Schneider Andrea L C, Kamath Vidyulata, Reed Nicholas S, Mosley Thomas, Gottesman Rebecca F, Sharrett A Richey, Lin Frank R, Deal Jennifer A
Author Affiliations: Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Schneider); Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Schneider); Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Dr Kamath); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Drs Reed, Sharrett, Lin, and Deal); The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi (Dr Mosley); National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland (Dr Gottesman); Department of Otolaryngology, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Drs Lin and Deal); and Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Drs Lin and Deal).
J Head Trauma Rehabil. 2025;40(4):287-295. doi: 10.1097/HTR.0000000000001032. Epub 2025 Jul 1.
To examine associations of traumatic brain injury (TBI) with self-reported and clinical measures of hearing function.
Four US communities.
A total of 3176 Atherosclerosis Risk in Communities Study participants who attended the sixth study visit in 2016-2017, when hearing was assessed.
Prospective cohort study. TBI occurring prior to the hearing assessment was defined using self-reported questions and "International Classification of Diseases-9th/10th Edition" (ICD-9/10) codes.
Hearing function was assessed by self-reported questionnaires and clinically measured indices (audiometry [4-frequency pure tone average for each ear] and speech-in-noise testing). Linear, logistic, and multinomial logistic models adjusted for sociodemographics, vascular risk factors, and occupational noise exposure were used to examine associations.
Participants were a mean age of 79 years, 59% were female, 21% were of self-reported Black race, and 33% had a history of TBI (median time from first TBI to hearing assessment: 39 years (25th-75th percentile = 19-63 years). Compared to participants without TBI, participants with prior TBI had higher age-adjusted prevalence of self-reported hearing loss (42.3% vs 35.3%), tinnitus (28.0% vs 23.8%), hearing aid use (23.4% vs 17.8%), pure tone average > 40 dB (30.6% vs 24.8%), and presence in the lowest quartile of speech-in-noise performance (27.6% vs 22.8%). With further adjustment, and particularly with adjustment for occupational noise exposure, associations with hearing measures were largely no longer statistically significant. In secondary analyses of associations of TBI frequency and severity with hearing function, results were similar to our main analyses, without evidence of dose-dependent associations.
In this community-based cohort, prior TBI was associated with impaired hearing on both self-reported and clinically measured assessments, but these associations were attenuated after adjustment for occupational noise exposure. These results underscore the importance of the consideration of loud noise exposures, which may confound associations of TBI with hearing, in future studies.
研究创伤性脑损伤（TBI）与自我报告的听力功能及临床听力测量指标之间的关联。
美国四个社区。
共有3176名社区动脉粥样硬化风险研究参与者，他们于2016 - 2017年参加了第六次研究访视，当时进行了听力评估。
前瞻性队列研究。听力评估之前发生的TBI通过自我报告问题和“国际疾病分类第9/10版”（ICD - 9/10）编码来定义。
听力功能通过自我报告问卷和临床测量指标（听力测定[每只耳朵的4频率纯音平均值]和噪声环境下言语测试）进行评估。使用针对社会人口统计学、血管危险因素和职业噪声暴露进行调整的线性、逻辑回归和多项逻辑回归模型来研究关联。
参与者的平均年龄为79岁，59%为女性，21%自我报告为黑人种族，33%有TBI病史（从首次TBI到听力评估的中位时间：39年（第25 - 75百分位数 = 19 - 63年））。与无TBI的参与者相比，有TBI病史的参与者经年龄调整后的自我报告听力损失患病率更高（42.3%对35.3%）、耳鸣患病率更高（28.0%对23.8%）、助听器使用率更高（23.4%对17.8%）、纯音平均值>40 dB的比例更高（30.6%对24.8%）以及在噪声环境下言语表现处于最低四分位数的比例更高（27.6%对22.8%）。经过进一步调整，尤其是调整职业噪声暴露后，与听力测量指标的关联在很大程度上不再具有统计学意义。在TBI频率和严重程度与听力功能关联的二次分析中，结果与主要分析相似，没有剂量依赖性关联的证据。
在这个基于社区的队列中，既往TBI与自我报告和临床测量评估中的听力受损有关，但在调整职业噪声暴露后，这些关联减弱。这些结果强调了在未来研究中考虑可能混淆TBI与听力关联的高强度噪声暴露的重要性。
