American Speech-Language-Hearing Association

Incidence and Prevalence of Hearing Loss and Hearing Aid Use in the United States - 2008 Edition

Communication skills are central to a successful life for all individuals. Such skills affect education, employment, and general well-being. However, each day is a challenge for those individuals who have a communication disability.

General Demographics

  • The pertinent literature presents different statistics concerning the overall incidence and prevalence of individuals with hearing loss. Readers should keep in mind that data are often collected via voluntary surveying of the non-institutionalized population (i.e., with participants who admit to having some degree of hearing loss), as well as other survey methods (1-6). Clinical data to determine if hearing impairment rates are changing are not available since there are no ongoing, clinical, annual studies of hearing impairment in the United States (6).
  • An independent researcher estimates that 31.5 million Americans had hearing loss in 2004, with continued major increases in the baby boomer and elderly 75+ age brackets (5). This figure is similar to the figure gleaned from the National Health Interview Survey in 2005 (3).

Incidence/Prevalence of Selected Causes of Auditory Disorders

Acoustic Neuroma

An acoustic neuroma is a tumor arising in or just outside the internal auditory canal, from the nerve sheath of the inferior branch of the vestibular nerve.

  • According to several studies, acoustic neuromas may affect one in 80,000 to 100,000 individuals (7, 8).
  • Acoustic neuromas are thought to account for the majority of intracranial nerve sheath growths (8).

Ototoxicity

Ototoxicity is drug-induced damage affecting the auditory system.

  • Ototoxicity has been recognized since the 1800s. Among the drugs on the list as ototoxic substances: aminoglycoside antibiotics, loop diuretics or antineoplastic drugs, salicylates, and antimalarial drugs (9-11).
  • The number of therapeutic substances and industrial chemicals available that can cause a greater or lesser degree of ototoxicity is very large (12). Over 130 drugs and chemicals are reported to be potentially ototoxic (10, 13).
  • The most common symptoms of drug-induced ototoxicity are tinnitus, sensorineural hearing loss, and vestibular dysfunction (11).
  • Ototoxicity-induced hearing loss tends to first manifest in the high frequencies and in the basal portion of the cochlea (14).
  • Individual susceptibility seems highly variable, but some predisposing factors are renal failure; age; combination of ototoxic drugs; familial sensitivity to ototoxic effects, or previous neurosensorial deficit (13).

Meniere's Disease

Meniere's disease affects the membranous inner ear and may be characterized by episodes of deafness, vertigo, and tinnitus.

  • Meniere's disease affects 615,000 individuals in the United States (15).
  • Meniere's Disease is more common in adults, with an average age of onset in the fourth decade, the symptoms beginning usually between ages 20 and 60 years (16).

Otosclerosis

Otosclerosis is an abnormal growth of bone that affects the function of the ossicles and can invade the inner ear.

  • Otoslcerosis is an uncommon disease, typically presenting in young patients, with a 2:1 female:male ratio. It is bilateral in up to 85% of patients, but is often asymmetric (17).
  • Otosclerosis occurs most frequently between 30 years and 50 years of age and is known to worsen during pregnancy. The etiology remains unknown, although an inflammatory response may be responsible. The condition may also be inherited (17).
  • Otosclerosis occurring with other pathologies has received little attention in the literature, although these concomitant occurrences can be clinically relevant. One study found clinical pathologic relationships between oto- and vestibular symptoms and otitis media (18).

Presbycusis

Presbycusis is the loss of auditory sensitivity as a result of aging.

  • Hearing loss is the third most prevalent chronic condition in older Americans, and it is the number one communicative disorder of the aged; between 25% and 40% of the population aged 65 years or older is hearing impaired (19, 20).
  • The prevalence of presbycusis rises with age, ranging from 40% to 66% in patients older than 75 years, and more than 80% in patients older than 85 years (19).

Tinnitus

Tinnitus is often described as "head noises" or "ear noises," with ringing, roaring, or hissing in the ears as common characteristics.

  • One-third of all adults report experiencing tinnitus at some time in their lives. Ten percent to 15% of adults have prolonged tinnitus requiring medical evaluation (21).
  • Up to 18% of the general population of industrialized countries is mildly affected by chronic tinnitus, and 0.5% report tinnitus having a severe effect on the ability to lead a normal life (22, 23).
  • Prevalence estimates of individuals with tinnitus vary; an overview of several studies indicate a 10%-15% rate in adults (24).
  • While the exact cause of tinnitus is unknown, it may be a symptom of other problems such as hearing loss, exposure to loud noise, exposure to ototoxic medicine, or allergies (25, 26).

Incidence and Prevalence by Type of Hearing Loss

Central Auditory Processing Disorder (CAPD)

Central auditory processing disorder refers to limitations in the ongoing transmission, analysis, organization, transformation, elaboration, storage, retrieval, and use of information contained in audible signals (27).

