The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and ...potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.
Purpose: This study aimed to evaluate the effect of speech recognition performance, working memory capacity (WMC), and a noise reduction algorithm (NRA) on listening effort as measured with ...pupillometry in cochlear implant (CI) users while listening to speech in noise. Method: Speech recognition and pupil responses (peak dilation, peak latency, and release of dilation) were measured during a speech recognition task at three speech-to-noise ratios (SNRs) with an NRA in both on and off conditions. WMC was measured with a reading span task. Twenty experienced CI users participated in this study. Results: With increasing SNR and speech recognition performance, (a) the peak pupil dilation decreased by only a small amount, (b) the peak latency decreased, and (c) the release of dilation after the sentences increased. The NRA had no effect on speech recognition in noise or on the peak or latency values of the pupil response but caused less release of dilation after the end of the sentences. A lower reading span score was associated with higher peak pupil dilation but was not associated with peak latency, release of dilation, or speech recognition in noise. Conclusions: In CI users, speech perception is effortful, even at higher speech recognition scores and high SNRs, indicating that CI users are in a chronic state of increased effort in communication situations. The application of a clinically used NRA did not improve speech perception, nor did it reduce listening effort. Participants with a relatively low WMC exerted relatively more listening effort but did not have better speech reception thresholds in noise.
This study investigated the role of contextual information in speech intelligibility, the influence of verbal working memory on the use of contextual information, and the suitability of an ...ecologically valid sentence test containing contextual information, compared with a CNC (Consonant-Nucleus-Consonant) word test, in cochlear implant (CI) users. Speech intelligibility performance was assessed in 50 postlingual adult CI users on sentence lists and on CNC word lists. Results were compared with a normal-hearing (NH) group. The influence of contextual information was calculated from three different context models. Working memory capacity was measured with a Reading Span Test. CI recipients made significantly more use of contextual information in recognition of CNC words and sentences than NH listeners. Their use of contextual information in sentences was related to verbal working memory capacity but not to age, indicating that the ability to use context is dependent on cognitive abilities, regardless of age. The presence of context in sentences enhanced the sensitivity to differences in sensory bottom-up information but also increased the risk of a ceiling effect. A sentence test appeared to be suitable in CI users if word scoring is used and noise is added for the best performers.
Objective: To investigate the relation of a hearing-specific patient-reported outcome measure (PROM) with speech perception and noise tolerance measurements. It was hypothesised that speech ...intelligibility in noise and noise tolerance may explain a larger part of the variance in PROM scores than speech intelligibility in quiet.
Design: This cross-sectional study used the Speech, Spatial, Qualities (SSQ) questionnaire as a PROM. Speech recognition in quiet, the Speech Reception Threshold in noise and noise tolerance as measured with the acceptable noise level (ANL) were measured with sentences.
Study sample: A group of 48 unilateral post-lingual deafened cochlear implant (CI) users.
Results: SSQ scores were moderately correlated with speech scores in quiet and noise, and also with ANLs. Speech scores in quiet and noise were strongly correlated. The combination of speech scores and ANL explained 10-30% of the variances in SSQ scores, with ANLs adding only 0-9%.
Conclusions: The variance in the SSQ as hearing-specific PROM in CI users was not better explained by speech intelligibility in noise than by speech intelligibility in quiet, because of the remarkably strong correlation between both measures. ANLs made only a small contribution to explain the variance of the SSQ. ANLs seem to measure other aspects than the SSQ.
This study examines whether speech-in-noise tests that use adaptive procedures to assess a speech reception threshold in noise (SRT50n) can be optimized using stochastic approximation (SA) methods, ...especially in cochlear-implant (CI) users. A simulation model was developed that simulates intelligibility scores for words from sentences in noise for both CI users and normal-hearing (NH) listeners. The model was used in Monte Carlo simulations. Four different SA algorithms were optimized for use in both groups and compared with clinically used adaptive procedures. The simulation model proved to be valid, as its results agreed very well with existing experimental data. The four optimized SA algorithms all provided an efficient estimation of the SRT50n. They were equally accurate and produced smaller standard deviations (SDs) than the clinical procedures. In CI users, SRT50n estimates had a small bias and larger SDs than in NH listeners. At least 20 sentences per condition and an initial signal-to-noise ratio below the real SRT50n were required to ensure sufficient reliability. In CI users, bias and SD became unacceptably large for a maximum speech intelligibility score in quiet below 70%. In conclusion, SA algorithms with word scoring in adaptive speech-in-noise tests are applicable to various listeners, from CI users to NH listeners. In CI users, they lead to efficient estimation of the SRT50n as long as speech intelligibility in quiet is greater than 70%. SA procedures can be considered as a valid, more efficient, and alternative to clinical adaptive procedures currently used in CI users.
