vital and health statistics; series 11, no. 32 (11/68)

INATIONAL CENTER Series 11

For HEALTH STATISTICS Number 32

VITAL and HEALTH STATISTICS

13ATA FROM THE NATIONAL HEALTH SURVEY

HearingStatus andEar ExaminationFindingsAmongAdultsUnited States -1960-1962

Hearing testresults compared with medical history, !louse-

kold interview, and e~r examination findings by age and

sex among adults 18-79 yeors of age.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Services and Mental Health Administration

Washington, D.C. November 1968

.

Public Health Service Publication No. 1000-Series II-NO. 32

For sale by the Superintendent of Documents, U.S. Government Printing OfficeWashington, D.C., 20402- Price 35 cents

NATIONAL CENTER FOR HEALTH STAT

THEODORE D. WOOLSEY, Director

PHILIP S. LAWRENCE, SC. D., Associate Director

S-ncs

OSWALD K. SAGEN, PH.D.>, Assistant Director for Health Statistics Development

WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development

ALICE M. WATERHOUSE, M. D., Medical Consultant

JAMES E. KELLY, D.D. S, Dental Advisor

EDWARD E. MINTY, Executive O/ficer

MARGERY R. CUNNINGHAM, in/orrrzation O//icer

DIVISION OF HEALTH EXAMINATION STATISTICS

ARTHUR J. McDOWELL, Director

PAUL T. BRUYERE, M.D., Assistant Director

JAMES T. BAIRD, JR., Cbr’e/, Analysis and Reports Branch

HENRY W. MILLER, Chief, Operations and Quality Control Branch

PETER V. HAMILL, M.D., Medical Advisor

LAWRENCE E. VAN KIRK, D. D. S., Dental Advisor

HAROLDJ. DUPUY, Ph. D., Psychological Advisor

COOPERATION OF THE BUREAU OF THE CENSUS

In accordance with specifications established by theN:ational Health Survey, the Bureau of the Census, under acontractual agreement, participated in the design and selec-tion of the sample, and carried out the first stage of the fieldinterviewing and certain parts of thq statistical processing.

Public Health Service Publication No. 1000-Series 1 l-No. 32

Library of Congress Catalog Card Number 68-60077

CONTENTSPage

Introduction ----------------------------------------------------------

Sources of Data -------------------------------------------------------Hearing Tests ------------------------------------------------------Medical History ----------------------------------------------------Household Interview ------------------------------------------------Ear Examination ---------------------------------------------------

Findings From Tests and Questionnaires --------------------------------Heartig Tests ------------------------------------------------------Medical History ----------------------------------------------------Interview ----------------------------------------------------------Impaired Heartig ---------------------------------------------------

Findings From Ear Examination ----------------------------------------Relation to Impaired Hearing -----------------------------------------

Discussion -----------------------------------------------------------

Summary -------------------------------------------------------------

References -----------------------------------------------------------

Detailed Tables -------------------------------------------------------

Appendix 1, Health Examination Survey Record Forms -------------------

Appendix II. Statistical Notes ------------------------------------------The Survey Design --------------------------------------------------Reliability ---------------------------------------------------------Sampling and Measurement Errors -----------------------------------Small Categories ---------------------------------------------------

1

1

1

222

22344

88

9

9

11

12

26

2727272728

THIS REPORT compares the four methods wsed in the Health Exami-nation Survey in 1960-62 for determining hearing status among adultsand assessing their relationship to ear examination findings and certainmedical history items.

In this survey heaving status was rated by the following four methods:puve-tone, air-conduction audiometric tests; self-evaluation of hearing(good, fair, or poor); self-evaluation of heaving trouble (trouble ornone); and household inteniew of the examinee or a knowledgeable adultin his family vegavding his hearing impairment (deafiess or serioustrouble heaying).

The ear examination by the staff physician included an inspection of theexternal ear for malformations and a limited examination with an oto-scope of the auditovy canal for exwdate and of the drum for perforationor scarring.

Medical history questions about conditions which may affect hearing—such as tinnitus or dizziness o?’a history of stroke, scarlet fever, ordiphtheria—are also considered.

Prevalence estimates for these vomious conditions among the civiltin,?wninstitutional population of the United States 18-79 years of age basedon the survey findings are shown as well as the extent of agreementamong them generally but particularly with reference to audiometrictest data.

SYMBOLS

Data not available ------------------------ ---

Category not applicable ------------------- . . .

Quantity zero ---------------------------- -

Quantity more than O but less than 0.05---- 0.0

Figure does not meet standards ofreliability or precision ------------------ *

iv

HEARING STATUS AND EAR EXAMINATION

FINDINGS AMONG ADULTS

Jean Roberts, Division of Health Examination Statistics

INTRODUCTION

The four methods used in the Health Exami-nation Survey in 1960-62 for determining hearingstatus among adults are compared, and their re-lation to ear examination findings and certain

, medical history items are assessed in this report.National estimates given here are based on

data obtained during the first cycle of the HealthExamination Survey, one of three programs de-signed to secure statistics on the health status ofthe population of the United States. This programobtains data principally through medical exami-nations, tests, and measurements on a scientifi-cally selected random sample of the population.In the other two programs, health related dataare obtained chiefly through household interview,hospital records, and other medical records.

In the first cycle, the Health Examination Sur-vey was limited to civilian adults living outsideinstitutions. Its purpose was to determine theprevalence of certain chronic diseases, the statusof dental health, auditory sensitivity and visualacuity levels, and certain anthropometric meas-urements.

During the survey, which extended fromOctober 1959 through December 1962, 6,672 per-sons were examined out of 7,710 persons 18-79years of age selected in the nationwide proba-bility sample. Medical and other survey staff per-formed the standard examination, which lastedt~bout 2 hours, in mobile clinics especially de-signed for this purpose.

General plans and the initial program of theHealth Examination Survey, the sample populationselected as well as those responding, and theeffect of nonresponse on the findings are given inprevious publications.1~2

SOURCES OF DATA

Hearing Tests

Hearing thresholds were determined monau-rally and individually by trained technicians in anacoustically treated booth within each of the mo-bile examining centers. As indicated previously,3hearing thresholds (or levels) correspond to theweakest intensity of a pure tone produced in theaudiometric earphone that is just audible to theear of the examinee being tested. Pure-tone audi-ometers were used for testing at frequencies of500, 1000, 2000, 3000, 4000, and 6000 cycles persecond.

Within the testing booth, ambient noise wasgenerally attenuated well below the maximumallowable sound pressure level specified by theAmerican Standards Association for no maskingabove audiometric zero. Quality of the test resultswas further controlled by periodic factory calibra-tion of the audiometers and by frequent fieldchecks. 3

Data from the hearing tests are limited tothresholds for the better ear for comparison withquestionnaire data; for the relevant ear in rela-tion to ear examination findings; and to the aver-

age of these thresholds at 500, 1000, and 2000cycles per second—the estimate of speech recep-tion thresholds as recommended by the AmericanMedical Association’s Committee on MedicalRating of Physical Impairment.4 The levels aregrouped into those with “better than normal” hear-ing (thresholds of 5 decibels or more below audio-metric zero), those testing from 4 decibels belowto 15 decibels above audiometric zero, and thosewith some hearing impairment (thresholds of 16decibels or more above audiometric zero). Thelatter group is assumed to be persons with somedegree of hearing impairment, ranging fromdifficulty only with faint speech to inability tounderstand even amplified speech, following ap-proximately the proposal of the Committee onConservation of Hearing of the American Academyof Ophthalmology and 0tolaryngology.5

Medical History

Prior to the start of the examination, eachexaminee completed a self-administered medicalhistory tailored to the special examination. Whennecessary, the receptionist- interviewer read thequestions to the examinee but did not providehelp in defining terms. The six questions on themedical history, related or possibly related tohearhg (as shown in appendix I), are ones ontinnitus; dizziness; history of stroke, scarletfever, or diphtheria; general hearing status; andtrouble with hearing.

Household Interview

Information on known impairments was ob-tained about all persons in the sample prior tothe examination from either the individual or aclose adult relative, as part of the household in-terview. The question was asked, “Does anyonein the family have any of these conditions?” Therespondent was then shown a card listing selectedimpairments including one on “Deafness or SERi-OUS trouble with hearing.” The replies to thisquestion were classified into the following grada-tions of impaired hearing:

X06 Deafness, total, both ears includingdeaf-mutism. Included persons, with orwithout speech, who are completely

X07

X09

deaf and cannot benefit from a hearingaid.

Impaired hearing, severe. Included per-sons who have some hearing ability butcannot hear ordinary conversation (ex-cept with a hearing aid).

Impaired hearing, except as classifiableto x06 or X07.

Ear Examination

The examination of the ear was performed bythe staff physician and included an inspection ofthe external ear for malformation and an exami-nation of the auditory canal and tympanic mem-brane with an otoscope for exudate and for per-forations or scarring of the drums. Sections ofthe physical examination form used for recordingthe findings for each ear are shown in appendix 1.

FINDINGS FROM TESTSQUESTIONNAIRES

Hearing Tests

AND

As indicated in the first report on audiometrictest results from the Health Examination Surveyof 1960-62,3 an estimated 52.0 million (47 per-cent) adults in the United States had “better thannormal” hearing (thresholds of 5 decibels or morebelow audiometric zero) within the frequencyrange considered most essential for understand-ing speech (500 through 2000 cycles per second)in the better ear; 51.0 million (46percent) testedbetween 4 decibels below and 15 decibels abovethis reference point; and 8.1 million (7 percent)were considered to have some hearing impairmentwithin the “speech” range (thresholds of 16 deci-bels or more above-less sensitive than—audio-metric zero).

At the extremes of the sensitivity range, theproportion with “better than normal” hearingtended to decrease consistently with age, whilethe proportion with some hearing impairmentincreased throughout the age span included in thestudy (table 1).

