Is gout associated with a higher risk of hearing loss in adults?

A new cohort study examines whether gout is associated with a higher risk of hearing loss in older adults. 



Objectives To evaluate whether gout is associated with a higher risk of hearing loss in older adults.
Design Retrospective cohort study.
Setting USA.
Participants 5% random sample of US Medicare claims 2006–2012, representative of US adults aged 65 years or older.
Primary and secondary outcomes Incident (new) hearing loss identified by the presence of at least two claims at least 4 weeks apart with an International Classification of Diseases, Ninth Revision, 389.xx, with no respective claim in the baseline 1-year observation period.
Results Among the 1.71 million eligible people, 89 409 developed incident hearing impairment. The crude incidence rates of incident hearing impairment in people with versus without gout were 16.9 vs. 8.7 per 1000 person-years. Using Cox regression analyses adjusted for demographics, medical comorbidity and common cardiovascular and gout medications, we found that gout was associated with a significantly higher HR of incident hearing impairment, HR was 1.44. Findings were confirmed in sensitivity analyses that substituted continuous Charlson-Romano Index with categorical variable or all comorbidities and additionally cardiovascular risk factors, with minimal attenuation of HR.
Conclusions Gout is associated with a higher risk of development of hearing loss in older adults. Future studies need to assess the underlying mechanisms of this association.

The full article is available to read at BMJ Open  

Full reference: Singh, J.A.Cleveland, J.D. | 2018| Gout and hearing impairment in the elderly: a retrospective cohort study using the US Medicare claims data| 


Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology

Hodgetts, W. E., Aalto, D., Ostevik, A., & Cummine, J. |2018 | Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology| Ear and hearing| Epub ahead of print | Doi: 10.1097/AUD.0000000000000634

A new article, soon to be published in the journal Ear and hearing, adds to the literature on nonauditory factors such as motivation, effort, and task demands that can impact performance in clinics and laboratories. 



In this article, we explore two manipulations of “meaning response,” intended to either “impart” meaning to participants through the manipulation of a few words in the test instructions or to “invite” meaning by making the participant feel involved in the setting of their preferred sound.


In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told “this hearing in noise test (HINT) you are about to do is really hard,” while the second group was told “this HINT test is really easy.” In experiment 2, 59 normal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was “best” to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice.


In experiment 1, those who were told the test was hard performed significantly better than the easy group. In experiment 2, a significant preference was found in the group when comparing “my setting” to “another participant.” No significant difference was found in the group comparing “my setting” to the “expert.”


Imparting or inviting meaning into the context of audiological outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories.

Rotherham NHS staff can request this article here 


Comorbidities of hearing loss and the implications of multimorbidity for audiological care

Besser, J., Stropahl, M., Urry, E., & Launer, S. |2018| Comorbidities of hearing loss and the implications of multimorbidity for audiological care| Hearing Research|

Hearing Research has published an article that considers the impact of  multimorbidities in audiological patients, it is available to read in full from Hearing Research. 




With increasing age, the risk of developing chronic health conditions also increases, and many older people suffer from multiple co-existing health conditions, i.e., multimorbidity. One common health condition at older age is hearing loss (HL). The current article reflects on the implications for audiological care, when HL is one of several health conditions in a multimorbidity. An overview of health conditions often co-existing with HL, so called comorbidities, is provided, including indications for the strength of the associations. The overview is based on a literature study examining cohort studies that were published in the years 2010–2018 and examined associations of hearing loss with other health conditions, namely Visual impairment, Mobility restrictions, Cognitive impairment, Psychosocial health problems, Diabetes, Cardiovascular diseases, Stroke, Arthritis, and Cancer. This selection was based on previous publications on common chronic health conditions at older age and comorbidities of hearing loss. For all of these health conditions, it was found that prevalence is larger in people with a HL and several longitudinal studies also found increased incident rates in people with a HL. The examined publications provide little information on how hearing loss should be managed in the clinical care of its comorbidities and vice versa. The current article discusses several options for adaptations of current care. Nonetheless, solutions for an integrated audiology care model targeting HL in a multimorbidity are still lacking and should be subject to future research.

Read the article here 

The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

A new article published in the journal Ear and Hearing considers how a hearing aid contributes to the ability to perceive a gap in noise for children and adults with hearing loss.


ObjectivesThe objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing losschildren with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience.

