Ear diseases and other risk factors for hearing impairment among adults: An epidemiological study

Abstract

Objective: To investigate the prevalence of ear diseases, other otological risk factors potentially affecting hearing, and noise exposure among adults. Furthermore, subject-related factors possibly associated with hearing impairment (HI), i.e. handedness, eye color, and susceptibility to sunburn, were studied. Design: A cross-sectional, unscreened, population-based, epidemiological study among adults. Study sample: The subjects (n =?850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Results: Chronic middle-ear disease (both active and inactive) was the most common ear disease with a prevalence of 5.3%, while the prevalence of otosclerosis was 1.3%, and that of Ménière's disease, 0.7%. Noise exposure was reported by 46% of the subjects, and it had no effect on hearing among those with no ear disease or other otological risk factors for HI. Dark eye color and non-susceptibility to sunburn were associated with HI among noise-exposed subjects. Conclusions: Common ear diseases and other otological risk factors constitute a major part of the etiologies of HI among adults. Contrary to previous studies, noise exposure turned out to have only marginal effect on hearing among those with no otological risk factors.     

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.     

The association of food intake on the development of hearing impairment after middle age among Japanese community dwellers

ObjectivesThis study aimed to determine whether food intake modifies the risk of developing hearing impairment (HI) in Japanese adults in their 40s.MethodsData for individuals who were in their 40s with no HI at baseline and had participated in the survey multiple times were extracted from the National Institute for Longevity Sciences, Longitudinal Study of Aging. A total of 1846 samples observed for up to 11.5 years in 421 participants were included in the analyses. The average 3-day food intake was calculated. HI is defined as a pure-tone average of the better ear at frequencies of 0.5, 1, 2, and 4 kHz greater than 25 dB. The risk of developing HI in the 18 food groups was calculated longitudinally using multivariable cumulative data analyses.ResultsEven after adjusting basic confounding factors, food groups, and baseline hearing level, significant associations were found between beverage consumption and risk increments for HI (odds ratio [OR] = 2.374, 95% confidence interval [CI]:1.141–4.940) and also between mushroom intake and risk reduction (OR = 0.215, 95% CI:0.069–0.667). Other foods did not consistently show significant results when the combination of analysis variables were changed.ConclusionsAlthough the effect of food on hearing is modest to the extent that the significance varies with the variables used in the analysis, the intake of beverages and mushrooms could potentially modify the risk of developing HI after middle age.     

Cardiovascular risk factors and hearing loss: The HUNT study

Objective: The purpose of the present paper was to examine the association between prospectively and cross-sectionally assessed cardiovascular risk factors and hearing loss. Design: Hearing was assessed by pure-tone average thresholds at low (0.25–0.5 kHz), middle (1–2 kHz), and high (3–8 kHz) frequencies. Self-reported or measured cardiovascular risk factors were assessed both 11 years before and simultaneously with the audiometric assessment. Cardiovascular risk factors were smoking, alcohol use, physical inactivity, waist circumference, body mass index, resting heart rate, blood pressure, triglycerides, total serum cholesterol, LDL cholesterol, HDL cholesterol, and diabetes. Study sample: A population-based cohort of 31 547 subjects. Results: After adjustment for age, sex, level of education, income, recurrent ear infections, and noise exposure, risk factors associated with poorer hearing sensitivity were smoking, diabetes, physical inactivity, resting heart rate, and waist circumference. Smoking was only associated with hearing loss at high frequencies. The effects were very small, in combination explaining only 0.2–0.4% of the variance in addition to the component explained by age and the other cofactors. Conclusion: This cohort study indicates that, although many cardiovascular risk factors are associated with hearing loss, the effects are small and of doubtful clinical relevance.     

