Epidemiology of Age-Related Hearing Impairment

  • Karen J. CruickshanksEmail author
  • Weihai Zhan
  • Wenjun Zhong
Part of the Springer Handbook of Auditory Research book series (SHAR, volume 34)


Hearing loss in older adults is an important problem affecting communication and quality of life, yet few epidemiological studies have been conducted to evaluate the magnitude of the problem, identify modifiable factors contributing to the risk of hearing impairment, or test potential prevention strategies. The purpose of this chapter is to summarize the available epidemiological data about the prevalence and incidence of age-related hearing loss (ARHL) and its risk factors. Although prevalent cases of hearing impairment in older adults may represent a wide range of causes or disorders, prospective studies of older adults that can identify new cases occurring at older ages offer great promise for identifying modifiable factors for ARHL. Longitudinal epidemiological studies can identify ways to reduce the burden of hearing loss among older adults.


Hearing Loss Hearing Impairment Noise Exposure Framingham Heart Study Blood Lead Level 
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  1. Agrawal Y, Platz EA, Niparko JK (2008) Prevalence of hearing loss and differences by demographic characteristics among US adults. Arch Intern Med 168:1522–1530.CrossRefPubMedGoogle Scholar
  2. Bainbridge KE, Hoffmann HJ, Cowie CC (2008) Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Exam Survey, 1999 to 2004. Ann Intern Med 149:1–10.PubMedGoogle Scholar
  3. Berner B, Odum L, Parving A (2000) Age-related hearing impairment and B vitamin status. Acta Otolaryngol 120:633–637.CrossRefPubMedGoogle Scholar
  4. Borchgrevink HM, Tambs K, Hoffman HJ (2005) The Nord-Trondelag Norway audiometric survey 1996–98: unscreened thresholds and prevalence of hearing impairment for adults >20 years. Noise Health 7:1–15.CrossRefPubMedGoogle Scholar
  5. Brant LJ, Gordon-Salant S, Pearson JD, Klein LL, Morrell CH, Metter EJ, Fozard JL (1996) Risk factors related to age-associated hearing loss in the speech frequencies. J Am Acad Audiol 7:152–160.PubMedGoogle Scholar
  6. Brown KD, Balkany TJ (2007) Benefits of bilateral cochlear implantation: a review. Curr Opin Otolaryngol Head Neck Surg 15:315–318.CrossRefPubMedGoogle Scholar
  7. Chia EM, Wang JJ, Rochtchina E, Cumming RR, Newall P, Mitchell P (2007) Hearing impairment and health-related quality of life: the Blue Mountains Hearing Study. Ear Hear 28:187–195.CrossRefPubMedGoogle Scholar
  8. Christensen K, Frederiksen H, Hoffman H (2001) Genetic and environmental influences on self-reported reduced hearing in the old and oldest old. J Am Geriatr Soc 49:1512–1517.CrossRefPubMedGoogle Scholar
  9. Cruickshanks KJ, Nondahl DM, Klein R, Klein BEK (1996) Sex, cardiovascular disease and hearing loss: the Epidemiology of Hearing Loss Study. Am J Epidemiol 143, Suppl 11:S65.Google Scholar
  10. Cruickshanks KJ, Klein R, Klein BEK, Wiley TL, Nondahl DM, Tweed TS (1998a) Cigarette smoking and hearing loss. The Epidemiology of Hearing Loss Study. J Am Med Assoc 279:1715–1719.CrossRefGoogle Scholar
  11. Cruickshanks KJ, Wiley TL, Tweed TS, Klein BE, Klein R, Mares-Perlman JA, Nondahl DM (1998b) Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin. Am J Epidemiol 148:879–886.PubMedGoogle Scholar
  12. Cruickshanks KJ, Tweed TS, Wiley TL, Klein BE, Klein R, Chappell R, Nondahl DM, Dalton DS (2003) The 5-year incidence and progression of hearing loss: the Epidemiology of Hearing Loss Study. Arch Otolaryngol Head Neck Surg 129:1041–1046.CrossRefPubMedGoogle Scholar
  13. Dalton DS, Cruickshanks KJ, Klein R, Klein BE, Wiley TL (1998) Association of diabetes and hearing loss. Diabetes Care 21:1540–1544.CrossRefPubMedGoogle Scholar
  14. Dalton DS, Cruickshanks KJ, Wiley TL, Klein BEK, Klein R, Tweed TS (2001) The association of leisure time noise exposure and hearing loss. Audiology 40:1–9.CrossRefPubMedGoogle Scholar
