4/27/2012
Christopher Spankovich, Au.D., Ph.D., M.P.H.
Department of Speech, Languages, and Hearing Sciences
College of Public Health & Health Professions
Public Health
• Future of Public Health—IOM 1988
– the fulfillment of society’s interest in assuring the conditions in which people can be healthy
– a coalition of professions united by a shared mission; a coalition of professions united by a shared mission;
with focus on disease prevention and health promotion; using a prospective approach in contrast to a reactive focus of medicine; and founded in the common science, epidemiology 1
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Prevention & Treatment
Epidemiology & Basic Study
Observation
Audiology
• Audiology is the study of hearing, balance, and related disorders.
• The primary role of audiologists is in prevention
prevention, diagnosis, and treatment of diagnosis and treatment of
hearing loss.
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Public Health in Audiology
Public Health in Audiology
• 278 Million people worldwide
• Hearing impairment costs between $154 billion to $186 billion per year in the US alone
• Congenital vs. Later Acquired HL
• The consequences are significant in regards to language and social development and quality of life.
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Public Health in Audiology
• The primary cause of acquired permanent HL are aging, noise exposure, ototoxic drugs, and infections.
• Estimated that 50% can be prevented
– Immunizations MMMR
– Alternative medications
– Noise exposure prevention 100% preventable
• Less than 1% of persons with HL use hearing aids in developing countries, about 25% of people in the US with HL use hearing aids
Public Health in Audiology
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•
•
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HL is highly prevalent
HL is highly preventable
HL is highly treatable
The consequences are downplayed, compliance with preventative strategies is low, and patient’s seeking and using treatment is low, hearing loss can be quite insidious
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Hearing Loss in “Normal Hearing”
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12‐19 year olds increase in hearing loss from 14.9% in 1988‐1984 to 19.5% in 2005‐2006 Shargorodsky et al., 2010
Henderson et al, 2010 examined the same dataset and found a significant increase in females but not males, they also found a significant increase in use of audio players
Public Health & NIHL & UF
• NIHL in many cases is 100% preventable
– What covariates mitigate or exacerbate risk?
– What is the publics knowledge, attitude, and beliefs toward NIHL?
beliefs toward NIHL?
– How can we effectively improve active healthy hearing behaviors of the individual?
– How can we effectively implement passive healthy hearing changes to the environment?
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Covariates
• Metabolic Function
– Type‐1 diabetes • Dietary intake – Dietary health and Dietary health and
susceptibility to hearing loss
– Micronutrient supplement Vitamin A, C, E, Mg and prevention
Covariates
Spankovich et al., 2011
Covariates
Figure 3. Treatment with β‐carotene, vitamins C and E,
and magnesium, reduces permanent NIHL in guinea pigs
and mice . This treatment also reduces acute threshold
shift in the first 24 hours post noise (3E) as well as PTS 7‐
days post‐noise (3F) . Guinea pigs were injected with
study agents; mice received enhanced diets.
diets Reprinted
from Le Prell and Bao .
Le Prell et al., 2007 & 2011
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Knowledge, Attitudes, Behaviors
• Something we know a lot about is knowledge, attitudes and beliefs
– Young adults know that exposure to loud sound can cause hearing damage Crandell et al., 2004; Rawool et al., 2008
– Yet young adults rarely use hearing protection and have low perceived severity or no effect until much older p
y
Crandell et al., 2004
– Believe hearing loss can be fixed by hearing aid Rawool et al., 2008
– Attitude toward noise can have an impact on behavior Widen et al., 2006; Holmes et al., 2007; Wident et al., 2009
– If experienced hearing loss before they are more likely to view loud sound as negative Widen et al., 2006; Holmes et al., 2007; Widen et al., 2009
– If hearing protection was provided for free 85% would try it Crandell et al., 2004
Behavioral Change & Prevention
• People know loud sound can cause hearing loss, yet compliance in using hearing protection and reducing sound levels are difficult
• Active vs. Passive Prevention
Silent Epidemic
• Hearing loss is a significant medical condition
• Many causes of hearing loss can be completely prevented
• Current research at UF is examining prevention strategies including dietary intake and improved healthy hearing behaviors
hearing behaviors
• Further research is needed in novel prevention strategies, theory based behavioral interventions, improving use of hearing protection devices and access to hearing health care. NIDCD Announcements.
• Blindness separates us from things but deafness separates us from people‐ Helen Keller
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Mabann Tribe
Rosen et al., 1962
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