  • The body of literature on CAPD indicates that the disorder is not uncommon. Several groups of patients have been identified with CAPD such as children with language-learning problems, people with known lesions of the central auditory system, people complaining about an apparent inability to hear well in difficult listening situations, and people with age-related changes in the central rather than the peripheral auditory system (28).
  • Prevalence data for CAPD are lacking. Although reports have appeared consistently in the literature describing auditory perceptual and auditory processing deficits associated with a variety of conditions, no authoritative estimates of the prevalence of CAPD are available (29).
  • Age-related CAPD abnormality has been described in many studies with widely varying prevalence reported. To date, there has been only one population study to report prevalence of this age-related condition, and these rates were significantly lower than in reports from clinical studies (30).

Conductive Hearing Loss

  • According to one study within a population of individuals with Rett Syndrome, the prevalence of hearing loss was increased in older participants and in those with seizures requiring the use of anticonvulsants (31).
  • Hearing loss, both sensorineural and conductive, has been reported in patients with rheumatoid arthritis (RA). Sensorineural hearing loss of the cochlear variety is a common finding in patients with RA, whereas conductive loss, although seen, is much less common. Increased laxity of the middle ear transducer mechanism is the likely cause of the conductive element (32).

Hyperacusis

Hyperacusis may be defined as an unusual intolerance of ordinary environmental sounds presented at normal levels.

  • Little research has been done on hyperacusis. One study suggests that the prevalence of hyperacusis in the general population is probably underreported when it occurs with medically recognized symptoms such as tinnitus, headache, or depression (33).
  • Hyperacusis is mainly a consequence of the noise level in the 21st century, owing to dramatic changes in people's lifestyles. Of every 100 people affected with otological complaints (e.g., tinnitus and hyperacusis), 20 are affected by hyperacusis. Because of its high incidence, this symptom has long been the subject of investigation (34).
  • Hyperacusis is associated with concentration difficulties, use of ear protection, avoidance, tension, and sensitivity to light/colors. According to one study, hyperacusis is a common problem (33).

Mixed Hearing Loss

Authoritative data concerning the general incidence and prevalence of mixed hearing loss are unavailable in the allied health or medical literature.

Sensorineural Hearing Loss

Sensorineural hearing loss (SNHL) describes abnormalities of the inner ear and/or nerve pathways beyond the inner ear to the brain.

  • Sudden hearing loss is infrequent, with an estimated 5-20 cases yearly per 10,000 individuals (35).
  • Sudden sensorineural hearing loss (SSHL) is a symptom of cochlear injury resulting from idiopathic causes. It is defined as a sensorineural hearing loss of 30dB or more over at least three contiguous audiometric frequencies that develops over a period of a few hours to three days (36, 37).
  • In SSHL, many hypotheses have been proposed to explain the etiology: viral inflammation, vascular occlusive disease, allergic reactions, rupture of intralabyrinthine membranes, local histamine production, and autoimmune disease (36, 38, 39).

Hearing Aid Use and Cochlear Implants

  • According to a study conducted 2004, there were 24.1 million individuals with a hearing loss who do not own a hearing aid device. This is in contrast to 12.5 million individuals who own hearing instruments, and 11.1 million individuals who use their instruments (5).
  • About 6 out of 10 hearing instrument owners and non-owners are male (5).
  • The overall prevalence of device nonuse, according to one study, was noted to increase slowly with time. The role of psychological factors in contributing to the decision of an individual to elect to opt out of device use remains unproven (40).
  • Both hearing loss and the use of hearing aids are widely reported as unacceptably different from normal, or stigmatizing. Perceptions of stigmatization often result in denial of hearing problems and lack of adherence to professional recommendations to use hearing aids (41, 44).
  • Barriers to hearing aid use are complex and multifactorial involving, among other things, a lack of system commitment to utilization of hearing aids and hearing aid design, fit issues, and price of aid (42, 44).
  • Overall customer satisfaction with new hearing instruments is 77%, placing this product in the top-third of products and services in the United States (5).
  • Cochlear implants are electronic devices that contain a current source and an electrode array that is implanted into the cochlea; electrical current is then used to stimulate the surviving auditory nerve fibers (43). Worldwide, about 60,000 cochlear implants have been placed during the past 20 years, approximately one half of them in adults and one half in children (45).
  • Data vary as to how many individuals in the U.S. are potential candidates for receiving cochlear implants. These figures range from 250,000 (46) to 1 million people (45).

References

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Compiled by Andrea Castrogiovanni * American Speech-Language-Hearing Association * 2200 Research Boulevard, Rockville, MD 20850* acastrogiovanni@asha.org

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