  15. Davis AC (1989) The prevalence of hearing impairment and reported disability among adults in Great Britain. Int J Epidemiol 18:911–917.CrossRefPubMedGoogle Scholar
  16. Davis AC, Ostri B, Parving A (1991) Longitudinal study of hearing. Acta Otolaryngol Suppl 476:12–22.CrossRefGoogle Scholar
  17. DeStefano AL, Gates GA, Heard-Costa N, Myers RH, Baldwin CT (2003) Genomewide linkage analysis to presbycusis in the Framingham Heart Study. Arch Otolaryngol Head Neck Surg 129:285–289.PubMedGoogle Scholar
  18. Doll R, Peto R (1981) The Causes of Cancer. New York: Oxford Press.Google Scholar
  19. Durga J, Anteunis LJ, Schouten EG, Bots ML, Kok FJ, Verhoef P (2006) Association of folate with hearing is dependent on the 5.10-methylenetetrahdyrofolate reductase 677C → T Mutation. Neurobiol Aging 27:482–489.CrossRefPubMedGoogle Scholar
  20. Durga J, Verhoef P, Anteunis LJ, Schouten E, Kok FJ (2007) Effects of folic acid supplementation on hearing in older adults. Ann Intern Med 146:1–9.PubMedGoogle Scholar
  21. Evans AS (1995) Causation and disease: a chronological journey. The Thomas Parran Lecture. Am J Epidemiol 142:1126–1135.PubMedGoogle Scholar
  22. Fransen E, Topsakal V, Hendrickx JJ, Van Laer L, Huyghe JR, Van Eyken E, Lemkens N, Hannula S, Mäki-Torkko E, Jensen M, Demeester K, Tropitzsch A, Bonaconsa A, Mazzoli M, Espeso A, Verbruggen K, Huyghe J, Huygen PL, Kunst S, Manninen M, Diaz-Lacava A, Steffens M, Wienker TF, Pyykkö I, Cremers CW, Kremer H, Dhooge I, Stephens D, Orzan E, Pfister M, Bille M, Parving A, Sorri M, Van de Heyning P, Van Camp G (2008) Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study. J Assoc Res Otolaryngol 9:264–276.CrossRefPubMedGoogle Scholar
  23. Fuente A, McPherson B (2006) Organic solvents and hearing loss: the challenge for audiology. Int J Audiol 45:367–381.CrossRefPubMedGoogle Scholar
  24. Gates GA, Cooper JC (1991) Incidence of hearing decline in the elderly. Acta Otolaryngol 111:240–248.CrossRefPubMedGoogle Scholar
  25. Gates GA, Cooper JC Jr, Kannel WB, Miller NJ (1990) Hearing in the elderly: the Framingham cohort, 1983–1985. Part I. Basic audiometric test results. Ear Hear 11:247–256.Google Scholar
  26. Gates GA, Cobb JL, D’Agostino RB, Wolf PA. (1993) The relation of hearing in the elderly to the presence of cardiovascular disease and cardiovascular risk factors. Arch Otolaryngol Head Neck Surg 119:156–161.PubMedGoogle Scholar
  27. Gates G, Couropmitree N, Myers R (1999) Genetic associations in age-related hearing thresholds. Arch Otolaryngol Head Neck Surg 125:654–659.PubMedGoogle Scholar
  28. Helzner EP, Cauley JA, Pratt SR, Wisniewski SR, Zmuda JM, Talbott EO, de Rekeneire N, Harris TB, Rubin SM, Simonsick EM, Tylavsky FA, Newman AB (2005) Race and sex differences in age-related hearing loss: the Health, Aging, and Body Composition Study. J Am Geriatr Soc 53:2119–2127.CrossRefPubMedGoogle Scholar
  29. Houston DK, Johnsson MA, Nozza RJ, Gunter EW, Shea KJ, Cutler GM, Edmonds JT (1999) Age-related hearing loss, vitamin B-12, and folate in elderly women. Am J Clin Nutr 69:564–571.PubMedGoogle Scholar
  30. Huyghe JR, Van Laer L, Hendrickx JJ, Fransen E, Demeester K, Topsakal V, Kunst S, Manninen M, Jensen M, Bonaconsa A, Mazzoli M, Baur M, Hannula S, Mäki-Torkko E, Espeso A, Van Eyken E, Flaquer A, Becker C, Stephens D, Sorri M, Orzan E, Bille M, Parving A, Pyykkö I, Cremers CW, Kremer H, Van de Heyning PH, Wienker TF, Nürnberg P, Pfister M, Van Camp G (2008) Genome-wide SNP-based linkage scan identifies a locus on 8q24 for an age-related hearing impairment trait. Am J Hum Genet 83:401–407.CrossRefPubMedGoogle Scholar
  31. Jacobsen P, Hein HO, Suadicani P, Parving A, Gyntelberg F (1993) Mixed solvent exposure and hearing impairment: an epidemiological study of 3284 men. The Copenhagen male study. Occup Med 43:180–184.Google Scholar