Audiometric test results are considered forthe purpose of this report to provide the most

Fair

20

Poor

o I I20 40 60 80

AGE IN YEARS

Figure 1. Prevalence rates for adults with good,fair, and poor hearing, by age.

accurate and objective method (of the four usedin this survey) of measuring hearing status. Themedical history and interview information indi-cate the person’s awareness of his condition, butthis information is subject to possible variationsin interpretation and extent of recall.

Medical History

Two indications of hearing status were ob-tained through the self-administered medicalhistory used in the Health Examination Survey--the examinee’s evaluation of his own hearing asgood, fair, or poor and his evaluation of whetheror not he has trouble hearing. An estimated 3percent (3.7 million) of the adult population ofthe Lhited States considered their hearing to be

poor, 25 percent (27.9 million) reported it to befair, and 72 percent (79.5 million) indicated thatit was good. This measure is associated with ageas are the hearing test findings (tables 1 and 2).

The prevalence of poor hearing increased con-sistently with age from the youngest to the oldestage group. “Fair hearing” rates increased fairlyrapidly to 45 years, then leveled off. Conversely,“good hearing” rates decreased with age and at aslightly slower rate for those 45 years and over(fig. 1).

Hearing trouble was reported among an esti-mated 15 percent (16.3 million) of the adults,while the remaining 85 percent (94.8 million) in-dicated no trouble. This measure shows a con-sistent trend with age (fig. 2 and table 3), as didthat for impaired hearing from the test findings.

Certain conditions reported on the medicalhistory which may affect hearing, or appear to doso, are also considered here in relation to thesemeasures of hearing status.

Tinnitus (ringing in the ears), which may beassociated with conditions affecting hearing suchas Meniere’s disease, was reported among anestimated 32 Dercent (36.0 million) of the adults

AGE IN YEARS

Hearinglevel of I

/

+16 dBor higher

,4’

4

●8’

1.

,4’Heoring ,4trouble .*

,,...

,4 ,,.

*,,,.

,4’,@

,/..’’’’’’’”;’ /’

““:/

L:!HH ‘Oorh-ing

*,*

20 40 60 8C

Figure 2, Prevalence rates for adults with im-pai red heari ng, as measured by four criteria,by age.

3

80

r

(’~\u

I Severe

20 40 60 80

AGE IN YEARS

Figure 3. Prevalence rates for cdults with se-vere, mild, and no tinnitus, by age.

(table 4). Less than one-fifth of them consideredit to be severe. The prevalence of the severeform increased slowly with age from 25 through74 years. The slight drop at75-79years probablyreflects sampling error rather than anydecreasein prevalence or difference in interpretation ofthequestion (fig. 3).

Dizziness -- which may be symptomatic of avariety of conditions some of which, like Meni-ere’s disease, affect hearing— was slightly moreprevalent than tinnitus. It was reported amongan estimated 42 percent (46.8 million) of theadults. About one- sixth of those indicating thatthey had spells of dizziness considered them tobe severe. The prevalence of severe dizzinessincreased slightly with age from 25 years on,while mild dizziness or the absence of this con-dition showed no consistent trend with age (fig. 4and table 5).

Three other conditions which may have se-quelae affecting hearing are stroke, scarlet fever,and diphtheria. A history of stroke was reportedby an estimated 2 percent (1.8 million) of adults.The increase in the prevalence rate with age from0.4 to 7.5 per 100 adults accelerated from 55

years on as may be seen in figure 5 and table 6.The proportion of persons who indicated that theyhad at some time had scarlet fever or diphtheriamay be seen to increase with age also, but notbeyond age 65. In all, about 12 percent reporteda history of scarlet fever but only 5 percent re-ported a history of diphtheria (tables 7 and 8).

Interview

According to information given about the ex-aminee by the adult interviewed prior to the ex-amination— an adult from the same householdbut not necessarily the examinee— less than 6percent of the adults in this country (or an esti-mated 6.5 million) have some degree of hearingimpairment of the nature defined previously(table 9). This fourth measure of hearing statusobtained in the survey is also associated with ageas indicated in figure 2.

Impaired Hearing

The gross prevalence of impaired hearing asdetermined from pure-tone audiometric tests (7.3

Mild

Severe

01[ I I I I I I

20 40 60 80

AGE IN YEARS

Figure W. Prevalence

vere, mild, andrates for adults with se-no dizziness, by age.

4

20

[15

m3

!2<

0~

10ixw&IIJ1-4a

5

0 I I I

20 40 60 80

AGE IN YEARS

Fiaure 5. Prevalence rates for adults with aiistory of stroke, diphtheria, and scarlet fe-ver, by age,

120

90

i-Zw0m 60wn

30

0

12CHEARING CONDITION

■ Poor

~ Fair

~ Good90

+16dB -4to ‘5dBor h(gher +15d B or lower

HEARING LEVEL

per 100 adults with levels of16 decibels ormoreabove audiometric zero) exceeded that for poorhearing derived from the medical history(3.3per100 adults) and hearing impairment from thehousehold interview (5.9 per 100 adults) but fellshort of that for trouble with hearing from themedical history (14.7 per 100 adults).

By age, thepattern of agreement, or lack ofit, differed substantially among the measures asindicated in figure 2. Rates for poor hearing andhearing impairment were in fairly good agree-ment with those for impaired hearing (levels of16 decibels or higher) through age 64 but sub-stantially below from age 65 years on. Hearingimpairment was reported more frequently thanpoor hearing among older adults, the differencebecoming statistically significant from age 65years on.

Hearing trouble as reported in the medicalhistory was substantially more prevalent thanthat reported by the two comparable measuresfrom the medical history and household inter-view throughout the age span included in the sur-vey. Audiometric test results also showed fewer

1?.0HEARING TROUBLE

= Trouble~ No trouble

N 90

1-Zuu 60awu

30

0t16d B -4to -5dB

+15d B orhi~;er lower

!-Z

; 60

k’

30

0

HEARING LEVEL

Figure 6. Relation of three quest ionna

HEARING IMPAIRMENTm lmp.irment

❑ No irnp.irment

re ratings of hearing condition to hearing levels among adults.

5

persons with impaired hearing up to age 65. Forages 75-79 years, however, the prevalence ofimpaired hearing based on test results exceededthat from the interview andmedical history data.

Audiometric test results were used in thisreport as a standard against which the accuracyof the questionnaire ratings were assessed. Itcan be seen in figure 6 that for all ages combinedhearing trouble showed the best agreement withthe test results: 60 percent of those with hearinglevels of 16 decibels or more reported suchtrouble as compared with about 40 percent withhearing impairment (according to the interview)and 30 percent with self-ratings of poor hearing.

However, persons with poor hearing or hearingimpairment (interview) were less likely thanthose with hearing trouble to have Mter hearinglevels (15 decibels or less re audiometric zero).

By age, hearing trouble also showed theclosest agreement with the test results, of themeasures used, with 59 to 70 percent of those25 years or older found to have hearing levels of16 decibels or higher also reporting that they hadhearing trouble (tables 2, 3, and 9). Agreementwas slightly but not significantly better amongthose in the youngest age group. Hearing impair-ment (as reported in the interview) showed some-what better agreement with test results than pocm

90

60

+E0lxL#

30

0 I

TINNITUS

W Severe

❑ Mild

❑ None

d..}.:..<..,.<..,.,.,;::;.:~\+:,,,.,/<,./,>,.,/,,.,,,.,.,::4;;...

“q;<+16d B

—-4to

or higher +15d B or lower

HEARING LEVEL

Poor Foi r Good

HEARING CONDITION

90 —

601-

Eivawa

30 I

HEARING TROUBLt?

60

$w

!2Illn.

30

0 —Impoirmenl

HEARING IMPAIRMENT

Figure 7. Relation of tinnitus to each of the four measures of hearing status among adults,

6

+16dB -4 to -5d Bor higher +15d B or Lower

HEARING LEVEL

90

60

+zwo~0.

30

0

DIZZINESS

- Severe

~ Mild

Poor Fair Good

HEARING CONDITION

—

90

60

30

0Impairment No

Impairment

HEARING IMPAIRMENT

Figure 8. Relation of dizziness to three measures of hearing condition among adults.

hearing from 25 years on but was substantiallybelow that of hearing trouble throughout the age

l“an~c.

Wmptanls of SeVeretilUlitusweremore likely

to have been reported by persons with impairedhcwring thanby others,regardless ofwhichmeas-

u ru was considered (fig. 7). Similarly, severedizziness was found more frequently among per-Rons with impaired hearing than among others

(fig, S),

A history of stroke was reported somewhat

more frequently among those with impaired hear-

ing, regardless of the measure of impairment

used, than among those without such hearing im-pairment. Histories of scarlet fever and diphthe-

ria were about as likely to be found among thosewith hearing impairment as those without; thedifferences noted in figure 9 are not statisticallysignificant.

16

10

1-Zlo0Ew

‘5

Ct i

.:<....:.:,,.,.:.:,,.,,.:.:....>:.:::.:\,.,,

- Stroke

~ Scarlet fever

+16 dB -4 to -5 dBor higher +15 d8 or lower

HEARING LEVEL

Poor Fair Good

HEARING cONOITION

15

10

LwoLxw0.

5

0

Trouble Notrouble

HEARING TROUBLE

Figure 9, Relation of histories of stroke, scarlet fever, and diphtheria to three measures of hearingcondition among adults.

7

FINDINGS FROMEAR EXAMINATION

Physicians’ findings from inspection and ex-amination with an otoscope indicated that an esti-mated 77 percent (85.5 million) of the adults inthe United States had no abnormal conditions ob-servable in either ear. However, 10 percent (11.6million) of the adults did have abnormalities inone or both ears, and the drum in at least one earcould not be visualized for about 13 percent or14.8 million (table A).

Among those for whom the presence of anabnormality was noted, one ear was nearly twiceas likely as both ears to have some abnormality,but not necessarily the same condition. When thedrum could not be visualized, one ear was slightlymore likely than both to be so obstructed, but thedifference is not statistically significant.

