吸烟者）中进行听力筛查时听力困难的患病率。
方法
前瞻性参与者（N = 219）完成了一份提供个人信息、健康状况和吸烟信息的问卷。他们对听力或沟通困难的是/否回答为自我报告的听力损失提供了数据。符合条件的参与者（N = 170）接受了包括声导抗、纯音和言语测听的听力测试。确定双耳纯音平均（PTA）听力阈值；PTA分贝（dB）水平表明听力损失的程度（如轻度）。所有听力筛查数据进行编码，并最初在Access数据库中进行分析。基于条件概率的统计分析包括SR与听力测定指标的患病率、敏感性、特异性和预测值的测量。参与者提供尿液样本进行生化分析以确认吸烟者/非吸烟者状态。
结果
在所有参与者（N = 170）中，自我报告的听力困难的总体患病率（15.9%）与测得的轻度听力损失（16.5%）高度一致。然而，考虑年龄和吸烟因素后发现，SR与听力测定不一致，因为吸烟者和年轻参与者高估了听力损失，而中年个体低估了听力损失。SR问题总体上具有较高的特异性（80 - 90%）。特异性在非吸烟者（89 - 94%）和年轻人（90 - 91%）中最高，在吸烟者和中年参与者中表现较低。仅当听力损害临界值> 40 dB（中度损失）和> 60 dB（重度损失）时，SR敏感性较高（86 - 100%）。敏感性在吸烟者中最高（100%），支持将SR用于筛查。吸烟者、年轻人和中年人出现高阴性预测值和低阳性预测值（PPV）。本研究报告了吸烟者（N = 98）、年轻人（N = 80）和中年人（N = 90）自我报告听力困难的新敏感性和特异性数据，表明SR作为成人听力筛查措施的有效性。
结论
由于很少有听力正常的人被标记为听力受损，所以SR是有效的。然而，听力测定应补充SR，以优化对有风险成年人轻度听力损失的检测。结果可为听力筛查、预防和健康促进的社区健康倡议提供指导。
关键词
衰老；吸烟；自我报告；健康促进；听力筛查
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