Background
Previous studies identifying hearing loss as a promising modifiable risk factor for cognitive decline mostly adjusted for baseline age solely. As such a faster cognitive decline at a ...higher age, which is expected considering the non-linear relationship between cognition and age, may have been overlooked. Therefore it remains uncertain whether effects of hearing loss on cognitive decline extend beyond age-related declines of cognitive function.
Methods
3,590 non-demented participants were eligible for analysis at baseline, and a maximum of 837 participants were eligible for the longitudinal analysis. Hearing loss was defined at baseline. Cognitive function was measured at baseline and at follow-up (4.4 years SD: 0.2). Multivariable linear regression analysis was used for the cross-sectional analysis. Linear mixed models were used to assess the longitudinal association between hearing loss and cognitive decline over time while adjusting for confounders and the interaction of age and follow-up time.
Results
Hearing loss was associated with lower cognitive function at baseline. Moreover, hearing loss was associated with accelerated cognitive decline over time on a memory test. After additionally adjusting for the interaction between age and follow-up time, we found that hearing loss did not accelerate cognitive decline anymore.
Conclusions
Hearing loss was associated with lower cognitive function at baseline and accelerated cognitive decline on a memory test. The association between hearing loss and accelerated cognitive decline was non-significant after additional adjustment for non-linear age effects. More evidence is needed to ensure the role of hearing loss as a modifiable risk factor for cognitive decline.
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, ...psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Tinnitus is a prevalent auditory disorder that frequently co-occurs with hearing loss. It is suggested that tinnitus might have negative impact on speech perception. However, studies thus far have ...not been able to disentangle tinnitus, hearing loss, and speech in noise intelligibility. We therefore investigated whether there is an association between tinnitus and speech understanding in noise, independent of hearing loss.
Of 4,211 participants from the population-based Rotterdam Study (mean age 67.8 SD 8.9, 57.3% female) data was available on tinnitus, pure-tone audiometry, and digits in noise test. We compared the speech reception threshold in noise (SRTn) in participants with and without tinnitus for the whole population as well as for subgroups stratified for average hearing threshold in 10-dB strata. Additionally, we regressed tinnitus on SRTn with a multivariable regression model, adjusting for sex, age, highest achieved education, and cognitive function.
Participants with tinnitus (20.8%) had a higher SRTn (-3.6 dB SD 3.7 versus -4.6 dB SD 3.1). This difference remained only in the subgroups of participants with hearing loss, between 0.6 and 0.8 dB difference in the SRTn for the different subgroups. In the fully adjusted model tinnitus was associated with 0.2 dB (95% CI 0.00, 0.39) SRTn increase.
We have shown that tinnitus is associated with speech intelligibility in noise, but it is a small effect, only found in people with co-occurring hearing loss.
Objectives/Hypothesis
To obtain actual status of age‐related hearing loss in a general unscreened population of older Dutch adults and to investigate whether the prevalence or degree has changed over ...time.
Study Design
To investigate the prevalence and degree of hearing loss, we conducted a large prospective cohort study of older adults between February 2011 and July 2015.
Methods
Pure‐tone air‐ and bone‐conduction thresholds were measured for 4,743 participants. Results were compared to previous cohort studies.
Results
As expected, hearing loss increased with age. We found a correlation of R2 = 0.317 for men and R2 = 0.354 for women (right ears). A prevalence of hearing loss greater than 35 dB hearing level the average of 0.5/1/2/4 kHz in the better ear, was found in 33% of the male and almost 29% of the female participants aged 65 years and older. Compared with previous studies, men had less hearing loss at the frequencies of 2 kHz and above. Hearing thresholds in women were significantly higher at 4 and 8 kHz. The difference in hearing loss between men and women is significantly less than in earlier studies.
Conclusions
Our study confirms that hearing loss is highly prevalent in the general unscreened population of older adults. However, the difference in hearing between sexes was considerably less than previously reported. This is probably due to changing lifestyle and environmental circumstances,
Level of Evidence
2b Laryngoscope, 127:725–730, 2017
PDF
