Aging and the binaural advantage in reverberation and noise.

The consonant identification ability of younger normal-hearing adults and older adults with little or no peripheral hearing loss was assessed using monaural and binaural presentation in four listening conditions: quiet, noise, reverberation, and reverberation + noise. Performance was examined in terms of identification accuracy and amount of binaural advantage. Results suggest that the small amount of hearing loss in the older subjects limited their perception of distorted consonants. Neither age nor peripheral hearing loss was related strongly to the amount of benefit obtained from binaural presentation.     

Comparison of hearing thresholds obtained using pure-tone behavioral audiometry, the Cantonese Hearing in Noise Test (CHINT) and cortical evoked response audiometry

CONCLUSION: Speech thresholds measured using Cantonese Hearing in Noise Test (CHINT) and cortical evoked response audiometry (CERA) thresholds were highly correlated with pure-tone behavioral results. Both tests are considered to provide good estimates of hearing thresholds and can be employed to confirm the degree of hearing loss in Cantonese-speaking communities. OBJECTIVES: This study aimed to evaluate how well a speech threshold obtained using a newly developed speech assessment tool (the CHINT) and CERA thresholds relate to pure-tone behavioral results and how the results compared in terms of their ability to predict hearing thresholds. SUBJECTS AND METHODS: Thirty adults with normal hearing to profound sensorineural hearing loss were tested. Speech thresholds were measured using the CHINT in four conditions: quiet, noise from the front, noise from the right, and noise from the left. CERA thresholds were measured at 0.5, 1, 2, and 4 kHz in both ears. RESULTS: Most participants had speech thresholds in quiet within+/-10 dB of pure-tone averages, and had CERA thresholds within+/-15 dB of pure-tone thresholds. Speech and CERA thresholds were highly correlated (p<0.01) with pure-tone behavioral thresholds.     

A 5-year prospective study of diabetes and hearing loss in a veteran population.

HYPOTHESIS: Veterans with diabetes will have significantly greater hearing loss than nondiabetic veterans. BACKGROUND: The association between diabetes and hearing loss remains unclear despite the volume of research that has been devoted to the question. Often, differences in hearing thresholds between diabetic and nondiabetic patients are confounded by age and noise exposure. METHODS: In this 5-year prospective study, 342 diabetic veterans and 352 nondiabetic veterans from the Portland VA Medical Center in Oregon were tested on a variety of audiometric measures, including pure-tone thresholds. RESULTS: Age and noise exposure were accounted for in the analyses. There was a trend toward greater hearing loss in diabetic patients 60 years of age and younger across the frequency range. These differences were statistically significant only in the highest frequencies tested (10, 12.5, 14, and 16 kHz). The effects of both diabetes and noise exposure on high-frequency hearing thresholds were dependent on age. For patients older than 60 years, the mean thresholds were not significantly different. CONCLUSION: These results suggest that diabetic patients 60 years old or younger may show early high-frequency hearing loss similar to early presbycusis. After age 60, difference in hearing loss between diabetic and nondiabetic patients was reduced.     

The influence of hearing and age on speech recognition scores in noise in audiological patients and in the general population

OBJECTIVE: To describe the influence of pure-tone audiometry and age on the speech recognition score in noise, both in audiological patients and also in a random population sample. DESIGN: In a cross-sectional study, speech recognition scores (SRS) using monosyllabic words presented in a fixed background noise were evaluated on 1895 audiological patients of both genders with normal hearing or sensorineural hearing losses. The background noise was speech weighted and presented with a signal to noise ratio of +4 dB. In 291 participants, SRS in quiet was estimated as well. A female random population sample also was tested (N = 513). RESULTS: The major predictor for the SRS-noise was high-frequency hearing thresholds. If hearing was normal, age had no effect on speech recognition. Young persons with hearing loss had higher SRS-noise than older persons with the same degree of hearing loss. The difference between young and old persons became larger the greater the hearing loss. Predictive SRS-noise with consideration taken to hearing function and age are presented. SRS-noise correlated stronger with pure-tone audiometry and age than SRS-quiet. Controls performed better (by 10 to 20%) than their same-aged peers with similar hearing loss. CONCLUSION: It is recommended that speech recognition tests be performed in background noise. SRS-noise is a valuable tool for audiologists and audiological physicians to identify patients in need of pedagogic rehabilitation programs or further diagnostic investigations.     