The majority of those with some abnormality(88 percent) were found to have scarring of oneor both tympanic membranes. One ear was morelikely to be so affected than both. An exudate inthe auditory canal was observed about as fre-quently as perforation of the drum. When an exu-date was observed, however, it was nearly as

Table A. Prevalence rates for adultsof findings from the ear examination:Health Examination Survey, 1960-62

BothOne

Ear condition ears earonly

Norma l----------------------Drum not visualized ---------Abnormality’i ----------------

Malformati.on --------------Malformation-------------Exudatein auditory canal-Perforation of drum-------Scarring of drum----------

Rate per100 adults

77.06.14.00.1

::?3.4

12.1

:::0.10.7

M

lIn some ears more than one abnormalcondition was observed such as a malfor-mation of the external ear and a condi-tion within the canal or drum or bothperforation of the drum and an exudate inthe canal.

01 1 1 T I I I I20 40 60 80

AGE IN YEARS

Figure [0. Prevalence razes for adults withgross findings on examination of the right ear,by age.

likely to represent inbothearsasin one, whereasaperforation was usually found in just one ear.

Prevalence rates for gross findings andspe-cific abnormalities observedonexaminationoftheright and left ear are shown by age and sex intables 10-13. As indicated in figure 10 and table10 for the right ear, the prevalence rate for nor-mal findings generally decreased with age fromthe youngest to those 65-74 years of age. Theslight upsurge at 75-79 years is small enoughtobe due to sampling errors alone. An upwardtrendin the rate with age was found for those whosedrum could not be visualized andto alesser ex-tent for those with abnormal findings-the lattercontinuing only through ages 55-64.

Relation to Impaired Hearing

The extent of the relationship of these earexamination findings, or the absence of them,to the four measures of hearing impairment areshown in figure 11.

8

RIGHT EAR EXAMINATION FINDINGS

- Abnormal

= Drurn,otvlsuollzed

= Normal

30

201-2x~n

10

0Hearing level Poor Hearing Hearing

+16d B hewing trouble impairmentor higher

MEASURE OF IMPAIREO HEARING

Figure Il. Relation of ear examination findingsfor right ear to each of the four measures ofimpaired hearing among adults,

Persons with abnormal findings or whosedrum was not visualized on the ear examinationwere more likely than those with normal exami-nation findings to have impaired hearing by anyoftlw four measures of this condition. Those withulmormalities were also more likelythanpersonswhose drum was not visualized to have impairedhearing as rated by the question ontrouble withhearing or by the household interview, but thedifferences are not statistically significant whenbased on test results or self-ratings ofhearingcondition.

Adults found to have a scarred drum weresomewhat more likely than expected to have im-paired hearing in that ear on the basis ofaudio-metric test results (table 12) as well asonthethree questionnaire ratings of hearing condition.The prevalence of the other abnormal findingswas too lowtoprovide inadequate basis for suchcomparison.

DISCUSSION

Comparable information on the prevalence ofsymptoms and conditions which may have affected

hearing sensitivity, on the prevalence of otologicexominat ion findings, and on the relation of either

or both tb hearing is not readily available in theliterature.

As part of the clinical investigation of hearingfollowing the 1935-36 National Health Surve y,6an otologic examination was given to some 8,000children and adults, and a measure of hearingimpairment was obtained by interview. Prelimi-nary data showed that the prevalence of such ab-normalities as perforated or scarred drum wasover twice that found for adults in the presentstudy, while the proportion with normal ears orwhose drum could not be visualized was only halfas great. The proportion reporting themselvesto have impaired hearing on interview was morethan twice that from the present study. The ques-tions used in the interview differed substantiallyfrom any of those used in the present study, whichmay account for some, but not all, of the differ-ence. The otologic examination was also a morecomplete one than that given in the present study.It should be kept in mind too that data from the1935-36 National Health Survey are based on asample from selected large urban areas only,whereas the present study is a probability samplerepresentative of the adult population of the entireUnited States.

In the present study the comparison of thefour measures of impaired hearing gives someindication of the possible extent to which thequestionnaire responses may be affected by re-finement in wording of the questions, changingattitudes toward such a condition with age as wellas by the extent to which symptoms such astinnitus or dizziness may affect hearing or appearto do so and thus color the response to thesequestions.

SUMMARY

Health Examination Survey findings in 1960-62 on hearing among a probability sample ofadults aged 18-79 years in the civilian, noninsti-tutional population of the United States indicatethat:

1. On the basis of pure-tone audiometrictests, an estimated 7 percent (8.1 million)of the adults had hearing thresholds 16decibels or more above— less sensitivethan-–audiometric zero in the better ear

9

within the tonal range usually consideredessential for understanding speech. Threepercent reported poor hearing and 15per-cent reported hearing trouble on theirmedical history, while less than 6 percentreported impaired hearing in the house-hold interview. Prevalence rates gener-ally increased with age for each measureof impaired hearing, but the patterns

differed substantially.

2. When audiometric test results were usedas the standard for assessing the accu-racy of the questionnaire ratings, hearingtrouble showed the best agreement withthe test results: 60 percent of those withhearing levels of 16 decibels or higherreported hearing trouble as comparedwith 40 percent with hearing impairment(as reported in the interview) and 30percent with self-ratings of poor hearing.However, persons reporting poor hearingor impaired hearing were less likely thanthose with hearing trouble to have betterhearing levels (thresholds of 15 decibelsor less). A somewhat similar pattern wasfound throughout the age range.

more likely to have been reported by per-sons with impaired hearing than thosewithout, regardless of the measure ofimpairment considered.

4. Persons with a history of stroke werealso somewhat more likely to have im-paired hearing than others, while thosewith histories of scarlet fever or diph-theria showed no such relationship,

5. An estimated 77 percent (85.5 million)of the adults in the United States werefound to have normal ears on the basis

of the limited examination given with anotoscope. Ten percent were found to havean abnormality y in one or both ears, andone ear was more likely to be affecteclthan both. For nearly 88 percent of thosewith an abnormality, the condition notedwas scarring of the tympanic membrane.

6, Persons with abnormal findings on exami-nations or whose drum could not be visual-ized were more likely than those withnormal ears to have impaired hearing onthe basis of any of the four measures ofthis condition.

3. Symptoms of severe tinnitus and, to alesser extent, severe dizziness were

10

REFERENCES

lNational Center for Health Statistics: Plan and initial

program of the Health Examination Survey. Vital and Health

Statistics. PHS Pub. No. 1000-Series l-No. 4. Public Health

Service. Washington. U.S. Government Printing Office, July1965.

2National Center for Health Statistics: Cycle I of the

Health Examination Survey, sample and response. Vital and

Health Statistics. PHS Pub. No. 1000-Series 1 l-No. 1. Pub-

lic Health Service. Washington. U.S. Government Printing

Office, Apr. 1964.

3National Center for Health Statistics: Hearing levels of

adults by age and sex, United States, 1960-1962. Vital ano

Hea2th Statistics. 3?HS Pub. No. 1000-Series 11-No. 11. Pub-Iic Health Service. Washington. U.S. Government printing

Office, Oct. 1965.

~Committee on hledical Rating of Physical Impairment:

Guides to the evaluation of permanent impairment–ear, nose,throat, and related structures. J.A .M.A. 177:489-501, Aug. 19,

1961.

5National Institutes of Health: Methodological problems

in collecting data on the deaf, the survey, by E. L. Eagles.

Proceedings-Conference on the Collection of Statistics of

Severe Pearing Impairments and Deafness in the United States.

PHS Pub. No. 1227. Public” Health Service. Washington. U.S.Government Printing Office, 1964.

6National Health Survey (1935- 1936), Preliminary Reports,Hearing Study Series, Bulletin No. 3: Prevalence of AuralPathology and Clinical History of Impaired Hearing AmongMales and Females of various Specific Ages. U.S. PublicHealth Service, Washington, D.C. 1938 pp. 6 (Mult,ilithed).

000

11

— — ----DETAILED TABLES

Table 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Number and percent of adults with specified hearing sensitivity levels, by sexand age: United States, 1960-62----------------------------------------------..”--

Prevalence rates for adults with poor, fair, and good hearing condition and per-cent distribution of adults in specified hearing sensitivity levels, by hearingcondition according to sex and age: United States, 1960-62----------------------

Prevalence rates for adults with and without hearing trouble and percent distri-bution of adults in specified hearing sensitivity levels, by condition accordingto sex and age: United States, 1960-62--------------------------------------------

Prevalence rates for adults with severe, mild, and no tinnitus and percent dis-tribution of adults in specified hearing sensitivity levels, by condition ac-cording to sex and age: United States, 1960-62----------------------------------

Prevalence rates for adults with severe, mild, and no dizziness and percent dis-tribution of adults in specified hearing sensitivity levels,by condition accord-ing to sex and age: United States, 1960-62--------------------------------------

Prevalence rates for adults with and without a history of stroke and percent dis-tribution of adults in specified hearing sensitivity levels,by condition accord-ing to sex and age: United States, 1960-62--------------------------------------

Prevalence rates for adults with and without a history of scarlet fever and per-cent distribution of adults in specified hearing sensitivity levels,by conditionaccording to sex and age: United States, 1960-62--------------------------------

Prevalence rates for adults with and without a history of diphtheria and percentdistribution of adults in specified hearing sensitivity levels, by conditionaccording to sex and age: United States, 1960-62--------------------------------

Prevalence rates for adults with and without hearing impairment and percent dis-tribution of adults in specified hearing sensitivity levels,by condition accord-ing to sex and age: United States, 1960-62--------------------------------------

Prevalence rates for gross findings on examination of the right ear and percentdistribution of these findings within specified hearing sensitivity levels amongadults in the United States, by sex and age-------------------------------------

Prevalence rates for gross findings on examination of the left ear and percentdistribution of these findings within specified hearing sensitivity levels amongadults in the United States, by sex and age-------------------------------------

Prevalence rates for adults with specific abnormalities of the right ear andpercentage of adults with these abnormalities in specified hearing sensitivitylevels, by sex and age: United States, 1960-62----------------------------------

Prevalence rates for adults with specific abnormalities of the left ear and per-centage of adults with these abnormalities in specified hearing sensitivitylevels, by sex and age: United States, 1960-62----------------------------------