A multivariate analysis of otological,surgical and patient‐related factors in determining success in myringoplasty

Objectives: The aim of this study was to evaluate the effects of smoking and other prognostic factors on long‐term surgical outcome and hearing results in myringoplasty. Design: Retrospective cohort. Setting: Tertiary medical centre. Participants: Eighty myringoplasty operations were analysed retrospectively from the charts of 74 patients who underwent myringoplasty between January 2000 and November 2002 at the First ENT Clinic of Atatürk Training and Research Hospital, using the chi‐squared test, Fisher's exact test, t‐test and multiple logistic regression statistical analysis. Main outcome measures: The effects of prognostic factors and smoking on myringoplasty were investigated by variables noted from patients’ files such as smoking status, operation type, duration of dry period of the diseased ear, peroperative otorrhoea, status of the opposite ear, presence of perforation at admission, place of perforation, size of perforation, status of middle ear mucosa, presence of cholesteatoma and tympanosclerosis, ossicular status, previous and related surgery, experience of the surgeon, presence of anterior overhang, presence of valsalva manoeuvre, postoperative antiobiotic cover and income per day. Results: The overall take rate of the myringoplasty graft was 71%. Based on the univariate analysis, smoking status of the patients (P = 0.008), status of the opposite ear (P = 0.01), size of perforation (P = 0.009) and the experience of the surgeon (P = 0.002) were found to be statistically significant (P < 0.01) prognostic factors influencing the success rate of the operations. Multiple logistic regression analysis was subsequently carried out on these prognostic factors and yielded the following classification (95% CI): senior surgeon (OR = 14.3), non‐smoking patient (OR = 11.4), longer duration of dry period of the diseased ear (OR = 5.3), normal opposite ear (OR = 5.0) and small perforation (OR = 4.8). Conclusions: A non‐smoking patient, a longer dry ear, a healthy opposite ear, a relatively smaller perforation and a senior surgeon were found to be significant prognostic factors positively influencing the success rate of myringoplasty.     

Clinical otosclerosis, prevalence estimates and spontaneous progress.

This retrospective study was performed in order to estimate the prevalence of clinical otosclerosis as a function of age and gender, characterize the hearing level in otosclerosis and describe the spontaneous progress of the disease as a function of age. Clinically based samples were obtained from an audiological department, including 556 subjects: n = 166 (30%) males and n = 390 (70%) females with a median age of 75 years (range 22-95 years) at the time of examination. A subdivision of the sample into 3 age-bands, 20-39 years (n = 39), 40-59 years (n = 78) and > or = 60 years (n = 439), was performed. The overall prevalence estimate of clinical otosclerosis in the area in question was 1.41/1,000 [95% confidence interval (CI) = 1.3-1.5/1,000] with an estimate of 0.9/1,000 (95% CI = 0.8-1.0/1,000) in males and 1.85/1,000 (95% CI = 1.7-2.1/1,000) in females, with an increase in the prevalence as a function of age from 0.22/1,000 (95% CI = 0.15-0.29/1,000) to 3.53/1,000 (95% CI = 3.2-3.86/1,000) in the elderly. The estimates should be considered underestimates, as not all clinical otosclerosis in the area was included. No significant differences in the better and worse ear hearing levels averaged across 0.5-4 kHz (BEHL/WEHL 0.5-4 kHz) were found as a function of gender, and in general the impairment in the BEHL 0.5-4 kHz was fairly moderate until the age of 60 years. In ears previously subjected to surgery a significantly better hearing level of median 63 dB (range 24-119 dB) was found than in the no-surgery ears, with a median hearing level of 71 dB (range 5-120 dB). An estimate of the progress showed an increment in the hearing level in the elderly > or = 60 years of 30 dB over 30 years in non-operated ears, fairly similar to the 40 dB progress in operated ears. It was concluded that a significantly higher prevalence of clinical otosclerosis is present in females than in males, that the overall hearing level in otosclerosis is fairly moderate until the age of 60 years, and that previously operated ears have significantly better hearing than non-operated ears.     