Perceptual weighting of stop consonant cues by normal and impaired listeners in reverberation versus noise.

PURPOSE: To determine if listeners with normal hearing and listeners with sensorineural hearing loss give different perceptual weightings to cues for stop consonant place of articulation in noise versus reverberation listening conditions. METHOD: Nine listeners with normal hearing (23-28 years of age) and 10 listeners with sensorineural hearing loss (31-79 years of age, median 66 years) participated. The listeners were asked to label the consonantal portion of synthetic CV stimuli as either /p/ or /t/. Two cues were varied: (a) the amplitude of the spectral peak in the F4/F5 frequency region of the burst was varied across a 30-dB range relative to the adjacent vowel peak amplitude in the same frequency region, (b) F2/F3 formant transition onset frequencies were either appropriate for /p/, /t/ or neutral for the labial/alveolar contrast. RESULTS: Weightings of relative amplitude and transition cues for voiceless stop consonants depended on the listening condition (quiet, noise, or reverberation), hearing loss, and age of listener. The effects of age with hearing loss reduced the perceptual integration of cues, particularly in reverberation. The effects of hearing loss reduced the effectiveness of both cues, notably relative amplitude in reverberation. CONCLUSIONS: Reverberation and noise conditions have different perceptual effects. Hearing loss and age may have different, separable effects.     

The Role of Age-Related Declines in Subcortical Auditory Processing in Speech Perception in Noise

Older adults, even those without hearing impairment, often experience increased difficulties understanding speech in the presence of background noise. This study examined the role of age-related declines in subcortical auditory processing in the perception of speech in different types of background noise. Participants included normal-hearing young (19?–?29 years) and older (60?–?72 years) adults. Normal hearing was defined as pure-tone thresholds of 25 dB HL or better at octave frequencies from 0.25 to 4 kHz in both ears and at 6 kHz in at least one ear. Speech reception thresholds (SRTs) to sentences were measured in steady-state (SS) and 10-Hz amplitude-modulated (AM) speech-shaped noise, as well as two-talker babble. In addition, click-evoked auditory brainstem responses (ABRs) and envelope following responses (EFRs) in response to the vowel /ɑ/ in quiet, SS, and AM noise were measured. Of primary interest was the relationship between the SRTs and EFRs. SRTs were significantly higher (i.e., worse) by about 1.5 dB for older adults in two-talker babble but not in AM and SS noise. In addition, the EFRs of the older adults were less robust compared to the younger participants in quiet, AM, and SS noise. Both young and older adults showed a “neural masking release,” indicated by a more robust EFR at the trough compared to the peak of the AM masker. The amount of neural masking release did not differ between the two age groups. Variability in SRTs was best accounted for by audiometric thresholds (pure-tone average across 0.5–4 kHz) and not by the EFR in quiet or noise. Aging is thus associated with a degradation of the EFR, both in quiet and noise. However, these declines in subcortical neural speech encoding are not necessarily associated with impaired perception of speech in noise, as measured by the SRT, in normal-hearing older adults.     

Hearing loss prevalence and risk factors among older adults in China

Objective: This study aims to investigate the prevalence of hearing loss, and to analyse the major demographics and risk factors that influence the prevalence in older adults of China. Design: Cross-sectional investigation. Study sample: Probability proportionate to size sampling (PPS) was adopted for this survey. Among 45,052 individuals, 6984 older adults (≥60?years) were selected as subjects for this study. Results: The prevalence of hearing loss defined as a speech frequency pure tone average of more than 25?dB HL in the better ear was 58.85%. Age and gender were the factors most strongly associated with hearing loss after multivariate adjustment. Ear disease, diabetes, hypertension, atherosclerosis, noise exposure, and ototoxic drugs were significantly correlated with hearing loss. The largest effects were found for ear disease and noise exposure (OR?=?2.83 [95% CI: 2.43–3.29]; OR?=?2.59 [95% CI: 1.80–3.72]). Conclusions: Hearing loss is prevalent in nearly two thirds of adults aged 60?years and older in China population. Chronic diseases, ear disease, and noise are important factors in adults aged 60?years and older.     