Page

13

14

14

15

15

16

16

17

17

18

20

22

24

12

Table 1. Number and percent of adults with specified hearing sensitivity levels, by sex and age:United States, 1960-62

Sex and age

18-24

25-34

35-44

45-54

55-64

65-74

75-79

18-24

25-34

35-44

45-54

55-64

65-74

75-79

18-24

25-34

35-44

45-54

55-64

65-74

75-79

Both sexes

All ages, 18-79 years---------

years -------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

Men


years-------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

Women


years-------------------------

yeak -------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

years-------------------------

Hearing level re audiometric zero

IzEEETzNumber per 100 adults

46.8

74.1

67.3

54.5

40.5

22.5

9.9

1,6

43.3

68.3

63.0

50.9

35.0

23.2

8.5

2.5

49.9

79.0

71,3

58.0

45.7

21.9

11,0

0.7

45.9

25.1

31.4

42.6

55.2

67.2

61.9

50.4

49.1

30.5

35.6

45.4

60.9

66.2

61.0

48.8

43.0

20.6

27.4

39,8

49.7

68.0

62.8

51.9

7.3

0.8

1.3

2.9

4.3

10.3

28.2

48,0

7.6

1.2

1.4

3.7

4.1

10.6

30.5

48.7

7.1

0.4

1.3

2.2

4.6

10.1

26.2

47.4

flumberof adults in thousands

51,983

11,535

14,524

12,929

8,328

3,518

1,103

46

22,845

4,873

6,479

5,786

3,508

1,742

421

36

29,138

6,662

8,045

7,143

4,820

1,776

682

10

50,984

3,914

6,771

10,089

11,352

10,501

6,911

1,446

25,845

2,180

3,663

5,172

6,121

4,979

3,034

696

25,139

1,734

3,108

4,917

5,231

5,522

3,877

750

8,120

120

277

680

896

1,618

3,150

1,379

4,054

86

139

415

405

796

1,517

696

4,o66

34

138

265

491

822

1,633

683

13

Table 2. Prevalence rates for adults with poor, fair, and good hearing condition and percent distributionof adults in SPeCifLCClhearinfzsensitivity levels. by hearin~ condition according to sex and age: United States, 1960-62

l-----+Hearingconditicm

Sex and age

pOOr\ Fair GOOd

—Hearing level re audiometriczero

+16 dB or higher -4 to +15 dB with -5 dB or lawurlithhearing condition: hearing condition: with hearinr c,,)ndjtl,.m:

:0 tal Poor Fair Good Total Poor Fair Good Tcital Poor Fair Ccmd

Percent distributionBoth sexes I Hate per100 adults

LAll ages, 18-79 years------ 3.3 71.6 30.6.

21.723.328.938.032.231.823.8

34.7

21.126.131.444.836.037.937.0

26.3

22.320.126.430.128.827.011.6

67.2

II

100.0 O.& 15.9

76.4 100.0 0.1 10.s76.4 100.0 0.4 1%.570.1 100.0 0.5 17.~59.3 100.0 0.4 22.!J63.7 100.0 0.4 21.866.4 100.0 0.9 15.673.6 100.0 - (d3.1J

62.8 100.0 0.4 19.1

25.1 .

-118-24 years---------------------- 0.925-34 years---------------------- 0.835-44 years---------------------- 1.645-54 years---------------------- 2.655-64 year~---------------------- 6.0

65-74 years---------------------- 9.975-79 years----------------------16.0

Hen—All ages, 18-79 years------ 4.0

18-24 years---------------------- 0.725-34 years---------------------- 0.835-44 years---------------------- 2.145-54 years---------------------- 2.655-64 years---------------------- 7.965-74 years----------------------11.075-79 years----------------------21.3

Women

All ages, 18-79 years------ 2.8

18-24 years---------------------- 1.025-34 years---------------------- 0.735-44 years---------------------- 1.145-54 years---------------------- 2.655-64 years---------------------- 4.165-74 years---------------------- 9.075-79 veals----------------------10.7

13.716.223.832.732.834.033.5

85.4B3.O74.664.761.256.150.5

66.7

83.279.870.558.555.748.937.7

75.9

87.286.078.570.666.461.863.2

100.0 43.0100.0 35.5100.0 29.9100.0 22.4100.0 29.8100.0 30.8100.0 30.6

42.5 14.536.9 27.658.3 11.856.9 20.761.1 9.145.6 23.636.1 33.3

100.0 1.9100.0 0.3100.0 1.0100.0 2.7100.0 4.1100.0 1.8100.0 2.6

t

100.0 2.5

100.0 1.5100.0 0.6100.0 0.6100.0 2.8100.0 6.1100.0 2.3100.0 2.4

29.3

16.119.427.438.936.440.141.0 1-

100.0 33.3

100.0 19.4100.0 34.6100.0 38.4100.0 20.7100.0 36.6100.0 30.9100.0 41.4

=1-58.7 21.9j:.; 2;.:

57:6 2$;56.953.5 L5:631.2 27.4

--IL100.0 26.2 -1--47.1 26.7

--

21.3

11.813.320.426.829.529.226.1 -11-

100.0100.0100.0 36.4100.0 16.5100.0 23.9100.0 23.3100.0 30.6100.0 19.6 -L

100.0 2.5100.0100.0 1.;100.0 2.6100.0 2.4100.0 1.5100.0 2.9L

33.4 30.260.6 22.956.3 19.865.0 11.738.2 31.241.0 39.4

Table 3. Prevalence rates fOr adults with and without hearing trouble and percent distributionof adults in specified t,c;,rin$sensitivity levels, by condition according to sex and age: United States, 1960-62

Tiearing he~ingtrouble trouble

Hearing level re audiometriczero

+16 dB or higher with:-4 ‘0 ’15 dB==l====~: ‘-Sex and age

+

Rate per100 adults

Percent distributionBoth sexes

All ages, 18-79 years-- 85.3

T100.0 61.5

100.0 75.5100.0 59.7100.0 69.5100.0 5s.5100.0 64.2100.0 60.5100.0 59.3

38.5 100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

16.2 S3.8 100.014.7

5.6

1;:+17.222.727.135.3

16.9

M14.119.724.930.140.2

12.7

M

1::;20.724.730.3

—24.540.330.541.535.839.540.7

37.3

35.645.325.643.837.037.737.4

39.6

l?::14.820.020.015.512.6

17.9

10.012.816.621.721.418.017.9

14.4

90.189,085.280.080.084.5S7.4

82.1

90.087.283.478.378.682.0S2.I

85.6

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

1S-24 years----------------25-34 years----------------35-44 years----------------45-54 years----------------55-64 years----------------65-74 years----------------75-79 years----------------

~

All ages, 18-79 years--

94.492.98S.382.877.372.964.7

83.1 _2!?Q!lL._w%.3~5.692.5H%.o82.3~7.753.6

q5.h

W4.4~5.fiqh.h93,293,493.0100.0

18-24 years----------------25-34 years----------------35-44 years----------------45-54 years----------------55-64 years----------------65-74 years----------------75-79 years----------------

92.392.0S5.980.375.169.959.8

87.3

96.393.790.585.279.375.369.7

WOmen

All ages, 1S-79 years--

1100.0 60.4

100.0 100.0100.0 64.8100.0 61.9100.0 60.3100.0 65.4100.0 58.S100.0 55.9

18-24 years----------------25-34 years----------------35-44 years----------------45.54 years----------------55-64 years----------------65-74 years----------------75-79 years----------------

100.0100.0100.0100.0100.0100.0100.0

9.8

1::;18.018.613.57.7

90.291.1S7.282.0S1.486.592.3

100.0100.0100.0100.0100.0100.0100.0

:::5.46.86,67.0

14

TahlI:&. Prcvukncc rates far adults with severe, mild, and no tinnitus and percent distributionof adults in specified hearingsensitivitylevels,by condition according to sex and age: United States, 1960-62


Tinnitus+16 decibels or higher -4 tO +15 decibelswith -5 decibels or lower

with tinnitus: tinnitus: with tinnitus:

IF=FT=FF=’F=F Total Severe Mild Ncme

Sateper 100 adults I Percent distribution

28.7

27.927.428.528.929.529.528.3

25.2

5.6-

3.0

:::6.1

1::;10.6

4.7

1.72.12.46.1

1!:;.

6.5

4.13.55.26.2

1?::14.4

26.8.

23.624.626.726.428.533.030.6

25.0

23.922.625,224.225.531.923.8

28.4

23.226.428.028.431.233.s37.3

*1 21.8136.81 41.4I I

73.5

1s-2/4,!t,rs--.--.--------25-M yt,lr:>--.-.-...-----35-44 yLvWs----.-.-------/+5-54Vc,trl+---------.-.--!,5.(,!+yL,,ire,--------------h!I-7/4yL,{ir::--------------7?I-7~1vL;(r:;--------------

Ncn—ALL (l!Y, L,!:, 18-7Q \6C~lX-

UI-2A y.;lrti-------.------

~!dk ~L,U7S--------------

35-$4 yLLlrs-..-.-.-.-----

WI-.14 yc,lr,,-..------.--.-

55-M ymr.l ,---------------

[15-74yuLlrs--------------75-711yc;~r;:--.-.----.-.--

WCIJICJ

All o!Iv$:, lH-7g “etlrs-

100.0 3.5100.0 3.4100.0 3.7100.0 5.9100.0 8.0100.0100.0 R

75.974.872.173.171.161.940.0

75.0

75.678.572.374.574.163.253.6

72.4T’1m70.3 100.0 18.3 36.8 44.9

74.4 100.0 22.9 77.175.3 100.0 22.9 40.0 37.;72.4 100.0 16.1 38.0 45.969.7 100.0 19.1 30.8 50.166.1 100.0 18.2 33.2 48.657.8 100.0 20.1 44.5 35.469.4 100.0 13.9 22.2 63.9

4.6

0.93.42.45.6

;::

70.21 100.01/ 2.31 22.7

24.625.523.226.226.0;;.:

32.3

74.5 100.071.1 100.074.4 100.068.2 100.066.1 100.068.1 100.075.7 100.0

1.7 22.70.9 20.61.5 26.25.4 20.15.4 20.52.3 34.5- 46.4

61.2] 100.0][65.11 100.oII 25.41 36.71 37.9 100.0/1 6.5 3.8] 23.8

111-24>fu,trs--------------~!i-jkyti,lr$--------------35-44 ycjlr:i-.------------45-M ,“ti:lr,:--------------!! 5.(,/+ ,f,,iir.s---------.-.--

(15-74yt,lrs--------------75-7~1?L,lr:;-------------- J-

100.0 6.9100.0 3.4100.0 5.1100.0100.0 :::100.0100.0 1;::

32.129.534.032.032.632.732.0

61.0 100.0 3.1 20.967.1 100.0 3.4 24.860.9 100.0 4.4 23.761.7 100.0 4.7 23.259.2 100.0 3.2 28.659.9 100.0 7.0 31.856.7 100.0 - 100.0

76.071.871.972.168.261.2

T, IIIL{ >. PreLP,l~tinccrates for adults with severe, mild, and no dizziness and percent distributionof adults in specified hearingsensitivity levels, hy condition according to sex and age: United States, 1960-62

Dizziness

EIEIE

Rateper 100 adults


+16 decibels or higher -4 to +15 decibels with -5 decibels or lowerwith dizziness: dizziness: with dizziness:

:otal Severe Nild None Total Severe Iiild None Total Severe Mild None—

Percent distribution

7.2

:;;

::;10.512.013.2

5.2

5.82.L

::;;.;

9:9

1

9.0

6.16.9

:::12.314.216.4

57.9

60.461.161.355.353.852.458.1

68.3

71.375.671.962.864.658.264.8

48.5

51.147.951.647.044,047.751.6

34.9.

33.734.332.938.535.735.628.7

26.5

33.5

54.C41.927.334.834.836.026.1

32.8

58.7

2;:;39.732.537.125.9

34.3

41.777.527.430.837.034.926.4

100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

100. C

100. C100.C100.C100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

59.6

60.861.461.251.559.264.634.1

70.5

72.577.571.355.347.071.446.4

51.0

52.348.553.048.851.860.3

51.7.

36.952.857.657.648.947.657.6

54.0

41.382.758.055.154.847.359.3

49.4

25.222.556.959.743.347.955.7

7.8

2:;6.27.7

10.210.510.6

5.2

5.9

i::4.78.87.05.6

10.4

5.5_

;::4.95.4

;:$

3.8

5.82.4

::;5.53.8

6.8

6.16.76.56.o11.512.1

34.9

33.233.833.943.132.226.565.9

25.7

21.720.125.740.2;;.:

53:6

42.2

18.24 yt:;trs --------------25-34 yuilr:i--------------35.44 ycilrs_________45-54 }“cllrs--------------~~,-,,/*~L.),r:+.,_.-._ ------115-74y.,~irs--------------75-1~1yt;kr:j-.------------

Ncn

All q;Lw,lH-7~ ycar9-

l/{-2&y,,:lr:l--------------25-.{4yc.trs--------------15-M yk,ir::--------------fi~-!ik~L,tr:;-.-......-----!,:,-(,/+y,!;,r.q------- -------

1,!,-7/+y,.,,r>,--------------j!,-p)~,%.,c:j--..--.----.--

Wmm,n

All ,L)~,v::,1:{-7Qycnrs-

+

100,0 9.1100.0 5.3100.0 15.1100.0100.0 1;:!100.0 16.4100.0 16.3

100.0 13.2

100.0100.0 10.;100.0 14.8100.0100.0 1::;100.0 15.6100.0 14.8

34.735.132.035.537.037.030.1

59.660.761.856.852.852.559.3

I26.2 68.6

24.226.822.627.626.031.423.3

44.1

47.944.!341.944.746.941.336.4

69.971.973.867.765.261.671.1

45.5

T100.0 16.3

100.0 33.1100.0100.0 15.;100.0100.0 1;:;100.0 17.2100.0 17.9

y-24 y,!;,rs--.-.-.-....--

)+-v+ y,,,. s--------------.{!, -/+/+ y,,, (r:; --------------

4!*-V14vt,.lrs--------------,,!,-(,,4\rl,/,rfi-......-------{!!,-74 vti,~tr,s---.----------7!t-7~8,.,;,rs--------------

5.3

M11.211.513.315.3

41.644.840.545.236.727.6.00.0

15

Table 6. Prevalence rates for adults with and without a history of stroke and percent distributionof adults in specifiedhearingsensitivitylevels, by condition according to ssx and age: United States, 1960-62

Sex and age


History of:

==F=

-5 decibels m- lower with:

Total IIStroke I NOstrake

Rate per 100adultsBoth sexes



98., 100.01.6 100.0—

100.0100.0100.0100.0100.0100.0100.0

100.0

5.8 94.2—

100.0100.095.597.s95.691.793.3

96.8

9S.21,

100.0,, 0.6 95.4

Y9.695.999.199.1Y9.496.9100.0


Men—All ages, 18-79 years--


Women


0.40.40.7

;:;5.37.5

99.199.(99.:98.I97.(94.”92.!

98.(

100.0100.0100.0100.0100.0100.0100.0

99.6 100.0 :.:99.1 100,099.8 100.0 0:998.3 100.0 o-q97.7 100.0 0.695.8 100.0 3.191.4 100.0

4.;

:::8.36.7

mr98.3 100.0 0.7

99.2 100.0 0.699.2 100,0 0.299.7 100.0 0,498.0 100.0 1.898.0 100.0 1,297.6 100,0 -86.6 100.0

1.4 3.2

Ir100.0 1.7

100.0 0.8100.0 0.8100.0 0.3100.0 2.0100.0 2.0100.0100.0 I::i

99.3

0.70.40.61.92.02.47.5

99.:99.(99./98.:98.(97.(92.!

98.:

99.[99.:99.:99.:97.[92.192.!

100.0100.0100.0100.0 R100.0 3.8100.0 3.2100.0 2.1

100.0100.092.798.096.296.897.9

91.6

100.0100.0100.097.795.086.988.7

9Y.49Y.899.698.298.8100,0100.0

T100.0 2.0

100.0100.0100.0 :::100.0 1.2100.0 2.5100.0100.0 :::

1.7

M0.80.82.2

;:; T100.0 8.4

100.0100.0100.0100.0 2.;100.0 5.0100.0 13.1100.0 11.3 n98.0 100.0 0.5

100.0 100.0 0.398.9 100.099.9 100.0 1.;98.8 100.0 0.297.5 100.094.3 100.0 S.li95.8 100.0 -

99.5

99.7100.098.799.LI100.CI95.0100.0

18-24 years----------------25-3L years----------------35-44 years----------------45-54 years----------------55-64 years----------------65-74 years----------------75-79 years----------------

Table 7. Prevalence rates for adults with and without a history of scarlet fever and percent distributionof adults in specifiedhearing sensitivitylevels, by condition according to sex and age: United States, 1960-62


.%x and age

History of:+16 decibels or higher

with: I -4 ‘0 +15 decibel,with: I -5 de’=ib~ls‘r 10W= with,

Total Scarletfever I None Total IIScarletfever

NcmeEE1-!lSate per 100

adults

Total Scarletfever

INone

Percent distributionBoth sexes

All ages, 18-79 years-- 88.5 100.0 13.6 86.4 100.0 11.9 100.0

100.0100.0100.0100.0100.0100,0100.0

100.0

89,2—

92.9Yo.189.286.784.175.777.8

90.2

11.5 S8.1 10.8


lien—All ages, 18-79 years--

6.1

1;::13.915.112.312.2

93.990.787.786.184.987.787.8

89.3

92.791.287.888.2S7.O89.291.0

87.8

100.0100.0100.0100.0100.0100.0100.0

100.0

3.00.075.3;;.;

83:990.186.9

89.0

100.091.492.985.586.090.886.2

83.8

100.059.080.570.251.989.387.6

100.0100.0100.0100.0100.0100.0100.0

100.0

3.3

M13.514.611.411.0

11.4

4.9

J:i13.s12.312.$

12.4

96.792.785.886.5:3.:

89:0

7.1

1;:;13.315.924.322.2

24.;11.922.916.1

1?:?

11.0

8.;

1::;14.0

1:::

16.2

10.7

i::12.211.813.010.89.0

88.6 9.8


100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

95.192.555.986.287.788.695.1

100.0100.0100.0100.0100.0100.0100.0

100.0

8.5

1;::

1:::12.6

91.590.6!39.092.285.687.4100.0

88.5

94.089.889.382.782.768.6

-

Women

All ages, 18-79 years-- 12.2 87.6 11,5


R12.315.817.013.415.2

95.090.387.784.283.086.684.8

100.0100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0100.0

1.3

1::!13.216.711.416.7

98,793.085.786.853.388.683.3

100.0100.0100.0100.0100.0100.0100.0

1::!10.717.317.331,4100.0

41.;19.529.S18.110.712.4

16

Tablu S. Prevalence rates for adults with and without a history of diphtheriaand percent distributionof adults in specifiedhearing sensitivitylevels, by condition according to sex and age: United States, 1960-62

1 Hearing level re audiometric zero

sw and age

History of:+16 deci~~~:or higher

-4 to +15 decibelswith: -5 decibels or lower with:

Diph-None Total Diph- Diph-

theria Nrme Total Diph-theria theria None Total theria None

Rate per 100adults I Percent distribution

3.9

Bath sexes

All ages, 18-79 ye.us-- 5.0 7.0

10.;1.28.66.5

::?