Cigarette Smoking,Passive Smoking,Alcohol Consumption,and Hearing Loss

The objective of this large population-based cross-sectional study was to evaluate the association between smoking, passive smoking, alcohol consumption, and hearing loss. The study sample was a subset of the UK Biobank Resource, 164,770 adults aged between 40 and 69 years who completed a speech-in-noise hearing test (the Digit Triplet Test). Hearing loss was defined as speech recognition in noise in the better ear poorer than 2 standard deviations below the mean with reference to young normally hearing listeners. In multiple logistic regression controlling for potential confounders, current smokers were more likely to have a hearing loss than non-smokers (odds ratio (OR) 1.15, 95 % confidence interval (CI) 1.09–1.21). Among non-smokers, those who reported passive exposure to tobacco smoke were more likely to have a hearing loss (OR 1.28, 95 %CI 1.21–1.35). For both smoking and passive smoking, there was evidence of a dose-response effect. Those who consume alcohol were less likely to have a hearing loss than lifetime teetotalers. The association was similar across three levels of consumption by volume of alcohol (lightest 25 %, OR 0.61, 95 %CI 0.57–0.65; middle 50 % OR 0.62, 95 %CI 0.58–0.66; heaviest 25 % OR 0.65, 95 %CI 0.61–0.70). The results suggest that lifestyle factors may moderate the risk of hearing loss. Alcohol consumption was associated with a protective effect. Quitting or reducing smoking and avoiding passive exposure to tobacco smoke may also help prevent or moderate age-related hearing loss.     

Prevalence of hearing loss and associated factors in subjects with normal otoscopy: a national cross-sectional study

Objective: To report the prevalence of hearing loss (HL) and associated factors in a nationwide study. Design: Cross-sectional study. Study sample: We investigated the prevalence of HL in 10,845 participants ≥12 years of age and analysed the associated factors with HL from 7434 participants ≥40 years of age. Results: The prevalence of worse ear HL was 21.9% (1.2% in youngest and 81.9% in oldest) and that of better ear was 12.5% (none in youngest and 65.3% in oldest). Based on the worse ear HL, the prevalence of HL was more common in men, and related with low education and income. In univariable analysis, hypertension, smoking, diabetes, depressive mood, stroke or cardiac disease, anaemia, hypercholesterolaemia and underweight showed positive associations with HL, and alcohol consumption and regular walking showed negative associations with HL. There were five associated factors in multivariable analysis, including smoking (OR?=1.36 for smokers with <20 pack years; OR?=1.55 for smokers with ≥20 pack years), noise exposure at workplace (OR?=?1.28), stroke (OR?=?1.72), anaemia (OR?=?1.36) and depressive mood (OR?=?1.29). Conclusion: Prevention of smoking and reduction of noise, as well as awareness of the association with stroke, anaemia and depression would help to reduce the burden of HL.     

Sex-specific predictors of hearing-aid use in older persons: The age,gene/environment susceptibility - Reykjavik study

Objective: We estimate the prevalence of hearing-aid use in Iceland and identify sex-specific factors associated with use. Design: Population-based cohort study. Study sample: A total of 5172 age, gene/environment susceptibility - Reykjavik study (AGES-RS) participants, aged 67 to 96 years (mean age 76.5 years), who completed air-conduction and pure-tone audiometry. Results: Hearing-aid use was reported by 23.0% of men and 15.9% of women in the cohort, although among participants with at least moderate hearing loss in the better ear (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz ≥ 35 dB hearing level [HL]) it was 49.9% and did not differ by sex. Self-reported hearing loss was the strongest predictor of hearing-aid use in men [OR: 2.68 (95% CI: 1.77, 4.08)] and women [OR: 3.07 (95% CI: 1.94, 4.86)], followed by hearing loss severity based on audiometry. Having diabetes or osteoarthritis were significant positive predictors of use in men, whereas greater physical activity and unimpaired cognitive status were important in women. Conclusions: Hearing-aid use was comparable in Icelandic men and women with moderate or greater hearing loss. Self-recognition of hearing loss was the factor most predictive of hearing-aid use; other influential factors differed for men and women.     