DesignThe ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification.

ResultsWhen fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds.

ConclusionThese findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech.

Full reference: Brennan, M. A., McCreery, R. W., Buss, E., & Jesteadt, W. |2018| The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss|Ear and hearing| Vol. 39|(5)| P. 969-979.

This article can be requested by Rotherham NHS staff here 

Sound therapy (using amplification devices and/or sound generators) for tinnitus in adults

Sereda  M, Xia  J, El Refaie  A, Hall  DA, Hoare  DJ| 2018|  Sound therapy (using amplification devices and/or sound generators) for tinnitus in adults. Cochrane Database of Systematic Reviews |Issue 8| Art. No.: CD013094| DOI: 10.1002/14651858.CD013094.

The Cochrane Library has published a  new protocol for an update of two Cochrane Reviews on sound therapy (masking) and on amplification with hearing aids for tinnitus that were first published in the Cochrane Library in Issue 12, 2010 and updated in 2012 (Hobson 2012).


The protocol is available from The Cochrane Library 

protocol for a Cochrane Review (Intervention). The protocol assesses the effect of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults.

Ear drops for the removal of ear wax systematic review

Cooper, A.,   Warner  L, Burton  MJ | 2018| Ear drops for the removal of ear wax| Cochrane Database of Systematic Reviews |Issue 7| Art. No.: CD012171| DOI: 10.1002/14651858.CD012171.pub2.

A new systematic review on the Cochrane Library  looks at ear drops for the removal of ear wax. The authors found and included 10 studies with a total of 623 participants; of these only six provided data which could be analysed to calculate the proporotion of patients with complete ear wax clearance.


Plain language summary

Ear drops for the removal of ear wax


Build up of ear wax is common. It can be uncomfortable for the patient and can cause hearing problems. Ear drops have been studied as a potential tool to soften the wax, preventing the need for further treatment such as syringing. This review looks at which treatment (oil‐ and water‐based drops or sprays) can help resolve wax build up.

Study characteristics

In March 2018 we searched for clinical trials where ear drops were used to help soften and remove build up of ear wax in patients’ ears. We found and included 10 studies with a total of 623 participants. However, only six of these studies provided data with which we could analyse our primary outcome, the proportion of patients with complete ear wax clearance. These six studies included a total of 360 participants, both children and adults (of all ages), with partial or full blockage of the external ear canal with ear wax.

Key results

The 10 included studies looked at either oil‐based drops (triethanolamine polypeptide, almond oil, benzocaine, chlorobutanol), water‐based drops (docusate sodium, carbamide peroxide, phenazone, choline salicylate, urea peroxide, potassium carbonate), saline (salty water) or water alone, or no treatment.

Only one study compared using drops with an active ingredient to not using drops at all. The drops may help increase the proportion of ears cleared of wax from 1 in 20 (if you do nothing) to about 1 in 5 (if you use drops).

We did not find any evidence that water‐based or oil‐based drops were any different to saline or water. However, we also did not find any evidence that water or saline were better than doing nothing.

Adverse (side) effects were not common. Fewer than 30 patients reported any adverse events when using the drops and these were mild (such as slight irritation or pain, or unpleasant smell). No serious side effects were reported by any participant.

Quality of the evidence

We rated the quality of the evidence from studies using four levels: very lowlowmoderate or high qualityHigh‐quality evidencemeans that we are very confident in the results. Very low‐quality evidence means that we are very uncertain about the results. For wax clearance, we rated the quality of the evidence as low. For adverse effects we rated the quality of the evidence as low.


We have found that using ear drops when you have a partially or completely blocked ear canal may help to remove the ear wax in your ear. It is not clear whether one type of drop is any better than another, or whether drops containing active ingredients are any better than plain or salty water.



The full systematic review is available from Cochrane 

NICE Guideline- Hearing loss in adults: assessment and management

NICE| July 2018| Hearing loss in adults: assessment and management

NICE have issued a new guideline which covers some aspects of assessing and managing hearing loss in primary, community and secondary care. It aims to improve the quality of life for adults with hearing loss by advising healthcare staff on assessing hearing difficulties, managing earwax and referring people for audiological or specialist assessment and management.

The guideline covers adults aged over 18, including adults whose age of onset of hearing loss was under 18 but who present for the first time in adulthood.

The guideline is available from NICE