Publications

BACKGROUND: Cisplatin is broadly used, but it is nephrotoxic and ototoxic. No large-scale investigation has analysed cisplatin-related ototoxicity while considering quantified renal function, cumulative dose, comorbidities, and modifiable risk factors. Our aim was to fill this knowledge gap.

METHODS: The Platinum Study is a well-characterised multicentre cohort study of cisplatin-treated testicular cancer survivors enrolled 2012-18 in eight academic cancer centres in the USA, Canada, and the UK, with follow-up ongoing. Measures include audiometrically assessed hearing (0.25-12 kHz), real-world speech-in-noise perception, and hearing loss progression. Multivariable analyses evaluated associations of audiometrically-assessed hearing with estimated glomerular filtration rate (eGFR), comorbidities, health-behaviours, and cisplatin dose. Mediation analyses tested direct and indirect eGFR contributions to ototoxicity and eGFR-dose interactions.

FINDINGS: Among 1422 survivors (median age 38 years, IQR 31-47), ototoxicity affected 1061 (75%), and audiometrically-assessed hearing was significantly associated with cumulative cisplatin dose (β = 8.72 per 100 mg/m2, p = 0.0004), reduced eGFR (β = 3.90 per 20 mL/min/1.73 m2, p = 0.043), hypertension (β = 4.06, p = 0.0005), non-White race (β = 3.26, p = 0.014), physical inactivity (β = -0.24 per 1000 kCal/week, p = 0.034), and age (β = 5.21 per 5 years, p < 0.0001). Cisplatin dose significantly interacted with eGFR (p = 0.017); 7.2% (95% CI 0.9-18.8; p < 0.05) of cisplatin's ototoxicity was mediated through reduced eGFR and 5.6% (0.4-16.1; p < 0.05) through interaction effects. Poorer speech-in-noise perception was associated with cognitive dysfunction (β = 1.01, p = 0.026), hypercholesterolaemia without statin use (β = 0.71, p = 0.029), lower education (β = 0.91, p = 0.0098), and hearing loss severity (β = 0.08, p < 0.0001). Hearing loss progression was associated with age (β = 0.30, p < 0.0001), while statin use for hypercholesterolaemia was protective (β = -4.09, p = 0.0048).

INTERPRETATION: Cisplatin's dose-dependent ototoxicity is amplified by its nephrotoxicity, with the dose-response becoming stronger as eGFR worsens. Given age-related declines in both eGFR and hearing, follow-up of cisplatin-treated survivors should monitor both, and include strict control of cardiovascular risk factors. Statin use for hypercholesterolaemia appeared protective against hearing loss progression, suggesting a potential therapeutic intervention for reducing long-term auditory complications in this population.

FUNDING: The National Cancer Institute.

UNLABELLED: Ventral horn microglia in the spinal cord proliferate after nerve injuries and migrate towards the cell bodies of injured motoneurons surrounding them. However, the significance of microglia enwrapping axotomized motoneurons has remained unclear. Moreover, some injured motoneurons degenerate while others regenerate. In mice spinal cords we found that each motoneuron fate associates with microglia of different activation profiles. Microglia surrounding degenerating motoneurons form cell clusters that fully envelop the cell body and express high TREM2 and large CD68 granules, with female microglia expressing higher levels. Microglia surrounding motoneurons undergoing regeneration remain individualized and also upregulate TREM2 and CD68, but to a lesser extent than microglia around degenerating motoneurons. Removal of TREM2, either globally throughout development or specifically in microglia prior to nerve injuries, reduces p-SYK signaling and CD68 expression in all activated microglia, but more so inside microglia forming tight cell clusters around degenerating motoneurons. This effect is also larger in females. TREM2 absence did not prevent microglia clustering around degenerating motoneurons but prevented the loss of some small MNs. In addition, TREM2 depletion interfered with the retrograde cell body chromatolytic reaction that is characteristic of regenerating motoneurons and delayed muscle reinnervation. We conclude that within the same motor pools, TREM2 facilitates microglia removal of some degenerating motoneurons while it facilitates regeneration of other motoneurons. The signals that direct the development of these different microglia phenotypes over degenerating and regenerating motoneurons, as well as the mechanisms that induce degeneration in some motoneurons while most others regenerate, remain to be investigated.

