Hearing acuity in nonagenarians aged 90 and 95 assessed in a home setting using standardized pure-tone audiometry

Figures & data

Figure 1. Flowchart of sample process and participation.

Figure 2. Comparison between participants, drop-outs and same-aged individuals in Gothenburg Municipality and in Sweden overall. Proportions and 95% confidence intervals (Wald intervals for proportions) for study participants regarding: sex, education level, ethnicity and housing. The same characteristics are presented with the proportions for the groups of drop-outs as well as same-aged individuals in Gothenburg Municipality and the population of Sweden. All of the variables are on an aggregated level from Statistics Sweden (SCB). Missing values for drop-outs in the 95-year-olds are due to the number of persons in that category is ≤ 3. * In 90-year-olds no confidence interval regarding special housing could be assessed due to the low number of participants in that group.

Table 1. Presentation and comparison of sociodemographic characteristics of participants and dropouts among 90- and 95-year-olds recruited to the current study.

Characteristics	90-year-olds, n (%)					95-year-olds, n (%)
	Participants (n = 42)		Drop-outs (n = 214)		p – value^a	Participants (n = 49)		Drop-outs (n = 31)		p – value^a
Sex					.425					.145
Female	26 (62)		146 (68)			34 (69)		26 (84)
Male	16 (38)		68 (32)			15 (31)		5 (16)
Ethnicity					.260					.491
Born in Sweden	38 (91)		179 (84)			45 (92)		27 (87)
Born elsewhere	4 (9.5)		45 (16)			4 (8.2)		4 (13)
Housing					na					na
Own house or apartment	36 (86)		182 (85)			34 (69)		≤ 3
Special housing^b	≤ 3		22 (10)			10 (20)		≤ 3
Other/Unknown	≤ 3		≤ 3			≤ 3		≤ 3
Education					.063					na
Primary and lower secondary ≤ 9 yrs.	12 (29)		84 (39)			> 14		14 (45)
Upper Secondary school	14 (33)		82 (38)			24 (49)		> 8
Post-secondary school and higher	16 (38)		45 (21)			> 7		≤ 3
Marital status					na					na
Married	≤ 3		56 (26)			> 7		≤ 3
Widowed	27 (64)		119 (56)			29 (59)		27 (87)
Divorced	≤ 3		32 (15)			> 6		≤ 3
Unmarried	≤ 3		≤ 3			≤ 3		≤ 3

Note. Sociodemographic variables for participants and dropouts were received on an aggregated level from Statistics Sweden (SCB). The Chi-Squared test indicated no significant differences between the groups regarding sex, ethnicity, and education (only 90-year-olds). The numbers in italics are not exact due to protection of the anonymity and therefore no statistical comparison could be made.

na: not available.

^a The p-values were adjusted with Bonferroni for multiple comparisons, resulting in a significant p-value < .017 for the 90-year-olds and p < .025 for the 95-year-olds.

^b Person living in a nursing home or other care facility.

Table 2. Prevalence rates of hearing loss degree in the study participants.

	All participants (n = 91) n (%)		90-year-olds (n = 42) n (%)		95-year-olds (n = 49) n (%)
Degree of hearing loss^a	Better ear (n = 89)^c		Better ear (n = 42)		Better ear (n = 47)^c
None	2 (2.2)		1 (2.2)		1 (2.1)
Mild	13 (15)		11 (26)		2 (4.3)
Moderate	33 (37)		18 (43)		15 (32)
Moderately severe	37 (42)		11 (26)		26 (55)
Severe	4 (4.5)		1 (2.4)		3 (6.4)
Profound or complete^b	none		none		none
Degree of hearing loss^a	Right ear (n = 89)^c	Left ear (n = 88)^c	Right ear (n = 42)	Left ear (n = 42)	Right ear (n = 47)^c	Left ear (n = 46)^c
None	1 (1.1)	1 (1.1)	1 (2.4)	none	none	1 (2.2)
Mild	10 (11)	10 (11)	7 (17)	10 (24)	3 (6.4)	none
Moderate	29 (32)	28 (32)	19 (45)	15 (36)	10 (22)	13 (28)
Moderately severe	35 (39)	38 (41)	11 (26)	13 (31)	24 (51)	23 (50)
Severe	14 (16)	8 (11)	4 (9.5)	4 (9.5)	10 (21)	6 (13)
Profound or complete^b	none	3 (3.4)	none	none	none	3 (6.5)

^a Degree of hearing loss: PTA4 (0.5, 1, 2 and 4 kHz) in the better ear: mild (20 to < 35 dB HL), moderate (35 to < 50 dB HL), moderately severe (50 to < 65 dB HL), severe (65 to < 80 dB HL), profound or total hearing loss/deafness (≥ 80) (World Health Organization 2021).

