The Association of a 15 dB Early Warning Sign on the Risk of Subsequent Standard Threshold Shifts
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2023
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Abstract
OBJECTIVE The objective of this study is to determine the association of a 15 dB change in hearing threshold on the risk of subsequent Standard Threshold Shifts (STS). METHODS Records for 11,307 individuals with serial audiometric assessments between 1990 and 2018 were reviewed. Nine-hundred-five (905) individuals with 11 consecutive years of audiograms were included in the study. An STS was determined based on the baseline audiogram and using the Occupational Safety and Health Administration (OSHA) standard. An STS in the left or right ear per person is possible based on each ear being treated separately, and the first STS for each ear was coded as an event. An Early Warning Sign (EWS) was recorded if a change of 15 dB was measured from baseline at 1000, 2000, 3000 or 4000 Hz, consistent with Department of Defense standards. Kaplan-Meier time-to-event method and Cox Proportional Hazards models were used to estimate associations.
RESULTS An EWS was associated with an increased risk of having an STS. Within a ten-year timeframe, the percent of the population that had an STS without an EWS was 22% in the left and right ears. When an EWS was present, the STS percent increased to 56% in the left and 59% in the right. Individuals experiencing an EWS were about twice as likely as those without an EWS to have an STS (left ear: adjusted hazard ratio [aHR] 1.98; 95% confidence interval [CI] 1.67, 2.35; right ear: aHR 2.16; 95% CI 1.82, 2.56). The positive predictive value of the EWS was 67%.
CONCLUSIONS A 15 dB change in hearing threshold resulted in an elevated risk for future changes in hearing, and should be used as evidence for further prevention practices being implemented.
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Epidemiology, audiograms, hearing conservation, noise induced hearing loss
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