title: Self-reported hearing difficulty versus audiometric screening in younger and older smokers and nonsmokers.
abstract: 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.
  
  
  BACKGROUND
  Aging; Smoking; Self Report; Health Promotion; Hearing Screening.
authors: Ishara Ramkissoon, University of South Alabama 5721 Drive N., HAHN 1119 Mobile, AL 36688, USA.
authors: Ishara
authors: I
authors: Ramkissoon
authors: Margaret
authors: M
authors: Cole