^b No distinction could be made between profound and complete hearing loss due to the maximum stimulus level used being 90 dB HL

^c No PTA4 could be determined for 2 participants due to missing threshold/s. One person had thresholds in one ear only (subjectively estimated as the better ear).

Table 3. Prevalence rates of type of hearing loss, tympanometric types, occurrence of cerumen and right-left asymmetry in the study participants.

	All participants (n = 91) n (%)		90-year-olds (n = 42) n (%)		95-year-olds (n = 49) n (%)
Type of hearing loss	Right	Left	Right	Left	Right	Left
Sensorineural	81 (89)	81 (89)	38 (91)	38 (91)	43 (88)	43 (88)
Mixed^a	6 (6.6)	3 (3.3)	4 (9.5)	2 (4.8)	2 (4.1)	1 (2.0)
Undefined^b	4 (4.4)	7 (7.7)	none	2 (4.8)	4 (8.2)	5 (10)
Cerumen (one or both ears)	27 (30)		6 (14)		21 (43)
Tympanometric type^c	Right	Left	Right	Left	Right	Left
A	56 (62)	55 (60)	30 (71)	26 (62)	26 (53)	29 (59)
As	16 (18)	16 (18)	6 (14)	7 (17)	10 (20)	9 (18)
Ad	4 (4.4)	4 (4.4)	2 (4.8)	3 (7.1)	2 (4.1)	1 (2.0)
C	6 (6.6)	8 (8.8)	1 (2.4)	3 (7.1)	5 (10)	5 (10)
B	5 (5.5)	3 (3.3)	2 (4.8)	2 (4.8)	3 (6.1)	1 (2.0)
Inconclusive	4 (4.4)	5 (5.5)	1 (2.4)	1 (2.4)	3 (6.1)	4 (8.2)
Asymmetric hearing loss	n (%)	Undefined^b	n (%)	Undefined^b	n (%)	Undefined^b
Air conduction^d	11 (13)	8	4 (9.8)	1	7 (17)	7
Strictly sensorineural^e	3 (3.6)	11	none	2	3 (7.5)	9

^a Air-bone-gap of > 15 dB at three consecutive frequencies and/or at least 20 dB at any frequency, in combination with either otoscopy, tympanometry or patient history that supports a middle ear pathology (Hoff et al. 2020).

^b Inconclusive due to the presence of cerumen, missing or unmasked air- and/or bone-conduction thresholds.

^c Types defined according to Jerger (1970). Type A indicates a normal middle ear peak pressure (TPP) and static compliance (Peak Y_tm): with subtypes A_S and A_D having a lower (< 0.03 mmho) versus higher (> 1.7 mmho) Peak Y_tm. Type C has a normal Peak Y_tm but abnormally low TPP (< - 100 daPa). Type B shows no compliance indicating a stiff middle ear system. Inconclusive results were due to technical problems or unattainable measurements.

^d A difference between the right and left air-conduction thresholds of ≥ 15 dB for PTA of 0.5, 1, 2, 3 kHz and/or 25 dB or more at two contiguous frequencies (Steiger 2005).

^e A difference between the right and left thresholds of ≥ 15 dB at two or more frequencies between 0.5 and 4 kHz.

Figure 3. Interpolated median hearing thresholds and quartile ranges by age groups (females and males combined).

Figure 4. Comparisons of pure-tone averages (PTA) for the right (R) and left (L) ear between the 90-year- and 95-year-olds using PTA4 (0.5, 1, 2, 4 kHz), PTA3 (0.5, 1, 2 kHz) and PTAHF (3, 4, 6 kHz). Median PTA for each group is presented in dB HL in their respective bar. The error bars represent the 25th and 75th quantiles of the respective variable, where the length of the interval equals the interquartile range. The Mann-Whitney U-test indicated a significantly higher average in the older age group for PTA4 and PTA3 (values in bolds). This was not seen for the high frequency PTA. The significance level was set to 0.008 to account for multiple comparisons (six independent comparisons).

Figure 5. Interpolated median hearing thresholds with quartile ranges by sex (age groups combined).

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Data availability statement

All data and analyses generated during the current study are available from the corresponding author on reasonable request.