University Hospitals Seidman Cancer Center, Cleveland, Ohio.
Division of Hematology and Medical Oncology, Case Western Reserve University, Cleveland, Ohio.
JAMA Otolaryngol Head Neck Surg. 2023 Dec 1;149(12):1101-1110. doi: 10.1001/jamaoto.2023.2941.
Cancer survivors are at a higher risk of developing hearing loss (HL) due to older age, chemotherapy, and radiotherapy. However, the prevalence of HL among US cancer survivors remains unknown. Additionally, there is a lack of uniform HL screening guidelines for this enlarging population.
To estimate the prevalence of subjective HL and objective HL by audiometry test among cancer survivors and compare them with the general population as well as to assess the performance of subjective HL questions in detecting true (ie, audiometry-confirmed) HL.
DESIGN, SETTING, AND PARTICIPANTS: In a cross-sectional design, adults between ages 20 and 80 years who had audiometry testing and responded to a hearing questionnaire from the National Health and Nutrition Examination Survey (2011-2012, 2015-2016, and 2017 to March 2020 prepandemic survey cycles) were selected. Data analysis was conducted from August 13, 2022, to July 26, 2023.
The weighted prevalence of subjective HL (troublesome hearing and tinnitus) and objective HL (speech-frequency HL and high-frequency HL) by audiometry were calculated. Analyses with χ2 testing and multiadjusted logistic regression models were used to compare HL between cancer survivors and the general population. To evaluate the performance of subjective HL questions as a tool to screen for objective HL by audiometry, areas under the curve were estimated using age- and gender-adjusted logistic regression.
Among the total 9337 participants (weighted n = 90 098 441; 51.2% women), 10.3% were cancer survivors. Compared with the general population, cancer survivors had a higher prevalence of troublesome hearing (adjusted odds ratio [AOR], 1.43; 95% CI, 1.11-1.84), tinnitus (AOR, 1.28; 95% CI, 0.94-1.74), speech-frequency HL (AOR, 1.43; 95% CI, 1.11-1.85), and high-frequency HL (AOR, 1.74; 95% CI, 1.29-2.34). When using the subjective HL tool and questioning regarding whether the participants were having troublesome hearing and/or tinnitus in screening for HL, the age- and gender-adjusted area under the curve was 0.88 in detecting speech-frequency HL and 0.90 in detecting high-frequency HL.
The findings of this study suggest that cancer survivors have a significantly higher prevalence of HL than the general population. Two subjective HL questions could potentially accurately identify those who have true HL and provide a simple and efficient screening tool for health care professionals. Cancer survivors and their families should be educated and encouraged to discuss hearing concerns, and health care professionals should facilitate raising awareness and provide early screening and timely referral when HL is identified.
由于年龄增长、化疗和放疗，癌症幸存者患听力损失（HL）的风险更高。然而，美国癌症幸存者中 HL 的患病率尚不清楚。此外，对于这个不断扩大的人群，缺乏统一的 HL 筛查指南。
通过听力测试评估癌症幸存者主观 HL 和客观 HL 的患病率，并将其与一般人群进行比较，并评估主观 HL 问题在检测真实（即听力测试确认）HL 方面的表现。
设计、地点和参与者：在一项横断面设计中，选择了年龄在 20 至 80 岁之间、接受过听力测试并对国家健康和营养检查调查（2011-2012 年、2015-2016 年和 2017 年至 2020 年大流行前调查周期）中的听力问卷做出回应的成年人。数据分析于 2022 年 8 月 13 日至 2023 年 7 月 26 日进行。
通过听力测试计算主观 HL（听力困扰和耳鸣）和客观 HL（言语频率 HL 和高频 HL）的加权患病率。使用 χ2 检验和多调整逻辑回归模型比较癌症幸存者和一般人群之间的 HL。为了评估主观 HL 问题作为通过听力测试筛查客观 HL 的工具的性能，使用年龄和性别调整的逻辑回归估计曲线下面积。
在总计 9337 名参与者（加权 n=90098441；51.2%为女性）中，10.3%为癌症幸存者。与一般人群相比，癌症幸存者听力困扰（调整后的优势比 [AOR]，1.43；95%置信区间 [CI]，1.11-1.84）、耳鸣（AOR，1.28；95% CI，0.94-1.74）、言语频率 HL（AOR，1.43；95% CI，1.11-1.85）和高频 HL（AOR，1.74；95% CI，1.29-2.34）的患病率更高。当使用主观 HL 工具并询问参与者是否存在听力困扰和/或耳鸣来筛查 HL 时，年龄和性别调整的曲线下面积在检测言语频率 HL 时为 0.88，在检测高频 HL 时为 0.90。
这项研究的结果表明，癌症幸存者 HL 的患病率明显高于一般人群。两个主观 HL 问题可能能够准确识别出真正患有 HL 的患者，并为医疗保健专业人员提供简单有效的筛查工具。癌症幸存者及其家属应接受有关听力问题的教育和鼓励，并应鼓励他们讨论听力问题，当发现听力问题时，医疗保健专业人员应促进提高认识并提供早期筛查和及时转诊。
