In recent studies, psychophysiological measures have been used as markers of listening effort, but there is limited research on the effect of hearing loss on such measures. The aim of the current study was to investigate the effect of hearing acuity on physiological responses and subjective measures acquired during different levels of listening demand, and to investigate the relationship between these measures. A total of 125 participants (37 males and 88 females, age range 37-72 years, pure-tone average hearing thresholds at the best ear between -5.0 to 68.8 dB HL and asymmetry between ears between 0.0 and 87.5 dB) completed a listening task. A speech reception threshold (SRT) test was used with target sentences spoken by a female voice masked by male speech. Listening demand was manipulated using three levels of intelligibility: 20 % correct speech recognition, 50 %, and 80 % (IL20 %/IL50 %/IL80 %, respectively). During the task, peak pupil dilation (PPD), heart rate (HR), pre-ejection period (PEP), respiratory sinus arrhythmia (RSA), and skin conductance level (SCL) were measured. For each condition, subjective ratings of effort, performance, difficulty, and tendency to give up were also collected. Linear mixed effects models tested the effect of intelligibility level, hearing acuity, hearing asymmetry, and tinnitus complaints on the physiological reactivity (compared to baseline) and subjective measures. PPD and PEP reactivity showed a non-monotonic relationship with intelligibility level, but no such effects were found for HR, RSA, or SCL reactivity. Participants with worse hearing acuity had lower PPD at all intelligibility levels and showed lower PEP baseline levels. Additionally, PPD and SCL reactivity were lower for participants who reported suffering from tinnitus complaints. For IL80 %, but not IL50 % or IL20 %, participants with worse hearing acuity rated their listening effort to be relatively high compared to participants with better hearing. The reactivity of the different physiological measures were not or only weakly correlated with each other. Together, the results suggest that hearing acuity may be associated with altered sympathetic nervous system (re)activity. Research using psychophysiological measures as markers of listening effort to study the effect of hearing acuity on such measures are best served by the use of the PPD and PEP.

Hearing loss (HL) has been associated with cognitive decline and dementia. We examined the temporal association between prevalent and incident HL and cognitive change.
A total of 1823 participants (24-82 years) from the Maastricht Aging Study (MAAS) were assessed at baseline, 6 and 12 years, including pure-tone audiometry. Linear-mixed models were used to test the association between HL and cognition, adjusted for demographics and other dementia risk factors.
Participants with prevalent and incident HL showed a faster decline in verbal memory, information processing speed, and executive function than participants without HL. Decline was steady from baseline to 6 and 12 years for prevalent HL, but time-delayed from 6 to 12 years for incident HL. Having a hearing aid did not change associations.
Findings support the notion that HL is a risk factor for cognitive decline independent of other dementia risk factors. Onset of HL preceded onset of cognitive decline.
We examined cognitive change in prevalent and incident hearing loss. Prevalent and incident hearing loss were associated with faster cognitive decline. For prevalent hearing loss, decline was steady from baseline to 6 and 12 years. Onset of hearing loss preceded the onset of cognitive decline. Having a hearing aid did not change the observed associations.

The purpose of this systematic review and meta-analysis was to summarize the results related to the effects of auditory cues on static postural control.
MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar were searched from inception until September 2020. Risk of bias was evaluated by both reviewers using Newcastle-Ottawa Quality Assessment Scale (NOS).
Twelve studies with 403 participants were included in the review and 9 studies with 305 participants in the meta-analysis. Results show that auditory cues have significant effects on postural sway in the anterior-posterior direction (p = 0.001), postural sway in the medial-lateral direction (p = 0.001), and static balance (p = 0.001). A low to high heterogeneity was observed across all comparisons.
Results of this meta-analysis revealed that auditory cues decrease postural sway in the anterior-posterior and medial-lateral direction; it also improves static balance. Thus, it can be concluded that auditory cues improve static postural control. Our results suggest that the auditory system can be a determinant of static postural control along with other sensory systems including visual, vestibular, and proprioception systems. Also, this study implies that auditory cues can be a significant therapeutic approach to improve static postural control.

