自我报告的听力困难与听力计诊断的听力损失之间的差异：一项全国性调查中的患病率及相关因素。
Discrepancies between self-reported hearing difficulty and hearing loss diagnosed by audiometry: prevalence and associated factors in a national survey.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Seoul, Republic of Korea.
出版信息
BMJ Open. 2019 May 1;9(4):e022440. doi: 10.1136/bmjopen-2018-022440.
OBJECTIVE
To evaluate discrepancies prevalent between self-reported hearing difficulty (SHD) and audiometrically measured hearing loss (AHL) and factors associated with such discrepancies.
DESIGN
Nationwide cross-sectional survey.
SETTING
Data from 2010 to 2012 Korea National Health and Nutrition Examination Survey conducted by the Korea Centers for Disease Control and Prevention.
PARTICIPANTS
We included 14 345 participants aged ≥19 years who had normal tympanic membranes (mean age of 49 years).
MEASURES
Self-reported hearing was assessed by asking participants whether they had difficulty in hearing. AHL was defined as >25 dB of mean hearing thresholds measured at 0.5, 1, 2 and 4 kHz in better ear. Underestimated hearing impairment (HI) was defined as having AHL without SHD. Likewise, overestimated HI was defined as having SHD without AHL. Prevalence of underestimated and overestimated HIs was determined. Univariable and multivariable analyses were performed to examine factors associated with such discrepancies compared with concordant HL.
RESULTS
Among 14 345 participants, 1876 (13.1%) had underestimated HI while 733 (5.1%) had overestimated HI. Multivariable models revealed that participants who had discrepancies between SHD and AHL were less likely to have older age (OR: 0.979, 95% CI: 0.967 to 0.991 for the underestimated HI, OR: 0.905, 95% CI: 0.890 to 0.921 for the overestimated HI) and tinnitus (OR: 0.425, 95% CI: 0.344 to 0.525 for the underestimated HI and OR 0.523, 95% CI: 0.391 to 0.699 for the overestimated HI) compared with those who had concordant HI. Exposure to occupational noise (OR: 0.566, 95% CI: 0.423 to 0.758) was associated with underestimated HI, and medical history of hypertension (OR: 1.501, 95% CI: 1.061 to 2.123) and depression (OR: 1.771, 95% CI: 1.041 to 3.016) was associated with overestimated HI.
CONCLUSION
Age, tinnitus, occupational noise exposure, hypertension and depression should be incorporated into evaluation of hearing loss in clinical practice.
目的
评估自我报告的听力困难（SHD）与听力计测量的听力损失（AHL）之间普遍存在的差异，并分析其相关因素。
设计
全国性横断面调查。
地点
韩国疾病控制与预防中心开展的 2010-2012 年韩国国家健康和营养检查调查的数据。
参与者
纳入年龄≥19 岁、鼓膜正常（平均年龄 49 岁）的 14345 名参与者。
测量方法
通过询问参与者是否存在听力困难来评估自我报告的听力情况。AHL 定义为在较好耳的 0.5、1、2 和 4 kHz 处平均听阈＞25 dB。未被低估的听力损伤（HI）定义为存在 AHL 但无 SHD。同样，HI 被高估定义为存在 SHD 但无 AHL。确定低估和高估 HI 的患病率。进行单变量和多变量分析，以评估与一致的 HL 相比，与这些差异相关的因素。
结果
在 14345 名参与者中，1876 名（13.1%）存在低估 HI，733 名（5.1%）存在高估 HI。多变量模型显示，在 SHD 和 AHL 之间存在差异的参与者不太可能为年龄较大者（低估 HI 的比值比 [OR]：0.979，95%可信区间 [CI]：0.967 至 0.991；高估 HI 的 OR：0.905，95%CI：0.890 至 0.921）或有耳鸣者（低估 HI 的 OR：0.425，95%CI：0.344 至 0.525；高估 HI 的 OR：0.523，95%CI：0.391 至 0.699）。与具有一致 HI 的参与者相比，接触职业噪声（OR：0.566，95%CI：0.423 至 0.758）与低估 HI 相关，高血压病史（OR：1.501，95%CI：1.061 至 2.123）和抑郁症病史（OR：1.771，95%CI：1.041 至 3.016）与高估 HI 相关。
结论
年龄、耳鸣、职业噪声暴露、高血压和抑郁症应纳入临床听力损失评估。
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