6.2

20.;2.0

::;8.95.0

7.8

96.194.1 100.0—18-24 years----------------7’5-34years----------------35-44 years----------------45-54 years----------------55-64 yllalw----------------65-7& ycara----------------75-79 years----------------

Men

All LIgcY~8-79 years--

99.397.095.192.292.194.093.4

100.0100.0100.0100.0100.0100.0100.0

100.0 100.089.8 100.0 2.;98.8 100.0 6.291.4 100.0 8.993.5 100.093.1 100.0 ;::90.3 100.0 2.6

100.098.o93.s91.192.294.497.4

100.0100.0100.0100.0100.0100.0100.0

100.0

99.196.795.993.891.394.156.4

4.6

0.42.45.5

:::

:::

5.4

0.9

:::8.99.2

?:

193.8

100.079.898.097.195.891.195.0 II

100.0

100.0100.0100.0100.0100.0100.0100.0

5.4 94.6 3.6

0.6

:::4.29.1

5::2

96.4

18-24 years----------------25-14 years----------------35-44 years----------------45-54 years----------------55-64 years----------------65-74 years----------------75-79 ywm-s----------------

Women


M-24 years----------------25-34 years----------------35-44 years----------------43-54 Veils!---------------- &

99,6 100.097.6 100.094.5” 100.093.4 100.093.5 100.093.0 100.096.2 100.0

94.6 100.0

99.1 100.096.5 100.095.6 100.091.1 100.090.8 100.094.8 100.090.5 7.00.0

100.099.092.991.894.093.9100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

99.497.295.695.890.993.746.4

I92.2

100.0100.0100.086.891.295.085.8 I

100.0

100.0100.0100.0100.0100.0100.0100.0

6.5 93.5 4.1 95.9

100.096.894.690.390.594.894.9

1.1

;:~

8:25.7

98.996.396.192.491.894.3100.0

13.;S.8

12::

3.25.49.79.55.25.1

55-64 @rs----------------65-74 ycare----------------75-79 years----------------

Tablo 9. Prevalence rates for adults with and without hearing impairmentand percent distributionof adults in specifiedhearingsensitivitylevels, by condition according to sex and age: united States, 1960-62

THearingimpsir- Nonement


Scx and oge+16 decibels or bigber

-4 to +15 decibels with:with: -5 decibels or lower with:

HearingTotal

Hearingimpsir- None Total impsir- None TOta1ment mentI

1

Rate per 100adultsBoth sexes

All agas, 18-79 years--


94.1 100.0 41.9 58.1

74.866.057.162.261.654.656.4

100.0 100.011 1.2 98.84.9_

3.63.02.65.86.5

;::

6.4

95.1—

96.497.097.494.293.592.996.7

93.6

18-24 years----------------25-34 yC,lr9----------------35-44 yl.wrs----------------45-54 ylxlriz----------------55-64 yCLlrS----------------65-74 years----------------75-79 years----------------

Mcn—All ages, 18-79 years--

18-24 years----------------25-34 years----------------35-44 years----------------45-54 years----------------55-64 jXWX----------------65-74 years----------------75-79 ycm-s----------------

98.597.897.294.491.182.677.4

92.6

100.0100.0100.0100.0100.0100.0100.0

100.0

25.234.042.937.838.445.443.6

100.0 0.6100.0 1.2100.0 0.8100.0100.0 ;::100.0 1.7100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

99.498.899.298.197.498.3100.0

1100.0

—100.0100.0100.0100.0100.0100.0100.0

1.37.4 48.5 51.5 98.7

2.1

;::

1:::22.229.7

97.997.595.793.289,177.870.3

95.6

98.998.298.6:;.;

86:484.5

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0100.0100.0

23.443.850.636.446.850.356.5

76.656.2::.:

53:249.743.5

100.0100.0100.0100.0100.0100.0100.0

100.0

$:;4.0

;:;11.24.4

3.4

97.396.596.092.291.988.895.6

96.6

1.41.11.2

;:;

98.698.998.898.497.6100.0100.0

WOmcn

All ages, 18-79 years-- 4.4

1.11.8

::!

lU15.5

35.3 64.7

1100.0

100.0 -100.0100.0100.0100.0100.0100.0

1.0 99.0

18-24 ymmx----------------25-34 ytiars----------------35-44 years----------------k5-54 yctlxs----------------55-b4 years----------------65-74 y$ar.!l----------------75-79 vuurs----------------

28.624.030.638.930.240.930.2

71.476.069.461.169.859.169.8

100.0100.0100.0100.0100.0100.0100.0

4.82.31.23.4

::~2.4

95.297.798.896.695.096.097.6

100.098.799.697.897.197.3

100.0

:::2.22.92.7

17

Table 10. Prevalencerates for gross findingson examinationof the right ear and percent distri.bution of these findingswithin specifiedhearing sensitivitylevelsamong adults in the UnitedStates,by sex and age


Right ear condition

Sex and age +16 decibelsor higherwith ear:

Abnor-mality D.N.V.lI Normal Total IIAbnor- D.N.V.l

INormalreality

Both sexes

All ages, 18-79 years---

Rate per 100 adults Percent distribution

100.0 11.9 15.0 73.17.3 10.3 82.4

18-24

25-34

35-44

45-54

55-64

65-74

75-79

4.8

6.0

6.4

8.4

9.9

9.8

8.0

7.3

6.4

7.6

8.4

10.4

11.7

19.9

20.3

12.7

88.8

86.4

85.2

81.2

78.4

70.3

71.7

80.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

26.6

15.7

11.6

9.1

18.6

8.0

8.7

8.4

10.4

15.9

6.1

11.4

8.6

23.7

16.1

18.3

63.0

68.4

82.3

79.5

72.8

68.3

75.2

73.3

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

Men

All ages, 18-79‘years---

18-24

25-34

35-44

45-54

55-64

65-74

75-79

years -----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

Iears-----------------1

5.7

5.2

8.3

7.8

8.8

8.6

5.4

7.5

8.4

9.6

9.7

12.5

14.0

27.1

25.6

8.0

85.9

85.2

82.0

79.7

77.2

64.3

69.0

84.5

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

17.4

6.6

10.6

3.3

14.4

5.6

5.1

15.7

11.2

14.4

6.7

14.5

12.2

29.8

20.7

11.5

71.4

79*O

82.7

82.2

73.4

64.6

74.2

72.8

Women


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

4.1

6.6

4.7

9.0

10.9

10.7

10.8

4.6

5.8

7.2

8.4

9.6

14.2

15.0

91.3

87.6

88.1

82.6

79.5

75.1

74.2

100.0

100.0

100.0

100.0

100.0

100.O

100.0

38.4

24.3

12.8

15.4

23.1

10.2

12.1

9.5

17.3

5.4

8.0

4.8

18.0

11.7

52.1

58.4

81.8

76.6

72.1

71.8

76.2

ID.N.V.= drum not visualized.

18

l’;tbleI().Prevalence rates for gross findings on examinaticm of the right ear and percent distri-bution of these findiruzswithin specified hearing sensitivity levels among adults in the UnitedStates, by sex and age-—Con. -


-4 to +15 decibels with ear:I

-5 decibels or lower with ear:

Total Abnor- D.N.V. 1 Normal TotalAbnor-

mality realityD.N.V. 1 Normal


100.0 8.4 11.6 80.0 6.9 88.6100.0 4.5

3.0

4.6

4.8

6.0

5.4

4.4

4.9

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

6.9

7.0

7.2

9.4

8.8

11.3

6.9

8.5

8.0

7.4

9.8

11.2

13.9

18.6

26.0

14.1

85.1

85.6

83.0

79.4

77.3

70.1

67.1

77.4

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.O

5.4

7.4

6.9

8.4

5.7

11.6

20.9

8.7

91.6

88.0

88.3

85.6

88.9

84.0

79.1

86.4

100.0

100.0

100.0

100.0

100.0

100.0

100.O

Loooo

100.0

100.0

100.0

100.0

100.0

100.0

100.0

6.8

5.5

9.0

10.4

8.2

10.8

5.2

8.2

8.4

9.4

11.4

12.7

17.0

27.2

33.8

9*3

84.8

85.1

79.6

76.9

74.8

62.0

61.0

82.5

100.0

100.0

100.0

100.0

100.0

100.0

100.0”

100.0

4.3

4.7

6.7

2.6

5.3

5.5

4.2

8.4

9.6

7.9

11.4

3.9

8.9

5.5

87.3

85.7

85.4

86.0

90.8

85.6

100.0

90.3

6.8

8.4

5.3

8.5

9.3

U.7

8.5

7.7

5.4

8.2

9.6

11.1

12.2

18.2

85.5

86.2

86.5

81.9

79.6

76.1

73.3

100.0

100.0

100.0

100.0

100.0

100.0

100.0

2.0

4.7

3.2

8.4

5.8

4.1

3.2

5.5

6.2

6.2

7.4

13.3

100.0

94.8

89.8

90.6

85.4

86.8

82.6

19

Table 11. Prevalence rates for gross findings on examination of the left ear and percent distri-bution of these findings within specified hearing sensitivity levels among adults in the UnitedStates, by sex and age-

Sex and age

Both sexes


18-24

25-34

35-44

45-54

55-64

65-74

75-79

years -----------------

years -----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

Men—


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

Women


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

Left ear condition

Abnor-mality D.N.V.l

INormal

Rate per 100 adults

8.0

5.4

6.3

7.3

9.1

10.1

10.1

14.9

7.8

7.1

6.8

7.9

7.6

8.7

8.8

12.3

8.2

3.8

5.7

6.7

10.6

11.3

11.3

17.7

9.8

6.6

6.1

8.7

11.6

10.5

16.4

20.9

12.8

7.6

8.5

10.9

15.0

14.2

22.7

27.2

7.0

5.8

4.0

6.6

8.3

7.1

11.2

14.6

82.2

88.0

87.6

84.0

79.3

79.4

73.5

64.2

79.4

85.3

84.7

81.2

77.4

77.1

68.5

60.5

84.8

90.4

90.3

86.7

81.1

81.6

77.5

67.7


-!-16decibels or higher with ear:

Total II Abnor-mality D.N.V.II

Normal

100.0


100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

18.1

12.5

20.9

26.7

17.6

22.1

12.9

16.9

15.4

15.8

24.2

24.6

16.8

18.0

8.8

11.3

21.1

7.1

17.9

30.4

18.4

26.8

16.6

23.1

13.7

17.8

5.2

9.0

15.7

9.5

16.5

17.6

16.6

21.2

11.0

7.4

14.0

12.5

22.4

22.5

10.6

12.4

11.6

17.2

6.0

11.0

12.2

68.2

69.7

73.9

64.3

66.7

68.4

70.6

65.5

68.0

63.0

64.8

68.0

69.2

69.5

68.8

66.2

68.3

80.5

82.1

58.0

64.4

67.2

72.4

64.7

lD.N.V. = drum not visualized.