老年性聋患者普通话快速噪声下言语测试及评估

目的评估老年性聋患者噪声下言语识别能力,探讨年龄、听力损失程度、认知功能对其噪声下言语识别能力的影响。方法选取2018年10月~2020年4月就诊的70例60岁及以上老年性聋患者为研究对象,按年龄分为60~69岁(20例40耳)、70~79岁(28例56耳)、≥80岁(22例44耳)三组,各组分别进行纯音听阈测试、简易智能精神状态量表(mini-mental state examination,MMSE)评估及普通话快速噪声下言语测试(Mandarin quick speech-in-noise test,M-Quick SIN),分别获得双耳0.5、1、2、4 kHz纯音平均听阈(pure-tone audiometry,PTA)、MMSE量表总得分及双耳信噪比损失(signal-to-noise ratio loss,SNR loss);分析年龄、平均听阈、MMSE量表得分对信噪比损失的影响。结果①60~69岁组SNR loss(5.25±5.42)dB明显小于70~79岁组(11.54±6.05)dB和≥80岁组(11.86±6.06)dB(P<0.01);70~79岁组和≥80岁组间SNR loss差异无统计学意义(P>0.05)。②SNR loss随PTA提高而升高,各组间差异均有显著统计学意义(P<0.01)。③MMSE量表得分对SNR loss的主效应不显著(P>0.05)。结论年龄、听力损失程度为老年性聋患者噪声下言语识别的主要影响因素;在一定范围内随着年龄增加,听力损失加重,其噪声下言语识别能力降低。     

Effects of reverberation on acceptable noise level measurements in younger and older adults

Acceptable noise level (ANL) test materials were digitally modified to create five reverberant conditions by applying different values of reverberation time (RT) to a non-reverberant condition (RT = 0, 0.4, 0.7, 1.2, and 2 s). Two groups of 12 subjects participated: younger individuals (22–29 years, M = 24.3) and older adults (50–69 years, M = 57.5). Mean hearing threshold levels (250 to 8000 Hz) for both groups were 30 dB HL or better. Most comfortable listening level (MCL) and background noise level (BNL) measurements were completed in each reverberant condition, and from these measurements, ANLs were calculated. Significant main effects for age and reverberation were not found for ANL or MCL. These results suggest that reverberation does not affect the amount of background noise individuals are willing to accept, or the level of speech individuals choose as the MCL. These results can be used by clinical audiologists to counsel patients regarding the use of communication strategies. Additionally, these results can be used to support previous findings that ANL is not related to the intelligibility of the speech signal.     

Effects of age and hearing loss on gap detection and the precedence effect: broadband stimuli.

Older listeners with normal-hearing sensitivity and impaired-hearing sensitivity often demonstrate poorer-than-normal performance on tasks of speech understanding in noise and reverberation. Deficits in temporal resolution and in the precedence effect may underlie this difficulty. Temporal resolution is often studied by means of a gap-detection paradigm. This task is similar to binaural fusion paradigms used to measure the precedence effect. The purpose of this investigation was to determine if within-channel (measured with monotic and diotic gap detection) or across-channel (measured with dichotic gap detection) temporal resolution is related to fusion (measured with lag-burst thresholds; LBTs) under dichotic, anechoic, and reverberant conditions. Gap-detection thresholds (GDTs) and LBTs were measured by means of noise-burst stimuli for 3 groups of listeners: young adults with normal-hearing sensitivity (YNH), older adults with normal-hearing sensitivity (ONH), and older adults with impaired-hearing sensitivity (OIH). The GDTs indicated that across-channel temporal resolution is poorer than within-channel temporal resolution and that the effects of age and hearing loss are dependent on condition. Results for the fusion task indicated higher LBTs in reverberation than for the dichotic and anechoic conditions, regardless of group, and no effect of age or hearing loss for the nonreverberant conditions. However, higher LBTs were observed in the reverberant condition for the ONH listeners. Further, there was a correlation between across-channel temporal resolution and fusion in reverberation. Gap detection and fusion may not necessarily reflect the same underlying processes; however, across-channel gap detection may influence fusion under certain conditions (i.e., in reverberation).     