SIGNIFICANCE STATEMENT: Microglia frequently enwrap neurons undergoing cellular stress being one example the microglia reaction around motoneurons axotomized after nerve injuries. The significance of this microglia-neuron relationship is unclear. We found that microglia surrounding axotomized motoneurons upregulate TREM2, but with differences depending on whether microglia associated with regenerative or degenerative motoneurons. Loss-of-function experiments showed that TREM2 promotes removal of some degenerating motoneurons while facilitates the regeneration of others. We conclude that microglia TREM2 serves a dual function depending on the motoneuron health state. This knowledge is critical for designing future therapies that aim to improve motoneuron regeneration or preservation by altering TREM2 function.

OBJECTIVES: Within the World Health Organization's International Classification of Functioning, Disability and Health, audiometric hearing loss and perceived hearing handicap are related but distinct. Family relational processes may buffer how sensory loss translates into lived burden via support, communication norms, and coping. We tested whether familism or family cohesion moderated the association between hearing loss and perceived handicap among Hispanic/Latino adults.

DESIGN: Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos and the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 4889). Hearing loss was defined as better-ear four-frequency pure-tone average (PTA) >25 dB HL. Perceived hearing handicap was measured with the 10-item Hearing Handicap Inventory for Adults/Elderly-Screening version (HHIA/E-S). Adjusted associations of hearing loss with perceived handicap were estimated by multivariable regression. Moderation was tested with continuous interaction terms for familism and family cohesion.

RESULTS: Participants with hearing loss had higher adjusted mean HHIA/E-S scores than those without (6.30 versus 2.91; Geometric Mean Ratio = 2.16, 116% higher; p < .001), indicating roughly double the perceived handicap among those with hearing loss. Although PTA was strongly related to handicap, variability in HHIA/E-S across the range of PTA continuum indicated incomplete correspondence between measures. Across all levels of familism and family cohesion, hearing loss was associated with approximately a two-fold higher perceived handicap (Geometric Mean Ratios ≈ 1.9 to 2.5). No consistent pattern of moderation by familism or family cohesion was noted.

CONCLUSIONS: Audiometric hearing loss was strongly associated with greater perceived handicap, and the magnitude of this association was similar across all levels of familism and family cohesion. Consistent with the World Health Organization's International Classification of Functioning, Disability and Health framework, audiometric thresholds and perceived impact only partially aligned in this cohort, and this relationship was not meaningfully altered by familism or family cohesion. Together, these findings underscore that audiometric thresholds alone do not fully capture the lived impact of hearing loss, as reflected by substantial variability in perceived handicap at similar levels of PTA, and highlight the importance of integrating self-reported experience with clinical history and patient context when identifying need and planning care.

This study examined state-level Medicaid hearing aid coverage for adults ages twenty-one and older across the United States. Using policy surveillance principles, we compiled a cross-sectional data set detailing hearing aid coverage policies from fifty states and Washington, D.C., as of December 31, 2023. We then merged these data with individual-level American Community Survey data to estimate national rates of Medicaid hearing aid coverage and identify how coverage varies according to demographic characteristics. We identified thirty-two states with Medicaid hearing aid coverage for adults, with substantial variability in policy features of that coverage. Approximately 70 percent of Medicaid beneficiaries ages twenty-one and older lived in a state with coverage. Women, working-age adults, and Black adults had slightly lower odds of coverage, whereas Hispanic and Latino and other or multiple race beneficiaries had higher odds of coverage. Expanding and standardizing Medicaid coverage of hearing aid benefits in line with best practices could improve access and utilization.

IMPORTANCE: Hearing loss is a significant public health issue, affecting 23% of individuals 12 years and older in the US. While hearing loss can be efficaciously treated in many cases, shortages in the supply of hearing health care (HHC) professionals may limit uptake.

OBJECTIVE: To quantify the US HHC professional workforce from 2012 to 2022 and identify areas experiencing HHC professional shortages in 2019.