A sense of purpose in life is a psychological resource that is associated with healthier outcomes. The present research examines whether a greater sense of purpose in life is associated with subjective and objective markers of hearing health and whether hearing acuity contributes to the association between purpose and episodic memory. We sought to evaluate whether these associations were replicable across 2 independent samples.
Participants in the Health and Retirement Study (N = 14,291) and the English Longitudinal Study of Ageing (N = 8,844) reported on their purpose in life and perceived hearing quality at baseline. Hearing acuity was measured using an audiometer 2-4 years later, and episodic memory was measured at baseline and 6-8 years later.
In both samples, higher purpose in life was associated with better hearing quality measured concurrently, lower risk of either subjective or objective hearing impairment, and hearing acuity accounted for some of the longitudinal relation between sense of purpose and better episodic memory.
Across samples, measures, and analytical approaches, the present research indicates replicable associations between sense of purpose in life and hearing health. It further indicates that hearing may be one factor that associates purpose with better episodic memory.

Subjective aging is consistently related to a range of health-related outcomes, but little is known about its relationship with sensory functioning. The present prospective study tested whether subjective age and self-perceptions of aging (SPA) are associated with objective hearing function.
Participants were 7,085 individuals aged 50-93 years (60% women, mean = 65.15, standard deviation [SD] = 8.71) from the Health and Retirement Study. Measures of subjective age, SPA, and information on demographic factors were obtained in 2008/2010. Objective hearing function was assessed 8 years later in 2016/2018. Furthermore, potential mediating variables (C-reactive protein, body mass index, physical inactivity, and chronic conditions) were assessed in 2012/2014.
In regression analyses that accounted for demographic factors, older subjective age and negative SPA were associated with lower hearing acuity 8 years later. In addition, 1 SD older subjective age and negative SPA were related to a 9% and 7% higher likelihood of hearing impairment. Mediation analyses revealed that physical inactivity and chronic conditions partially mediated subjective age and SPA associations with hearing acuity. There was little evidence that the link between subjective aging and hearing was moderated by hearing aids and partial support for a moderating role of age.
This study provides new evidence that subjective aging is prospectively related to hearing function. Individuals with older subjective age or negative SPA have unfavorable behavioral and clinical profiles that explain part of their lower hearing function. Individuals\' experience with their aging process is a marker of risk for impaired hearing.

It is unclear whether visual and hearing acuity are independently or synergistically associated with muscle strength. We aimed to examine the associations of visual and self-reported hearing acuity with low handgrip strength and the additive interaction between visual and hearing acuity on low handgrip strength in people over 60 years.
Data of 3,075 individuals aged over 60 years from the 2017 and 2018 Korea National Health and Nutrition Examination Survey were used for this cross-sectional study. Low handgrip strength was defined based on the 20th percentile of the study population (< 30.4 kg for male and < 17.7 kg for female). Visual and self-reported hearing acuity were each divided into three categories: good, moderate, and impaired. Multiple logistic regression and relative excess risk due to interaction (RERI) were performed.
Of the 3,075 participants, 993 (32.3 %) demonstrated low handgrip strength. Low handgrip strength was more prevalent in participants with moderate (adjusted odds ratio [AOR] = 1.54, 95 % confidence interval [CI] = 1.12-2.12) and impaired visual acuity (AOR = 2.00, 95 % CI = 1.34-2.96). Both moderate and impaired self-reported hearing acuity were significantly associated with low handgrip strength (moderate: AOR = 1.25, 95 % CI = 1.01-1.55; impaired: AOR = 1.66, 95 % CI = 1.15-2.38). The more severe the sensory function decline, the higher the association with muscle weakness. Moreover, combined sensory impairments were associated with deteriorating low handgrip strength (AOR = 8.38), with significantly strong additive interactions (RERI = 2.61, 95 % CI = 2.52-2.70).
Awareness is needed regarding the risk of reduced muscle strength in individuals with moderate and impaired sensory function. Older people with sensory function decline in clinical settings may benefit from programs such as exercise prescription to prevent muscle weakness.