  32. Jennings CR, Jones NS (2001) Presbyacusis. J Laryngol Otol 115:171–178.PubMedGoogle Scholar
  33. Johnsson LG, Hawkins JE (1972) Vascular changes in the human inner ear associated with aging. Ann Otol 81:364–376.Google Scholar
  34. Karlsson KK, Harris JR, Svartengren M (1997) Description and primary results from an audiometric study of male twins. Ear Hear 18:114–120.CrossRefPubMedGoogle Scholar
  35. Last JM (2001) A Dictionary of Epidemiology, 4th Ed. New York: Oxford University Press.Google Scholar
  36. Lee DJ, Carlson DL, Lee HM, Ray LA, Markides KS (1991) Hearing loss and hearing aid use in Hispanic adults: results from the Hispanic Health and Nutrition Examination Survey. Am J Public Health 8:1471–1474.CrossRefGoogle Scholar
  37. Lee FS, Matthews LJ, Mills JH, Dubno JR, Adkins WY (1998) Gender-specific effects of medicinal drugs on hearing levels of older persons. Otolaryngol Head Neck Surg 118:221–227.CrossRefPubMedGoogle Scholar
  38. Lin YS, Egeghy PP, Rappaport SM (2008) Relationships between levels of volatile organic compounds in air and blood from the general population. J Expo Sci Environ Epidemiol 18:421–429.CrossRefPubMedGoogle Scholar
  39. Mills JH, Matthews LJ, Lee FS, Dubno JR, Schulte BA, Weber PC (1999) Gender-specific effects of drugs on hearing levels of older persons. Ann NY Acad Sci 884:381–388.CrossRefPubMedGoogle Scholar
  40. Morata TC, Campo P (2002) Ototoxic effects of styrene alone or in concert with other agents:aA review. Noise Health 4:15–24.PubMedGoogle Scholar
  41. Morata TC, Johnson AC, Nylen P, Svensson EB, Cheng J, Krieg EF, Lindblad AC, Ernstgård L (2002) Audiometric findings in workers exposed to low levels of styrene and noise. J Occup Environ Med 44:806–814.CrossRefPubMedGoogle Scholar
  42. Mościcki EK, Elkins EF, Baum HM, McNamara PM (1985) Hearing loss in the elderly: an epidemiologic study of the Framingham Heart Study cohort. Ear Hear 6:184–190.CrossRefPubMedGoogle Scholar
  43. Moshe S, Frenkel A, Hager M, Skulsky M, Skulsky M, Sulkis J, Himelfarbe M (2002) Effects of occupational exposure to mercury or chlorinated hydrocarbons on the auditory pathway. Noise Health 4:71–77.PubMedGoogle Scholar
  44. Nondahl DM, Cruickshanks KJ, Wiley TL, Tweed TS, Ershler W, Klein R, Klein BEK (1998) Accuracy of self-reported hearing loss. Audiology 37:295–301.CrossRefPubMedGoogle Scholar
  45. O’Grady G, Boyles AL, Speer M, DeRuyter F, Strittmatter W, Worley G. (2007) Apolipoprotein E alleles and sensorineural hearing loss. Int J Audiol 46:183–186.CrossRefPubMedGoogle Scholar
  46. Popelka MM, Cruickshanks KJ, Wiley TL, Tweed TS, Klein BEK, Klein R (1998) Low prevalence of hearing aid use among older adults with hearing loss: the Epidemiology of Hearing Loss Study. J Am Geriatr Soc 46:1075–1078.PubMedGoogle Scholar
  47. Popelka MM, Cruickshanks KJ, Wiley TL, Tweed TS, Klein BE, Klein R, Nondahl DM (2000) Moderate alcohol consumption and hearing loss: a protective effect. J Am Geriatr 48:1273–1278Google Scholar
  48. Ries PW (1985) The demography of hearing loss. In: Orlans H (ed) Adjustments to Adult Hearing Loss. San Diego, CA: College Hill Press, pp. 3–20.Google Scholar
  49. Ries PW (1994) Prevalence and characteristics of persons with hearing trouble: United States, 1990–91. Vital Health Stat 10, p. 1–75.Google Scholar
  50. Rosen S (1966) Hearing studies in selected urban and rural populations. Trans NY Acad Sci 29:9–21.Google Scholar
  51. Rosen S, Olin P (1965) Hearing loss and coronary heart disease. Arch Otolaryngol 82:236–243.PubMedGoogle Scholar
  52. Rosen S, Bergman M, Plester D, El-mofty A, Satti MH (1962) Presbycusis study of a relatively noise-free population in the Sudan. Ann Otorhinol Laryngol 71:727–743.Google Scholar
  53. Rosen S, Preobrajensky N, Tbilisi SK, Glazunov I, Tbilisi Nk, Rosen HV (1970) Epidemiologic hearing studies in the USSR. Arch Otolaryngol 91:424–428.PubMedGoogle Scholar
