Design and Subject Selection

The cross-sectional design of the study required subjects to complete case history and demographic information forms, a health status questionnaire, and undergo audiometric evaluation. Audiometric testing was used to determine hearing loss accord­ing to the pure-tone average (РТА), which represents an arithmetic mean threshold in decibels hearing level (dB HL) across octave frequencies 0.5 kHz, 1 kHz, and 2 kHz. Categorical and continuous variables were associated with hearing loss, which were then used to determine the impact of hearing loss on self-reported HRQoL attributes.

Subjects were obtained based on printed announcements detailing the project, which were distributed to outpatient populations at a university-based speech and hearing clinic and a community-based healthcare practice in north central Florida. Inclusion criteria included: a) age between 60 and 90 years, b) English as a first language, and c) self-description of race/ethnic background as African-American on the case history/demographic profile. Exclusion criteria consisted of: a) normal hearing (РТА < 25 dB HL), b) chronic bedfast/chairfast history, c) history of chronic terminal illness or senile dementia, d) history of stroke or other cerebral vascular disorder with paresis/aphasia, and e) prior hearing-aid use (more than 30 days). tadalis sx 20


Independent variables in this investigation were gender and hearing loss. Gender was coded categorically, while the better hearing ear of each subject was determined numerically according to the ear with lower audiometric scores. In cases where PTAs were symmetrical bilaterally, the right ear was selected as the better hearing ear. Covariates such as age, income, highest level of completed education, number of medications in use, and number of coexisting medical conditions were obtained from written case history/demographic profiles.

Dependent variables were self-report scores across scales on the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a well-established instrument used to determine the influence of chronic health conditions on quality of life and well-being. The SF-36 is a standardized 35-item questionnaire that assesses HRQoL across eight separate dimensions: physical function (PF), role limitations due to physical problems (RP), bodily pain (BP), general health (GH), energy/vitality (VT), social function (SF), role limitations due to emotional problems (RE), and mental health (MH). Algorithms are available which can be used to compute scores for each dimension. The 36th item of the survey is a health transition rating that asks respondents to rate their current health status compared to one year ago. This item was neither included in the present study nor used when scoring any of the eight dimensions. Lower scores across each dimension indicate greater HRQoL deficits. However, higher scores on the BP scale represent freedom from pain. High levels of test-retest reliability and high levels of internal consistency reliability on the SF-36 across race/ethnic boundaries have been established.


The informed consent document was combined with relevant case history forms and a SF-36 into a single packet. All potential subjects were provided with the packet along with printed instructions, with the intent on having each subject review and sign the informed consent document as well as complete all forms without assistance. Each subject was instructed to endorse those items that corresponded as closely as possible to their condition at the time of measurement.

In order to provide appropriate written responses on each document, it was required that all subjects possess the ability to read and/or understand material written in the English language. Documentation of sufficient literacy to read and/or comprehend the written documents was obtained via direct inquiry by the author or by additional research personnel involved in data collection. When subjects presented questions concerning unfamiliar items, verbal explanations and clarifications were provided as needed. Potential subjects unable to complete the forms or furnished partial data were considered ineligible, and their data were excluded from the study. buy antibiotics canada

Subjects who met the inclusion criteria and completed the packet of forms underwent audiometric testing at no cost to the patient. Estimates of peripheral hearing sensitivity, obtained in sound-treated and isolated test environments under earphones, were measured in each ear at octave frequencies from 0.5-8 kHz using an adaptive ascending method of limits. Assessment of middle-ear function was conducted via tympanometry. All tympanometry measures were considered normal if middle-ear pressure was within ±100 daPa, and Type A configuration was obtained.

Statistical Evaluation

All data were stored on computer spreadsheets in a comma-delimited format and analyzed with SAS (version 8.2) software. Case profiles were determined via descriptive and Chi-square statistical tests. Analysis of variance (ANOVA) tests were used to determine statistically significant differences in the estimates of peripheral hearing in each ear owing to gender as well as gender differences across SF-36 scores. Bivariate relations between health status attributes and hearing loss were determined via Pearson-Product correlation coefficients. Ordinary least squares (OLS) regression was used to examine the influence of hearing loss on the means of SF-36 scores while controlling for experimental confounds (age, income, education level, number of medications in use, and number of coexisting medical conditions). Standardized regression coefficients (betas) for differing levels of hearing impairment were also determined. Where applicable, p-values <0.05 were considered as statistically significant.
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