OBJECTIVE: The association between hearing acuity and white-matter (WM) microstructure integrity was evaluated in a normal healthy population with a variety of hearing acuity using an automated tractography technique known as TRACULA (TRActs Constrained by UnderLying Anatomy) in order to investigate whether hearing acuity decline is correlated with brain structural connectivity.
METHODS: Forty healthy controls were recruited to this study, which used a Siemens 3T Trio with a standard eight-channel head coil. Hearing acuity was assessed using pure-tone air conduction audiometry (Amplivox 2160, with Audiocups to eliminate noise and allow accurate pure-tone audiometry). Handedness and anxiety and depression were assessed for all participants in this study using the Edinburgh Handedness Inventory and the Hospital Anxiety and Depression Scale, respectively.
RESULTS: This study showed a significant reduction in WM volume of the left cingulum angular bundle (CAB; t = 2.32, p = 0.02) in the mild to moderate hearing-loss group (238 ± 223 mm2) compared to the group with normal hearing (105  ± 121 mm2). The WM integrity of the left CAB was found to be significantly different (t = 2.06, p = 0.04) in the mild to moderate hearing-loss group (0.18 ± 0.06 mm2/s) compared to the group with normal hearing (0.22 ± 0.05 mm2/s). The WM integrity of the left anterior thalamic radiation (ATR) was found to be significantly different (t = 2.58, p = 0.014) in the mild to moderate hearing-loss group (0.33 ± 0.05 mm2/s) compared to the group with normal hearing (0.37 ± 0.03 mm2/s). A significant negative correlation was found between age and the WM integrity of the right ATR (r = -0.33, p = 0.038), and between hearing acuity and the WM integrity of the right ATR (r = -0.38, p = 0.013) and left CAB (r = -0.36, p = 0.019). Discussion and conclusion: An important finding in this study is that brain structural connectivity changes in the left hemisphere seem to be associated with age-related hearing loss found mainly in the ATR and CAB tracts.

Task-evoked changes in pupil dilation have long been used as a physiological index of cognitive effort. Unlike this response, that is measured during or after an experimental trial, the baseline pupil dilation (BPD) is a measure taken prior to an experimental trial. As such, it is considered to reflect an individual\'s arousal level in anticipation of an experimental trial. We report data for 68 participants, ages 18 to 89, whose hearing acuity ranged from normal hearing to a moderate hearing loss, tested over a series 160 trials on an auditory sentence comprehension task. Results showed that BPDs progressively declined over the course of the experimental trials, with participants with poorer pure tone detection thresholds showing a steeper rate of decline than those with better thresholds. Data showed this slope difference to be due to participants with poorer hearing having larger BPDs than those with better hearing at the start of the experiment, but with their BPDs approaching that of the better hearing participants by the end of the 160 trials. A finding of increasing response accuracy over trials was seen as inconsistent with a fatigue or reduced task engagement account of the diminishing BPDs. Rather, the present results imply BPD as reflecting a heightened arousal level in poorer-hearing participants in anticipation of a task that demands accurate speech perception, a concern that dissipates over trials with task success. These data taken with others suggest that the baseline pupillary response may not reflect a single construct.

OBJECTIVE: This study aimed to investigate hearing acuity of centenarians in Hainan Province and provide basis for interventional considerations.
METHODS: Door-to-door follow-up was conducted to investigate hearing acuity of centenarians (aged 100 years or above) in Hainan Province. Physical examination, pure tone audiometry and acoustic impedance test were performed, and the results were analyzed.
RESULTS: A total of 460 centenarians (920 ears) were tested by pure tone audiometry. The rate of normal hearing was 0.2%, the rate of mild hearing loss was 1.5%, 12% for moderate hearing loss, 33.9% for moderate to severe hearing loss, 37.4% for severe hearing loss is and 15% for profound hearing loss. Acoustic impedance test was performed in 340 centenarians (668 ears). Tympanogram was type A in 41.2% of the ears, type As in 34.1% ears, type Ad in 6.4%, type B in 11.8%, and type C in 4.9% of the ears, while no response was elicited in 1.5% of the ears.
CONCLUSIONS: Age related sensorineural hearing loss is prevalent among centenarians in Hainan Province. A probably beneficial intervention may be the use of hearing aids for effective communication.

To study the relation between the microstructure of white matter in the brain and hearing function in older adults we carried out a population-based, cross-sectional study. In 2562 participants of the Rotterdam Study, we conducted diffusion tensor imaging to determine the microstructure of the white-matter tracts. We performed pure-tone audiogram and digit-in-noise tests to quantify hearing acuity. Poorer white-matter microstructure, especially in the association tracts, was related to poorer hearing acuity. After differentiating the separate white-matter tracts in the left and right hemisphere, poorer white-matter microstructure in the right superior longitudinal fasciculus and the right uncinate fasciculus remained significantly associated with worse hearing. These associations did not significantly differ between middle-aged (51-69 years old) and older (70-100 years old) participants. Progressing age was thus not found to be an effect modifier. In a voxel-based analysis no voxels in the white matter were significantly associated with hearing impairment.