Vulnerability to noise-induced hearing loss in 'middle-aged' and young adult mice: a dose-response approach in CBA, C57BL, and BALB inbred strains

Vulnerability of the cochlea to noise-induced permanent threshold shifts (NIPTS) was examined in young adult (1-2 months) and 'middle-aged' (5-7 months) CBA/CaJ, C57BL/6J, and BALB/cJ inbred mice. For each age and strain, a dose-response paradigm was applied, whereby groups of up to 12 animals were exposed to intense broadband noise (110 dB SPL) for varying durations. Exposure durations reliably associated with <10% and >90% probability of a criterion amount of NIPTS (determined 2 weeks post-exposure) were identified, and the minimum NIPTS exposure and the slope of the dose-response relation were then derived by numerical modeling. For all three strains, young adult mice were more susceptible to NIPTS than older adults; That is, a shorter exposure was able to cause NIPTS in the younger mice. Strain comparisons revealed that C57 mice were more susceptible than CBAs in the older age group only. At both ages examined, however, BALB mice were most susceptible to NIPTS. When animals with a similar amount of NIPTS were compared, outer hair cell loss in the cochlear base was more widespread in the younger animals. BALB mice appear particularly susceptible to noise-induced outer hair cell loss throughout life. Our data suggest that the mechanism or site of noise injury differs between young adults and older adults, and may depend on genetic background. The finding that both BALB and C57 mice, which show pronounced age-related hearing loss, are also especially vulnerable to noise supports the notion that genes associated with age-related hearing loss often act by rendering the cochlea susceptible to insults.     

Prevalence of self-perceived auditory problems and their relation to audiometric thresholds in a middle-aged to elderly population

OBJECTIVE: Hearing loss has been identified as one of the most frequent conditions affecting the elderly population. The purpose of this study was to provide estimates of the prevalence of self-perceived hearing problems in a middle-aged to elderly general population and to make a comparison among generations and between genders regarding the relationship between audiometric measurements and hearing problems. MATERIAL AND METHODS: The study was conducted using a population-based sample of 2150 adults, aged 40-79 years, who participated in the Longitudinal Study of Aging conducted by the National Institute for Longevity Sciences between 1997 and 2000. A questionnaire on hearing problems was administered and pure-tone audiometry was conducted. RESULTS: A third of subjects in their 40s and half of the subjects aged > 60 years were aware of having difficulty hearing. The audiometric thresholds in both the better and worse ears were associated with self-perceived hearing difficulty in all age groups. Statistically significant age and gender differences were observed in each respondent group. The older group tended to underestimate their hearing difficulty in comparison with the younger group, and males tended to underestimate their hearing difficulty more than females. CONCLUSION: These results may contribute to the development of an intervention strategy for auditory rehabilitation for the middle-aged and elderly populations.     

The accuracy of self-reported hearing loss in older Latino-American adults

The purpose of this study was to examine the accuracy of self-reported hearing loss in older Latino-American adults. Fifty-nine individuals, 32 women (mean age 62.2 years) and 27 men (mean age 62.4 years), participated. The questionnaire addressed hearing loss, hearing aid use, and other people's views of their hearing abilities. Based on the question, 'Do you feel you have a hearing loss?', the prevalence of self-reported hearing loss was 57.6%, with 56.3% of women and 59.3% of men reporting a hearing loss. Sensitivity, specificity, and accuracy were calculated using this question and compared to the pure-tone average (PTA) at 500, 1000, 2000, and 4000 Hz in the poorer ear. Overall, sensitivity was 75.7%, specificity was 72.7%, and accuracy was 74.6%. Results of this smaller scale study suggest that a single question, used as a screening measure, is both sensitive and specific for hearing loss in older Latino-American adults and may overcome language and cultural barriers. This question can be easily implemented by physicians or other health-care employees to quickly screen for hearing loss.     

High-frequency sensorineural hearing loss after stapedectomy.

OBJECTIVE: To describe the pattern and duration of high frequency sensorineural hearing loss after stapedectomy. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: All patients who underwent stapedectomy by the senior author during the period between January 1, 1998, and October 1, 2005, with preoperative, 4- to 6-week postoperative, and at least 9-month postoperative audiograms were included. Fifty-three patients met the inclusion criteria, with surgeries performed on 61 ears. INTERVENTION(S): Stapedectomy was performed using a CO2 laser. MAIN OUTCOME MEASURE(S): Mean preoperative and postoperative pure-tone bone thresholds, mean preoperative and postoperative pure-tone air thresholds, and hearing outcomes for 4,000 Hz bone conduction (BC) and 8,000 Hz air conduction (AC) based on the patient's age and interval after the operative procedure. RESULTS:: Mean BC thresholds at 4,000 Hz BC worsened by 6 dB at 4 to 6 weeks and improved by 3 dB by 9 months. There was an 8-dB average loss at 8,000 Hz AC at 4 to 6 weeks with a gain of 4 dB by 9 months. Patients older than 40 years were 4 times more likely to experience early loss at 4,000 Hz BC when preoperative thresholds were held constant. The late outcome for hearing loss was dependent more on the preoperative threshold than was the age of the patient. At 8,000 Hz AC, the preoperative hearing threshold was a predictor of early and late hearing loss at 8,000 Hz. CONCLUSION: High-frequency sensorineural hearing loss is initially seen after stapes surgery, and improvement does occur over time. When preoperative hearing threshold is held constant, patients older than 40 years are more likely to experience short-term hearing loss at high frequencies than patients younger than 40 years. Age was not a predictor of postoperative high-frequency hearing loss in the long term.     

