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Abstract：
Hearing loss is common among Veterans, and extensive hearing care resources are prioritized within the Veterans Administration (VA). Severe hearing loss poses unique communication challenges with speech understanding that may not be overcome with amplification. We analyzed data from the VA Audiometric Repository between 2005 and 2017 and the relationship between hearing loss severity with speech recognition scores. We hypothesized that a significant subset of Veterans with severe or worse hearing loss would have poor unaided speech perception outcomes even with adequate audibility. Sociodemographic characteristics and comorbidities were compiled using electronic medical records as was self-report measures of hearing disability. We identified a cohort of 137,500 unique Veterans with 232,789 audiograms demonstrating bilateral severe or worse hearing loss (four-frequency PTA > 70 dB HL). The median (IQR; range) age of Veterans at their first audiogram with severe or worse hearing loss was 81 years (74 to 87; 21-90+), and a majority were male (136,087 [99%]) and non-Hispanic white (107,798 [78.4%]). Among those with bilateral severe or worse hearing loss, 41,901 (30.5%) also had poor speech recognition scores (<50% words), with greater hearing loss severity correlating with worse speech perception. We observed variability in speech perception abilities in those with moderate-severe and greater levels of hearing loss who may derive limited benefit from amplification. Veterans with communication challenges may warrant alternative approaches and treatment strategies such as cochlear implants to support communication needs.
摘要：
听力损失在退伍军人中很常见，和广泛的听力保健资源优先考虑在退伍军人管理局（VA）。严重的听力损失对言语理解提出了独特的沟通挑战，而放大可能无法克服。我们分析了2005年至2017年VA听力测定库的数据，以及听力损失严重程度与言语识别得分之间的关系。我们假设，即使有足够的听觉能力，患有严重或更严重听力损失的退伍军人的重要子集也会有较差的独立言语感知结果。社会人口统计学特征和合并症是使用电子病历以及听力残疾的自我报告指标进行汇编的。我们确定了一组137,500名独特的退伍军人，其中有232,789个听力图显示双侧严重或更严重的听力损失（四频PTA>70dBHL）。首次听力损失严重或更严重的退伍军人的中位数（IQR；范围）年龄为81岁（74至87岁；21-90岁），大多数是男性（136,087[99%]）和非西班牙裔白人（107,798[78.4%]）。在双侧严重或更严重听力损失的患者中，41,901（30.5％）的语音识别得分也很差（<50％的单词），听力损失的严重程度与言语感知的恶化有关。我们观察到中度-重度和更高水平的听力损失的人的言语感知能力的变异性，这些人可能从放大中获得有限的益处。有沟通挑战的退伍军人可能需要替代方法和治疗策略，例如人工耳蜗植入物，以支持沟通需求。