Low serum folate levels: a risk factor for sudden sensorineural hearing loss?

Objective Ischemic vascular damage of the inner ear is one of the known causes of sensorineural sudden hearing loss (SSHL). Folate is an emerging risk factor associated with an increased risk of vascular damage. The aim of this study was to investigate whether low serum folate levels are associated with SSHL.

Material and Methods Serum folate levels were determined in 43 patients with SSHL and in 24 controls.

Results Folate levels were found to be significantly lower in SSHL patients than in controls (mean difference ?1.96 ng/ml; 95% CI ?3.31, ?0.59 ng/ml; p=0.006). No significant relationship between folate levels and either sex, age, cigarette smoking, alcohol consumption or hypertension was observed, while a significant relationship was found between low folate levels and high homocysteine (HCY) levels in all 43 patients (p<0.01). The potential influence of low folate levels on hearing impairment in SSHL patients can be explained by the effects on HCY metabolism and the diminution of folate antioxidant capacity.

Conclusion Further studies are needed to elucidate whether low folate levels can be considered a risk factor for SSHL.     

Prevalence and risk factors for reduced sound tolerance (hyperacusis) in children

Objective: To estimate the prevalence of reduced sound tolerance (hyperacusis) in a UK population of 11-year-old children and examine the association of early life and auditory risk factors with report of hyperacusis. Design: A prospective UK population-based study. Study sample: A total of 7097 eleven-year-old children within the Avon longitudinal study of parents and children (ALSPAC) were asked about sound tolerance; hearing and middle-ear function was measured using audiometry, otoacoustic emissions, and tympanometry. Information on neonatal risk factors and socioeconomic factors were obtained through parental questionnaires. Results: 3.7% (95% CI 3.25, 4.14) children reported hyperacusis. Hyperacusis report was less likely in females (adj OR 0.64, 95% CI 0.49, 0.85), and was more likely with higher maternal education level (adj OR 1.72, 95% CI 1.08, 2.72) and with readmission to hospital in first four weeks (adj OR 1.98, 95% CI 1.20, 3.25). Report of hyperacusis was associated with larger amplitude otoacoustic emissions but with no other auditory factors. Conclusions: The prevalence of hyperacusis in the population of 11-year-old UK children is estimated to be 3.7%. It is more common in boys.     

Relationships among drinking and smoking habits,history of diseases,body mass index and idiopathic sudden sensorineural hearing loss in Japanese patients

Abstract

Objectives: To present the cardiovascular risk factors in idiopathic sudden sensorineural hearing loss (SSNHL) patients enrolled in a nationwide epidemiological survey of hearing disorders in Japan.

Materials and methods: We compiled the cardiovascular risk factors in 3073 idiopathic SSNHL subjects (1621 men and 1452 women) and compared their proportions with controls as part of the National Health and Nutrition Survey in Japan, 2014. The cardiovascular risk factors consisted of drinking and smoking habits, a history of five conditions related to cardiovascular disease and body mass index.

Results: The proportion of current smokers was significantly higher among men aged 50–59, 60–69 and 70+ and among women aged 30–39, 40–49 and 60–69. The proportion of patients with a history of diabetes mellitus was significantly higher among men aged 50–59, 60–69 and 70+, but not in women. In addition, male and female SSNHL subjects aged 60–69 showed lower proportions of current drinking; and female SSNHL subjects aged 60–69 showed higher proportions of overweight (BMI ≥25?kg/m²).

Conclusions: The present cross-sectional study revealed showed significantly higher proportions of current smokers among both men and women as well as those with a history of diabetes mellitus among men across many age groups in patients with idiopathic SSNHL compared with the controls.     