Pure-tone threshold description of an elderly French screened population.

OBJECTIVES: To describe the distribution of pure-tone hearing thresholds of a Caucasian population living in the south of France aged 70 years and older. To establish age- and sex-adjusted normative hearing thresholds based on results of subjects free of noise and ototoxic drug exposure and to compare them with hearing thresholds of exposed (E) subjects. DESIGN: Cross-sectional analysis of a longitudinal epidemiologic cohort study. SETTING: Montpellier suburb, south of France. PARTICIPANTS: A total of 778 subjects 70 years old and older were examined. Noise exposure, ototoxic medication use, and medical history were collected. Hearing thresholds were obtained via pure-tone audiometry. After excluding patients with ear-related disease, 659 subjects were further analyzed (270 men and 389 women). Noise or ototoxic medication exposure was found in 364 subjects (E subjects), whereas 295 had no exposure (nonexposed [NE] subjects). METHODS: Median pure-tone thresholds, lower deviation, and upper deviation were calculated for the NE subjects with a statistical method similar to the ISO 7029 norm and were compared with thresholds of E subjects. RESULTS: Hearing thresholds, especially in high frequencies, increased with age more for women than for men. Median thresholds of E subjects were significantly higher than those for the NE sample in men. CONCLUSION: Age- and sex-adjusted hearing thresholds could well be useful in the study of the impact of environmental and genetic factors on hearing loss in the elderly. The next step would be to quantify the impact of noise, ototoxic drug exposure, and genetics using these age- and sex-adjusted thresholds.     

Predictive validity and reliability of adult hearing screening techniques

The purpose of this study was to evaluate and compare the efficacy of hearing screening tools to identify hearing loss in the older adult population. The test-retest reliability of both the AuDX DPOAE hand-held screener and subjective otoscopic ratings of percent earwax accumulation were evaluated. Additionally, the predictive validity was investigated for five hearing screening tools: the DPOAE hand-held screener, pure-tone screening, screening otoscopy, self-assessment of communication, and case history screening. The research was conducted through typical community hearing screenings on normal-hearing and hearing-impaired volunteer subjects. The screening subjects included 67 adults aged 49 to 89 years. Of those, 44 returned for a full audiologic evaluation. Key findings include: (1) Pure-tone screening had predictive validity for actual hearing loss in the older adult population when a 25 dB HL fence is used; (2) Screening otoscopy ratings were highly reliable across time and raters; (3) Self-assessment scores did not predict compliance with referral recommendations; (4)The AuDX DPOAE hand-held screener proved to be reliable in the overall pass/refer outcome, but lacked predictive validity for actual hearing loss in older adults.     

Effects of adult aging and hearing loss on comprehension of rapid speech varying in syntactic complexity

Comprehension of spoken language by older adults depends not only on effects of hearing acuity and age-related cognitive change but also on characteristics of the message, such as syntactic complexity and presentation rate. When younger and older adults with clinically normal hearing and with mild-to-moderate hearing loss were tested on comprehension of short spoken sentences that varied in syntactic complexity, minimal effects of age and hearing were seen in comprehension of syntactically simpler sentences, even at rapid speech rates. By contrast, both age and hearing loss were associated with poorer comprehension for more syntactically complex sentences, and these differences were further exacerbated by increases in speech rate. These findings illustrate a dynamic interaction between age, hearing acuity, and characteristics of the spoken message on speech comprehension.     

Spectral contributions to the benefit from spatial separation of speech and noise.

