NCHS-CDC-NHANES, Audiometry, Balance, and Words in Noise Component

National Institute On Deafness And Other Communication Disorders

Investigators

Abstract

To provide support to the National Center for Health Statistics (NCHS), CDC for balance/vestibular testing and related questions on balance and dizziness problems in the U.S. population aged 40+ years.in the National Health and Nutrition Examination Survey (NHANES Epidemiology Survey), 2018 (pilot testing) and 2019-2020 (implementation). In addition the Audiometry Component of NHANES 2019-2020 will be augmented with a Word in Noise test administered to older adults, 70+ years of age. The prevalence of balance disorders in the US is high and increases with age. Data from NHANES 2000-2004 epidemiological survey indicate that 35.4% (69 million) US adults aged 40 or older have some balance dysfunction; prevalence jumps to 69% among those aged 70-79 years and 85% among those aged 80+ years. The higher risk of balance impairments among the elderly is due to functional changes associated with aging. The control of balance becomes increasingly dependent on visual and proprioceptive cues as we age, making the elderly more vulnerable to falls when those orientation cues are degraded. Individuals with balance trouble have a six-fold increase in the risk of falling; fall risk increases even further among individuals who report symptoms of dizziness. Falls are the leading cause of both fatal and nonfatal injuries among older adults (aged 65 years and older). In 2014, approximately 3 million older adults sought treatment in emergency rooms for fall-related injuries; 800,000 of these patients required hospitalization and 27,000 patients died. Direct medical costs of falls in the US in 2000 were more than $19 billion. Many people who fall develop a fear of falling, even if they are not injured. This fear may cause them to limit their activities leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling. In addition to the elderly, several other groups are at increased risk for balance disorders. Race other than white, lower educational status, diabetes, and hearing loss is associated with poorer balance function. In addition, individuals who have sustained head injuries are likely to suffer from problems with balance and dizziness. NHANES went on hiatus March 16, 2020 due to the COVID-19 pandemic. NHANES has since been restructured due to the continuing COVID-19 epidemic; it returned to the field in the fall of 2021 when home interviews and exams in mobile centers were resumed. The NIDCD-funded Balance Testing component continued to be included in the NHANES, albeit with a shortened protocol. The Word-in-Noise testing of older adults was conducted 2019-Mar 2020, then suspended due to COVID-19. It was not resumed last fall due to the NCHS mandate (because of continuing COVID-19 issues) to cut the NHANES exam time almost in half, from about 3 hours to 1.5 to 2 hours. The hearing component currently consists of a reduced set of hearing health questions, administered during the home interview. In FY 2023, a pilot study for a new, redesigned hearing exam protocol will be conducted. This pilot study will compare booth-less audiometry to the standard air-conduction protocol that has been conducted in sound-treated booths in NHANES mobile exam centers previously, from 1999 through March 2020.