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults

Abstract

Objective: Adult selection criteria for cochlear implantation have been developed based on analysis of the post-operative performance of a large group of postlingually deafened adults. Original criteria published in 2004 were reviewed and amended to reflect outcomes currently being achieved by implant recipients. Design: Retrospective review of 12-month post-operative speech perception performance of adults implanted at the Eye and Ear Hospital, Melbourne, Australia. Study sample: A total of 382 postlingually deafened adults, using a Freedom, Nucleus 5, or CI422 Slim Straight cochlear implant were used to create a comparative set of data. Results: Revised guidelines suggest that adults with postlingual hearing loss can now be considered cochlear implant candidates if they obtain scores of up to 55% for open-set phonemes in quiet in the ear to be implanted. Functional benefit may vary depending on the recipients’ contralateral hearing. Conclusions: This study supports the provision of cochlear implants to candidates with significant residual hearing when at least one ear meets the criterion outlined above. Patient-specific counseling is required to ensure the potential to benefit predicted by the current model is acceptable to the individual patient and their family. Counseling regarding functional benefit must take into consideration hearing in the contralateral ear.     

Risk factors for sudden deafness: a case-control study

In order to investigate risk factors for idiopathic sudden sensorineural hearing loss (sudden deafness), a case-control study was done in 109 patients with sudden deafness who visited our hospital between 1992 and 1994, with 109 controls matched to each patient by gender and age. Odds ratio (OR) and 95% confidence interval (CI) for smoking habits, drinking habits, dietary habits, environmental noise, past history of disease, sleeping hours, appetite, fatigue, incidence of common cold were obtained. Fatigue (OR: 3.28; 95% CI: 1.36–7.90) and loss of appetite (OR: 8.00; 95% CI: 1.00–64.0) elevated the risk for sudden deafness. Those who ate many fresh vegetables were at a decreased risk (OR: 0.48; 95% CI: 0.24–0.96 for light-colored vegetables, OR: 0.55; 95% CI: 0.30–1.02 for green-yellow vegetables). Personal histories of hypertension and thyroid disease, and susceptibility to colds appeared to be positively associated with the risk (0.05<P<0.10). Smoking habits, drinking habits and environmental noise had no significant association with sudden deafness. These results suggested that environmental factors, including diet, may be importantly involved in the genesis of sudden deafness.     

The association between cardiovascular disease and cochlear function in older adults.

The purpose of this research was to evaluate the relation between self-reported cardiovascular disease (CVD) and cochlear function in older adults. The Epidemiology of Hearing Loss Study (EHLS) is an ongoing population-based study of hearing loss and its risk factors in Beaver Dam, Wisconsin. As part of the EHLS questionnaire, participants were asked about their cardiovascular medical history. CVD history was determined from questions regarding history of angina, myocardial infarction (MI), and stroke. Questions about the use of antihypertensive medication and blood pressure measurements determined the presence or absence of hypertension. Among the audiologic measures completed were distortion product otoacoustic emissions (DPOAEs). Cochlear function was measured using DPOAEs and participants were categorized as having (a) cochlear impairment, (b) possible cochlear impairment, or (c) no cochlear impairment. There were 1,501 participants with complete CVD and DPOAE data from the 1998-2000 examination phase. Women with a self-reported history of MI were twice as likely (age-adjusted odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.15-3.46) to have cochlear impairment than women without a history of MI. This association was not significant in men (age-adjusted OR = 0.98, 95% CI = 0.61-1.58). Additionally, no other CVD variables were associated with cochlear impairment. This study provides data on a possible sex-specific association between CVD and DPOAEs in older adults.     

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment

Objective: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. Design: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. Study sample: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65?dB?HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. Results: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. Conclusions: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.     

An investigation of factors that influence help-seeking for hearing impairment in older adults

Abstract

Objective: To examine the influence of audiological and non-audiological factors on help-seeking for hearing impairment (HI) in older adults. Design: A retrospective research design was employed. Participants completed 14 measures, after which two multivariate, multinomial logistic regression models were fitted to the data to determine which factors were associated with consultation for HI and hearing aid uptake. Study sample: Three-hundred-and-seven individuals who were 60 years or older and who presented with a unilateral or bilateral HI participated in the study. Non-hearing aid owners were assigned to a non-consulter group (n = 55) or a consulter group (n = 92); hearing aid owners were assigned to an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85). Results: A similar combination of factors was associated with the decisions to consult a health professional about HI and/or to adopt hearing aids. The most important factors related to attitudinal beliefs (e.g. perceived benefits of hearing aids) and external cues to action (e.g. support from significant others). Greater HI also influenced consultation and adoption of hearing aids. Conclusions: Findings highlight the importance of non-audiological factors in hearing rehabilitation to improve consultation for HI and hearing aid adoption.     