Speech recognition in noise improves when speech and noise sources are separated in space. This benefit has two components whose effects are strongest in different frequency regions: (1) interaural level differences (e.g., head shadow), which are largest at higher frequencies, and (2) interaural time differences, which have their greatest contribution at lower frequencies. Binaural interactions enhance the separation of signals from noise through the use of these interaural differences. Here, the benefit attributable to spatial separation was measured as a function of the low- and high-pass cutoff frequency of speech and noise. Listeners were younger adults with normal hearing, older adults with normal hearing, and older adults with hearing loss. Binaural thresholds for narrowband noises were measured in quiet and in a speech-shaped masker as a function of masker low-pass cutoff frequency. Speech levels corresponding to 50% correct recognition of sentences from the Hearing in Noise Test (HINT) were measured in a 65-dB SPL speech-shaped noise. Thresholds for narrowband noises and for speech were measured with two loudspeaker configurations: (1) signals and speech-shaped noise at 0 degrees azimuth (in front of the listener) and (2) signals at 0 degrees azimuth and speech-shaped noise at 90 degrees azimuth (at the listener's side). The criterion measure was spatial separation benefit, or the difference in thresholds for the two conditions. Benefit of spatial separation for unfiltered speech averaged 6.1 dB for younger listeners with normal hearing, 4.9 dB for older listeners with normal hearing, and 2.7 dB for older listeners with hearing loss. Benefit was differentially affected by low-pass and high-pass filtering, suggesting a trade-off of the contributions of higher frequency interaural level differences and lower frequency interaural timing cues. As expected, older listeners with hearing loss benefited little from the improved signal-to-noise ratios in the higher frequencies resulting from head shadow, but showed some benefit from lower frequency cues. Spatial benefit for older listeners with normal hearing was reduced relative to benefit for younger listeners. This result may be related to older listeners' elevated thresholds at frequencies above 6.0 kHz.     

Hearing loss associated with ear infections in Nord-Trøndelag, Norway

OBJECTIVE: We have assessed the effect of recurrent childhood ear infections on adult hearing. We also examined whether adult hearing is poorer with an early age of onset of ear infections compared with later onset. DESIGN: A population-based cohort of 50,398 subjects, 20 yr of age or older, were examined with air-conduction, pure-tone audiometry and reported if they had had recurrent ear infections (EI) in childhood (or subsequently) with the age of onset. RESULTS: There were poorer hearing thresholds associated with recurrent EI for all frequency ranges from 0.25 kHz to 8 kHz, regardless of age or gender. The effect increased with age from approximately 2 dB among younger subjects (20 to 44 yr old) to approximately 5 to 6 dB among older subjects (65 yr or older). Among younger subjects, the effect of EI was somewhat stronger for men, whereas among older subjects the effect was somewhat stronger for women. Early age of onset for EI was associated with poorer hearing thresholds than late onset. The mean loss was close to 9 to 10 dB for all frequency ranges among older subjects reporting onset of EI before 2 yr of age. The mean loss was only about 4 dB among older subjects reporting onset of EI after 7 yr of age. CONCLUSIONS: Reported EIs are associated with similar consequences in terms of reduced hearing across frequencies 0.25 to 8 kHz for male and female subjects. The observed effects are stronger among older than among younger subjects, perhaps because effects increase with age or possibly because EI affected the hearing more before 1940 than during subsequent decades. Reported early age of onset of EI increases the risk of a substantially reduced hearing level later in life.     

Prevalence of Self-perceived Auditory Problems and their Relation to Audiometric Thresholds in a Middle-aged to Elderly Population

Objective --Hearing loss has been identified as one of the most frequent conditions affecting the elderly population. The purpose of this study was to provide estimates of the prevalence of self-perceived hearing problems in a middle-aged to elderly general population and to make a comparison among generations and between genders regarding the relationship between audiometric measurements and hearing problems. Material and Methods --The study was conducted using a population-based sample of 2150 adults, aged 40-79 years, who participated in the Longitudinal Study of Aging conducted by the National Institute for Longevity Sciences between 1997 and 2000. A questionnaire on hearing problems was administered and pure-tone audiometry was conducted. Results --A third of subjects in their 40s and half of the subjects aged > 60 years were aware of having difficulty hearing. The audiometric thresholds in both the better and worse ears were associated with self-perceived hearing difficulty in all age groups. Statistically significant age and gender differences were observed in each respondent group. The older group tended to underestimate their hearing difficulty in comparison with the younger group, and males tended to underestimate their hearing difficulty more than females. Conclusion --These results may contribute to the development of an intervention strategy for auditory rehabilitation for the middle-aged and elderly populations.