DESIGN, SETTING, AND PARTICIPANTS: In this quality improvement study, raw data from the National Plan and Provider Enumeration System were transformed to create a state- and county-level database of HHC professionals, including audiologists and hearing instrument specialists from 2012 to 2022, to assess HHC workforce supply. To assess HHC workforce demand, 2019 state- and county-level hearing loss prevalence data from Sound Check and US Census population data were used. Shortage areas were determined by comparing these measures of supply and demand in 2019. The audiologists and hearing instrument specialists included possessed National Provider Identifiers, allowing them to bill public and private insurance in the US. The data were analyzed between August 2022 and December 2024.

MAIN OUTCOMES AND MEASURES: Potential-shortage areas were defined using a threshold of 1 or fewer audiologists per 3500 individuals with hearing loss, and shortage areas were defined using a threshold of 1 or fewer HHC professionals per 3500 individuals with hearing loss.

RESULTS: From 2012 to 2022, the number of HHC professionals in the US increased from 16 770 to 30 704, or more than 83%. By the end of 2022, 72.4% of the HHC workforce were audiologists, and 27.6% were hearing instrument specialists, compared to 82.6% and 17.4%, respectively, in 2012. In June 2019, 75.0% of US counties were identified as shortage counties, and these counties were disproportionately rural. Ten states, primarily in the South Census region, are identified as shortage states.

CONCLUSIONS AND RELEVANCE: This quality improvement study showed that despite workforce growth, many areas of the US continue to experience shortages of HHC professionals, disproportionately affecting rural populations. Addressing these shortages may improve access to care for individuals with hearing loss.

OBJECTIVES: Hearing loss is a highly prevalent condition; however, it is widely under-treated, and Black Americans have been found to have significantly lower rates of hearing aid utilization than other ethnic/racial groups. In this exploratory study, we aimed to identify hearing health beliefs among Black adults, guided by the Health Belief Model, with social determinants of health, and examine individual differences in these perspectives.

DESIGN: The Hearing Beliefs Questionnaire (HBQ) was administered online to measure constructs of the Health Belief Model among 200 Black adults aged 18 to 75 ( M = 39.14, SD = 14.24). Approximately 13% reported hearing difficulty. In addition, 11 social determinants of health questions were included. Participants were recruited from a university otolaryngology clinic and local Black congregations, meeting inclusion criteria of being 18 or older and Black/African American. Mean scores and SDs for HBQ subscales were calculated. Analysis included analysis of variance and t tests to explore relationships with demographic variables and social determinants of health. Multiple regression analyses predicted HBQ subscale scores from sociodemographic variables.

RESULTS: Mean HBQ subscale scores ranged from 3.88 (SD = 2.28) for Perceived Barriers to 6.76 (SD = 1.93) for Perceived Benefits. Positive correlations were observed between Perceived Severity, Perceived Benefits, and Perceived Self-Efficacy scores and participant educational attainment. Lower economic stability was correlated with poorer scores in Perceived Self-Efficacy, Perceived Severity, and Perceived Benefits. Black adults' willingness to purchase a hearing aid was heavily influenced by their Perceived Benefit, Perceived Severity, and Perceived Self-Efficacy scores, with lower scores correlating with unwillingness to purchase devices. Higher frequency of racism/discrimination and financial hardship correlated with increased Perceived Barriers scores for accessing hearing healthcare. In addition, hearing health beliefs between participants with self-reported hearing difficulty and those without trouble only exhibited differences in the Perceived Susceptibility subscale, with those experiencing hearing difficulty having higher scores in this subscale; no other distinctions were identified.

CONCLUSIONS: The Health Belief Model, used with social determinants of health, revealed associations, and variations, in the hearing health beliefs held by Black adults. The present investigation reveals heterogeneity within this group and pinpoints individuals at higher risk for untreated hearing loss, stemming from their negative perceptions about hearing healthcare. These beliefs are influenced by demographics and social determinants of health, underscoring areas ripe for intervention.

BACKGROUND AND OBJECTIVES: To better understand racial/ethnic disparities in hearing aid use, we examined racial differences in discrepancies between subjective hearing ratings and objective hearing tests as a potential source of this disparity.