Prediction of the use of conventional hearing aids in Korean adults with unilateral hearing impairment

Objective: To determine the use of a hearing aid at six months post-fitting and to evaluate the predictors of its ongoing use in Korean adults with unilateral hearing impairment (HI). Design: Retrospective study at a secondary referral hospital over a 15-year period. Study sample: This study analysed 119 adults with unilateral HI who had been recommended for hearing amplification (55 men and 64 women, mean age, 58.0 ± 11.7 years). Six months after the fitting, all of the participants were surveyed regarding subsequent decisions and actions about obtaining hearing aids. Results: General uptake rate for a hearing aid was 68.1% (58.0% of participants surveyed were successful users, and 10.1% were intermittent users). The most significant parameter associated with hearing-aid use was social and/or work activities (R² = 0.457), and the significant predictors for successful hearing-aid use were social and/or work activities and method of signal processing (discriminatory power = 56.3%). Conclusions: Six months post-fitting, 68.1% of Korean adults with unilateral HI who had agreed to try a hearing aid continued to use it regularly. The predictors for hearing-aid use six months post-fitting included social and/or work activities and digital signal processing.     

Prevalence of usage of hearing aids and its association with cognitive impairment in Japanese community-dwelling elders with hearing loss

ObjectiveHearing loss is a risk factor for cognitive impairment, and the use of a hearing aid (HA) may prevent cognitive decline alongside hearing loss. We aimed to elucidate the prevalence of self-reported HA usage in Japanese community-dwelling elders with hearing loss, and the effect of hearing and HA on cognitive impairment.MethodsA total of 1193 participants, who had audiometric defined hearing loss and were aged 60 years or over, had their cumulative 3260 observations followed up for 10 years from a large cohort of a Japanese study. Association between hearing (pure-tone average threshold level at 500, 1000, 2000, and 4000 Hz from the better hearing ear: PTABHE) and HA usage with cognitive impairment (total score of Mini-Mental State Estimation was under 27 or diagnosed as dementia) was analyzed using generalized estimating equations.ResultsThe HA usage rate of the 1193 community-dwelling elders with hearing loss was 6% during the first involvement. The majority (59.2%) of HA users always used an HA. HA usage rate was 0.7% for the mild hearing loss group and 32.4% for the moderate or greater hearing loss group in the latest participating wave. PTABHE was significantly associated with cognitive impairment (odds ratio for every 10 dB 1.36; 95% CI 1.21–1.53, p<0.0001) after adjusting for age, sex, education, depressed mood, smoking status, alcohol intake, income, activity, obesity, histories of hypertension, dyslipidemia, ischemic heart disease, diabetes, stroke, ear disease, and occupational noise exposure. PTABHE was also significantly associated with cognitive impairment in the mild hearing loss group (odds ratio for every 10 dB 1.34; 95% CI 1.05–1.72, p = 0.020) and moderate hearing loss group (odds ratio for every 10 dB 1.82; 95% CI 1.27–2.61, p = 0.001). HA use showed a significant suppressive effect on cognitive impairment in those with moderate hearing loss who always use an HA (odds ratio 0.54; 95% CI 0.30–1.00, p = 0.049).ConclusionThe prevalence of HA usage among Japanese community-dwelling elders with hearing loss is consistent, at around 10%. The hearing level remained a primary risk factor for cognitive impairment among elders with hearing loss after adjusting for several confounding factors. Regular HA use may have a protective effect on cognitive impairment in those with moderate hearing loss.