20

Table 11, Prevalence rates for gross findings on examination of the left ear and percent distri-bution of these findings within specified hearing sensitivity levels among adults in the UnitedStates, by sex and age-Con. -


-4 to +15 decibels with ear:

TotalAbnor-mality

D.N.V,l Normal

100.C

100. c

Ioo.c

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

8.0

9.3

5.8

6.9

9.8

7.6

8.8

11.6

7.7

11.1

5.5

7.6

8.0

6.3

8.9

13.1

8.3

7.1

6.1

6.0

11.9

8.8

8.8

10.1

10.8

5.7

7.1

9.4

11.9

11.3

17.5

26.2

14.1

4.4

9.2

12.7

16.5

15.1

24.6

35.9

7.5

7.3

4.8

6.0

6.7

7.7

12.0

18.2

-5 decibels or lower with ear:

Total II Abnor-mality

D.N.V.l Normal


81.2

85.0

87.1

83.7

78.3

81.1

73.7

62.2

78.2

84.5

85.3

79.7

75.5

78.6

66.5

51.0

84.2

85.6

89.1

88.0

81.4

83.5

79.2

71.7

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

5.0

2.9

5.9

5.3

5.2

6.5

4.7

5.4

3.7

7.0

5.3

3.8

6.6

5.9

100.0

4.7

2.4

5.0

5.4

6.3

6.5

4.2

7.2

6.8

5.4

7.8

9.9

8.2

7.4

9.2

9.4

7.7

9.1

11.6

12.0

7.3

5.7

5.0

3.6

6.9

8.6

5.6

7.4

87.8

90.3

88.7

86.9

84.9

85.3

87.9

100.0

85.4

86.9

85.3

85.6

84.6

81.4

86.8

89.6

92.6

91.4

87.7

85.1

87.9

88.4

100.0

21

Table 12. Prevalence rates for adults with specific abnormalities of the right ear and percentage ofadults with these abnormalities in specified hearingStates, 1960-62

sensitivity levels, by sex and age: United

Sex and age

Right ear abnormality

ZEEIEI@

Rate per 100 adults

Hearing level re audiometric zero ,

+16 decibels or higher with:

Both sexes


Percentage

10.O

22.9

10.0I12.0.

0.1

0.1

0.2

0.1

0.3

0.2

0.8

0.5

0.6

0.9

0.7

0.9

1.6

0.7

0.8

0.6

0.3

0.9

0.8

0.4

0.8

0.3

0.6

6.5

4.4

5.0

5.7

7.e

8.6

8.4

8.1

6.5

14.1 0.1~

0.4

0.3

0.9

2.4 1.6

4.4

9.7

1,8

0.9

1.7

0.3

1.1

18-24

25-34

35-44

45-54

55-64

65-74

75-79

31.7

24.6

16.1

10.8

18.5

10.3

10.4

10.s

18.1

17.8

14.9

6.1

16.3

8.5

.5.7

17.6

4.4

4.9

2.3

1.3

3.1

2.5

1.2

2.0

4.0

2.4

2.4

3.1

1.8

2.8

years -----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

Nen—

8.6I

13.7,

7.1

9.2

7.4

18.1

6.o

11.0

3.7

11.3

5.1

5.7

12.7


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

0.7

0.3

1.1

1.1

1.0

1.0

0.8

0.3

0.5

1.1

0.2

0.6

0.3

0.6

5.2

4.5

7.3

7.0

7.9

7.7

5.4

6.5

0.1

0.5

0.7

0.1

7.8

1.5

1.9

0.7

2.1

Women


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

0.3

0.9

0.8

0.3

0.8

2.1

1.3

0.3

0.9

0.6

0.6

1.0

0.3

3.8

5.4

4.2

8.5

9.2

8.9

10.8

49.1

31.0

17.8

15.8

20.7

12.1

14.7

10.0

5.8

2.2

3.0

3.2

2.3

10.0

11.6

2.2

1.8

1.5

29.1

13.6

13.4

14.0

16.2

8.9

12.4

0.1

0.3

22

Table 12. Prevalence rates for adults with specific abnormalitiesof the right ear and percentage ofadults with these abnormalitiesStates, 1960-62-Con.

in specified hearing sensitivity levels, by sex and age: United


-4 to +15 decibels with:

Mal- Exu-Per-

Total for- date foratedmation drum

-5 decibels or lower with:

~

Scarreddrum

Scarreddrum

Percentage

O.l

0.2

0.2

0.2

0.2

0.1

1.0

0.7

0.8

0.7

0.5

1.2

0.8

0.6 7.5 4.8 0.1

0.3

0.5

0.2

0.4 0.3 4.0

8.(

7.!

8.:

100C

9.1

11.2

7.C

9.4

0.4

1.1

1.1

0.4

0.4

0.3

0.7

6.6

5.5

6.4

8.9

8.2

9.6

7.0

7.7

3.0

5.0

5.5

6.6

5.9

4.7

5.2

0.2

0.4

0.9

0.5

0.4

0.5

0.1

0.3

0.4

0.3

0.6

0.3

2.7

4.3

3.9

5.3

4.9

4.7

4.2

8.5

6.1

11.0

10.9

8,7

10,9

5.3

8.7

1.4

0.5

0.8

1.2

0,5

006

0.7

0.8

1.1

1.5

0.3

0.2

0.6

6.3

4.3

8.3

9.4

8.0

9.7

5.3

7.4

4.3

5.1

7.5

2.6

5.9

5.5

4.6

0.4

1.2

0.4

0.7

0.4

3.9

4.7

5.2

2.2

4.0

5.5

3.8

0.2

0.4

0.6

0.7

0.1

0.4

0.4

1.2

0.3

7.5

9.0

6,2

8.9

9.5

11.7

8.8

0.6

0.9

0.8

0.1

0,5

1.7

6.9

6.8

4.6

8.3

8.4

9.5

8.8

2.0

4.9

3.8

9.4

5.8

4.].

0.2

0.2

0.3

0.5

1.8

4.0

2.9

7.6

5.8

4.1

0.2 1.1

0.8

0.5

0.6

0.5

0.8

0.7

0..6

0.5

23

Table 13. Prevalence rates for adults with specific abnormalities of the left ear and percentage ofadults with these abnormalities in specified hearing sensitivity levels,States, 1960-62

by sex and age: United


Left ear abnormality

+16 decibels or higher with:

Mal-Total

m~i;n = ‘:::d ‘=”ed

Sex and age

Scarreddrum

Rate per 100 adults PercentageBoth sexes


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

Men—


L8-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

Vomen


18-24 years-----------------

25-34 years-----------------

35-44 years-----------------

45-54 years-----------------

55-64 years-----------------

65-74 years-----------------

75-79 years-----------------

1.0 7.00.1 0.9 22.0 0.2

1.0

2.4

7.6

8.7

2.0

2.6

0.6

1.1

2.2

4.5

5.1

7.6

9.4

4.4

4.5

4.0

1.4

5.0

14.9

14.(9“

21.9

21.3

14.3

‘15.0

11.5

16.8

I

12.4

0.7

0.6

1.5

0.8

1.0

0.9

0.7

1.1

0.7

0.7

0.8

0.7

1:2

2.0

1.5

0.9

4.6

5.7

6.2

8.4

8.2

8.8

14.0

6.8

19.1

37.1

39.4

20.7

23.1

16.1

19.3

19.6

0.1

0.2

0.2

0.1

0.1

0.8

0.5

2.1

1.0

1.1

0.7

0.8

0.7

0.6

0.9

0.7

1.0

1.1

1.3

0.9

0.5

1.1

0.5

0.8

2.0

3.1

1.0

0.5

0.9

0.6

1.0

1.7

2.0

5.9

6.7

6.0

7.1

7.4

7.8

10.3

7.2

25.5

47.7

39.3

17.3

18.3

12.5

13.6

24.7

8.3

11.2

11.5

2.4

2.9

5.0

2.7

4.1

17.2.

25.31

17.8:

12.7:

14,2

7.5

10.9

..

17.5’

11.2

10.0

2.2

1.2

2.6

0.1

0.3

0.3

0.1 0.5

3.5

4.9

6.3

9.7

8.9

9.6

17.7

8.9

27..5

39.3

23.9

28.9

19.5

25.6

8.9

18.9

27.1

15.8

16.0

15.3

23.3

0.1

0.5 2.2

4.3

6.4

1.7

4.3

1.1

2.3

4.3

5.8

6.4

6.4

3.1

24

Table 13. Prevalence rates for adults with specific abnormalitiesadults with these abnormalities

of the left ear and percentage of

States, 1960-62-Con.in specified hearing sensitivity levels, by sex and age: United


-4 to +15 decibels with: -5 decibels or lower with:

Ii 1 I

Mal- Exu- Per-Total for- date forated

mation drum

Mal- Exu- Per-Total for- date forated

mation drum

Scarreddrum

Scarreddrum

Percentage

8.8 0.1 0.9 0.7 7.1 5.4 0.1

0.1

0.1

0.1

0.5 0.3 4.5

9.7

6.6

7.9

10.7

8.2

10.0

11.6

8.5

0.7

0.6

1.4

0.8

0.6

1.3

1.2

0.9

0.7

0.7

0.6

0.5

0.9

1.7

0.4

8.1

5.2

5.6

9.3

7.0

7.5

9.9

6.8

3.6

6.2

5.7

5.5

6.9

4.8

5.4

0.7

0.3

0.7

0.4

0.9

0.4

0.5

0.4

0.6

0.2

2.4

5.4

4.9

5.1

5.4

4.8

4.7

0.1

0.2

0.1

0.3

0.1

11.9

6.4

8.7

8.9

6.8

10.1

13.3

9.1

1.4

0.6

2.0

0.9

1.0

1.2

0.6

1.1

0.3

0.6

0.4

3.8

0.9

9.4

5.5

5.7

7.6

5.8

8.3

9.5

7.5

3.7

7.1

5.3

4.5

7.6

5.8

5.3

0.4

0.8

0.7

1.0

0.6

0.5

0.1

1.6

0.3

2.8

6.8

4.2

3.8

5.0

5.8

4.4

0.4

0.6

0,1

0.2

0.3

7.1

6.7

7.L

12,5

9,5

9.9

10.3

0.6

1.0

0.8

0.7

1.0

1.7

6.5

4.8

5.5

11.1

8.1

6.9

10.3

3.3

5.4

6.0

6.3

6.4

4.3

0.9

0.5

0.6

0.2

0.8

0.4

0.6

2.0

4.3

5.4

6.1

5.6

4.3

0.3

0,2

0.6

0.8

0.7

0.2

1.3

25

3.