RESEARCH DESIGN AND METHODS: A cross-sectional assessment was conducted using the data from the Health and Retirement Study (HRS). Our analytic sample included 2,568 participants aged 50 and older: 1,814 non-Hispanic White Americans and 754 non-Hispanic Black Americans. Discordant groups were identified based on self-ratings of hearing abilities (positive vs negative) and objective hearing test results (normal vs hearing loss).

RESULTS: Analysis of HRS data revealed that approximately 73% of participants with objectively measured hearing loss reported positive hearing ratings. False positive hearing rates were found to be 80% among Black older adults and 70% among their White counterparts. Odds for false positive hearing ratings were significantly greater for Black older adults, men, those with less than a high school education, more health conditions and depressive symptoms, and current smoking. Racial differences were maintained after adjustment for these covariates.

DISCUSSION AND IMPLICATIONS: While cost of hearing aids has been a predominant explanation of low hearing aid use in Black Americans, false positive perceptions of hearing abilities may also play a significant role as a psychosocial mechanism. Future studies examining racial/ethnic differences in possible psychosocial mechanisms for discrepancies between objective and subjective hearing could guide the development and evaluation of culturally appropriate educational interventions.

BACKGROUND: Age-related hearing loss is common among older adults and may influence physical activity and sedentary behaviors, such as TV viewing. This study examined whether a hearing intervention could affect these behaviors over 3 years.

METHODS: A total of 977 participants (mean age of 76.8, 53.5% female, 11.5% Black), recruited from the ARIC study (n = 238) and de novo (n = 739) with hearing loss (pure-tone average = 39.4 dB), were randomized to a hearing intervention or a health education control group. Physical activity, leisurely walking, and TV viewing were interrogated at baseline and 3-year follow-up. We used regression models adjusted for demographic and hearing loss severity to examine the impact of the intervention on the change in the frequency of engaging in these activities.

RESULTS: At baseline, 57.6% of participants engaged in moderate-to-vigorous physical activity (MVPA), 29.1% in high-frequency leisurely walking, and 46.8% in high-frequency TV viewing. Over 3 years, MVPA decreased to 48.8%, whereas leisurely walking and TV viewing increased. After 3 years, the hearing intervention group had similar odds of engaging in MVPA (ratio of odds ratios [ROR] = 1.03, 95% confidence interval [CI], 0.93-1.14), leisurely walking (ROR = 1.04, 95% CI, 0.93-1.17), and TV viewing (ROR = 0.95, 95% CI, 0.87-1.02) compared with the control group. Results were consistent across recruitment sources (ARIC and de novo).

CONCLUSION: A hearing intervention did not significantly influence physical activity, walking, or TV viewing behaviors in older adults over 3 years. Additional strategies may be needed to change physical and sedentary behaviors in this population.

BACKGROUND: Hearing loss is prevalent in older adults and is associated with reduced daily physical activity, but whether hearing intervention attenuates declines in physical activity is unknown. We investigated the 3-year effect of a hearing intervention versus a health education control on accelerometer-measured physical activity in older adults with hearing loss.

METHODS: This secondary analysis of the ACHIEVE randomized controlled trial included 977 adults aged 70-84 years with hearing loss. Participants were randomized to either a hearing intervention group or a health education control group. Physical activity was measured using wrist-worn accelerometers at baseline, 1, 2, and 3 years. Linear mixed models assessed the impact of the intervention on changes in total activity counts, active minutes per day, and activity fragmentation.

RESULTS: Among 847 participants in the final analysis (mean age 76.2 years; 440 [52%] women; 87 [10%] Black; 5 [0.8%] Hispanic), total activity counts declined by 2.7% annually, and active minutes/day declined by 2.1% annually over 3 years in both intervention and control groups. Activity patterns also became more fragmented over time. No appreciable differences were observed between hearing intervention and health education control in the 3-year change in accelerometry-measured physical activity measures.

CONCLUSIONS: Hearing intervention did not appreciably attenuate 3-year declines in physical activity compared to health education control in older adults with hearing loss. Alternative strategies beyond hearing treatment may be needed to enhance physical activity among older adults with hearing loss.