  54. Rosenhall U, Sixt E, Sundh V, Svanborg A (1993) Correlations between presbyacusis and extrinsic noxious factors. Audiology 32:234–243.CrossRefPubMedGoogle Scholar
  55. Schuknecht HF (1964) Further observations on the pathology of presbycusis. Arch Otolaryngol 80:269–382.Google Scholar
  56. Schwartz J, Otto D (1987) Blood lead, hearing thresholds and neurobehavioral development in children and youths. Arch Environ Health 42:153–160.CrossRefPubMedGoogle Scholar
  57. Schwartz J, Otto D (1991) Lead and minor hearing impairment. Arch Environ Health 46: 300–305.CrossRefPubMedGoogle Scholar
  58. Sliwinska-Kowalska M, Zamyslowska-Szmytke E, Szymczak W, Kotylo P, Fiszer M, Wesolowski W, Pawlaczyk-Luszczynska M (2003) Ototoxic effects of occupational exposure to styrene and co-exposure to styrene and noise. J Occup Environ Med 45:15–24.CrossRefPubMedGoogle Scholar
  59. Susmano A, Rosenbush SW (1988) Hearing loss and ischemic heart disease. Am J Otol 9:403–408.PubMedGoogle Scholar
  60. Torre P, Cruickshanks KJ, Klein BEK Klein R, Nondahl DM (2005) The association between cardiovascular disease and cochlear function in older adults. J Speech Lang Hear Res 48:473–481.CrossRefPubMedGoogle Scholar
  61. Turyk M, Anderson HA, Hanrahan LP, Falk C, Steenport DN, Needham LL, Patterson DG Jr, Freels S (2006) Relationship of serum levels of individual PCB, dioxin, and furan congeners and DDE with Great Lakes sport-caught fish consumption. Environ Res 100:173–183.CrossRefPubMedGoogle Scholar
  62. Unal M, Tamer L, Doğruer ZN, Yildirim H, Vayisoğlu Y, Camdeviren H (2005) N -acetyltransferase 2 gene polymorphism and presbycusis. Laryngoscope 115:2238–2241.CrossRefPubMedGoogle Scholar
  63. Van Eyken E, Van Camp G, Van Laer L (2007a) The complexity of age-related hearing impairment: contributing environmental and genetic factors Audiol Neurotol 12:345–358.CrossRefGoogle Scholar
  64. Van Eyken E, Van Camp G, Fransen E, Topsakal V, Hendrickx JJ, Demeester K, Van de Heyning P, Mäki-Torkko E, Hannula S, Sorri M, Jensen M, Parving A, Bille M, Baur M, Pfister M, Bonaconsa A, Mazzoli M, Orzan E, Espeso A, Stephens D, Verbruggen K, Huyghe J, Dhooge I, Huygen P, Kremer H, Cremers CW, Kunst S, Manninen M, Pyykkö I, Lacava A, Steffens M, Wienker TF, Van Laer L (2007b) Contribution of the N-acetyltransferase 2 polymorphism NAT2*6A to age-related hearing impairment. J Med Genet 44: 570–578.CrossRefPubMedGoogle Scholar
  65. Van Laer L, Van Eyken E, Fransen E, Huyghe JR, Topsakal V, Hendrickx JJ, Hannula S, Mäki-Torkko E, Jensen M, Demeester K, Baur M, Bonaconsa A, Mazzoli M, Espeso A, Verbruggen K, Huyghe J, Huygen P, Kunst S, Manninen M, Konings A, Diaz-Lacava AN, Steffens M, Wienker TF, Pyykkö I, Cremers CW, Kremer H, Dhooge I, Stephens D, Orzan E, Pfister M, Bille M, Parving A, Sorri M, Van de Heyning PH, Van Camp G. (2008) The grainyhead like 2 gene (GRHL2), alias TFCP2L3, is associated with age-related hearing impairment. Hum Mol Genet 17:159–169.CrossRefPubMedGoogle Scholar
  66. Viljanen A, Era P, Kaprio J, Pyykkö I, Koskenvuo M, Rantanen T (2007) Genetic and environmental influences on hearing in older women. J Gerontol A Biol Sci Med Sci 62:447–452.PubMedGoogle Scholar
  67. Willott JF (1991) Age-related sensorineural histopathology. In: Aging and the Auditory System: Anatomy, Physiology, and Psychophysics. San Diego, CA: Singular Publishing Group, pp. 39–42.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Karen J. Cruickshanks
    • 1
    • 2
    Email author
  • Weihai Zhan
    • 1
  • Wenjun Zhong
    • 1
  1. 1.Department of Ophthalmology and Visual SciencesUniversity of Wisconsin, School of Medicine and Public HealthMadisonU.S
  2. 2.Department of Population Health ScienceUniversity of Wisconsin, School of Medicine and Public HealthMadisonU.S

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