‘4.

49.

50.

68.

a. At

in

In

If

APPENDIX I

HEALTH EXAMINATION SURVEYRecord Forms

History - Self -AdministeredI-IES-204

any time over the past few years, have you ever noticed rinqinq (tinnitus)

your ears or have you been bothered by other funny noisesmmmyour ears?

,, YES b. How often? ] Every few days 1~

c. Oo they bother you ~]~

a. Have you ever had spells of dizziness?Bmm

lfYES b. How often? Every few days 1-C. Do they bother you

~just a little

Is your hearingII@lmm

a. Do you have any trouble with your hearing?mmm

If YES b. Have you seen a doctor about it?EmKl

c. Did he say what caused it?

Have you ever had: YES NO ?

a. Scarlet fever 000

b. Diphtheria •1 au

c. Polio (infantile paralysis) ❑ UC

Physical ExaminationHES-205

EARS RIGHT ~FT REMARKS Com

20. Normal

21. Drum not Visualized

22. Malformation

23. Exudate

2u. Perforated Drum

26

APPENDIX II

STATISTICAL NOTES

he Survey Design

The first cycle of the Health Examination Surveynployed a highly stratified multistage probabilitywign in which a sample of the civilian, noninstitu-mal population of the conterminous United States 18-1 years of age was selected. At the first stage, a

Lmple of 42 primary sampling units (PSI-J’s) was drawnom omong the 1,900 geographic units into which theIitcd States was divided, Random selection was con-oIM within regional and size-of-urban-place stratato which the units were classified. As used here aKJ is &standard metropolitan statistical area or onethree contiguous counties. Later stages result in thencimn selection of clusters of typically about fourrsons from a neighborhood within the PSU. The totalmple included some 7,700 persons in 29 differentates. The detailed structure of the design and the,nducc of the survey have been described in previousports. l,S

liability

The methodological strength of the survey derivespecially from its use of scientific probability sam-.ng techniques and highly standardized and closelyntrolled measurement processes. This does not im-J that statistics from the survey are exact or withoutmr. Data from the survey are imperfect for threeIJor reasons: (1) results are subject to samplingror, (2) the actual conduct of a survey never agreesrfectly with the design, and (3) the measurementwesses themselves are inexact even though stand-~ized and controlled.

The first-stage evaluation of the survey was re-rted in reference 2, which dealt principally withmalysis of the faithfulness with which the sampling

+ign was carried out. This study notes that out of the‘t10 stimple persons the 6,670 who were examined—‘esponse rate of over 86 percent-gave evidence that‘y were &highly representative sample of the civilian,linstitutional population of the United States. Impu-ion of nonrespondents was accomplished by attributingnonexamined persons the characteristics of compa-

rable examined persons as described in reference 2.The specific procedure used amounted to inflating thesampling weight. for each examined person in order tocompensate for sample persons at that stand of thesame age-sex group who were not examined.

In addition to persons not examined at all, therewere some whose examination was incomplete in oneprocedure or another. Age, sex, and race were knownfor every examined person, but for a number of theexaminees, one or more of the hearing tests were notavailable. For each of the 27 examinees not given thehearing test, a respondent of the same age-sex-racegroups was selected at random, and his test resultswere assigned to the nonexamined person.

When only incomplete test results were available(56 persons), a variety of methods was used, dependingupon the extent of missing data. If only one ear wastested, it was assumed that the findings for the otherear would have been the same. If partial results wereavailable, the levels reached by the other ear at theparticular frequencies were used as the estimates ifthey were consistent with the rest of the audiogram forthe ear on which the data were missing. Otherwiseprojections were made on the parts of the audiogramavailable.

Sampling and Measurement Errors

In the present report, reference has been made toefforts to minimize bias and variability of the measure-ment techniques.

The probability design of the survey makes possiblethe calculation of sampling errors. Traditionally the roleof the sampling error has been the determination ofhow imprecise the survey results may be because theycome from a sample rather than from the measurementof all elements in the universe.

The estimation of sampling errors for a study ofthe type of the Health Examination Survey is difficultfor at least three reasons: (1) measurement error and“pure” sampling error are confounded in the data-itis not easy to find a procedure which will either com-pletely include both or treat one or the other sepa-rately, (2) the survey design and estimation procedure

27

are complex and, accordingly, require computationallyinvolved techniques for the calculation of variances,and (3) from the survey are coming thousands of sta-

tistics, many for subclasses of the copulation for whichthere are a small number of sample cases. Estimatesof sampling error are obtained from the sample dataand are themselves subject to sampling error when thenumber of cases in a cell is small or even, occasion-ally, when the number of cases is substantial.

Table 1. Standard error, expressed as percent-age of prevalence rates for adults with hear-ing and ear cond~ti.ons, by age: United Statea,1960-62

Age

All agea,18-79 yeara --------

18-24 years ---------------25-34 years ---------------35-44 years ---------------45-54 yeara ---------------55-64 years ---------------65-74 years ---------------75-79 years ---------------

Prevalencein percent

I15or or99 95 I25

or 5075

Standard error inpercent

0.0~

0.60.50.4

u0.60.9

1.5

4.03.52.52.52.52.55.5

2.0

4.0

:::3.03.0

t?::

Estimates ofapproximate sampling variability forselected statistics used in this report are presentedin table I. These estimates have been prepared bya replication technique which yields overall varia-bility through observation of variability among randomsubsamples of the total sample. The method reflectsboth “pure” sampling variance and apart of the meas-urement variance.

In accordance with usual practice, the intervalestimate for any statistic maybe considered the rangewitbin one standard error of the tabulated statistic,with 68 percent confidence; or the range within two

standard errors of the tabulated statistic, with 95per-cent confidence. For this report, as in the othersofthis series, only differences which equal or exceed the95-percent confidence interval are referred to asbeingstatistically significant.

An overestimate of the standard error of a dif-ferenced=x–yof two statistics xandyis given bythe formula s~=[x2V~+ y2VY2]Y2,where Vx andVY arethe relative sampling errors, respectively, ofxand y,andxVX andyVY are the sampling errors as shown intable I.

Small Categories

In some tables magnitudes are shown forcellsfolwhich sample size is so small that the sampling errormay be several times as great as the statistic itself.Obviously in such instances the statistic has no mean-ing in itself except to indicate that the true quantity issmall. Such numbers, if shown, have been included inthe belief that they help to convey an impression ofthe overall story of the table.

000

28

.

Sevies 1.

SeYies 2<

Series 3.

Series 4.

Sevies 10.

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH Statistics

Pubiic Heaith Service Pubiicatian No. 1000

ProgYams and collection pvoceduYes.— Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions,and other material necessary for understanding the data.

Data evaluation and methods vesearch. —Studies of new statistical methodology including: experi-

mental tests of new survey methods, studies of vital statistics collection methods, new analyticaltechniques, objective evaluations of reliability of collected data, contributions to statistical theory.

Analytical studies. — Reports presenting analytical or interpretive studies based on vital and healthstatistics, carrying the analysis further than the expository types of reports in the other series.

Documents and committee repovts. — Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised birthand death certificates.

Data fyom the Health Intevuiew Survey. —Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, based on data collectedin a continuing national household interview survey.

benes 11.

Sevies 12.

Sevies 13.

Series 14.

Series 20.

Sevies 21.

Series 22.

Data from the Health Examination Suvvey. —Data from direct examination, testing, and measure-ment of national samples of the population provide the basis for two types of reports: (1) estimatesof the medically defined prevalence of specific diseases in the United States and the distributions ofthe population with reqpect to physical, physiological, and psychological characteristics; and (2)analysis of relationships among the various measurements without reference to an explicit finiteuniverse of persons.

Data fvom the Institutional Population .Wvueys. — Statistics relating to the health characteristics ofpersons in institutions, and on medical, nursing, and personal care received, based on nationalsamples of establishments providing these services and samples of the residents or patients.

Data f~om the Hospital Dischavge Suvuey. —Statistics relating to discharged patients in short-stayhospitals, based cm a sample of patient records in a national sample of hospitals.

Data on health ~esources: rnanpowev and facilities. —Statistics on the numbers, geographic distri-

bution, and characteristics of health resources including physicians, dentists, nurses, other healthmanpower occupations, hospitals, nursiruz homes, and outpatient and other inpatient facilities.

Data on mortality. - Various statistics on mortality other than as included in annual or monthlyreports— special analyses by cause of death, age, and other demographic variables, also geographicand time series analyses.

Data on natality, marviage, and divovce. — Various statistics on natality, marriage, and divorce otherthan as included in annual or monthly reports— special analyses by demographic variables, alsogeographic and time series analyses, studies of fertility.

Data from the National Natality and Movtulity Surveys. — Statistics on characteristics of births anddeaths not available from the vital records, based on sample surveys stemming from these records,including such topics as mortality by socioeconomic class, medical experience in the last year oflife, characteristics of pregnancy, erc.

For a list of titles of reports published in these series, write to: Office of Information

National Center for Health StatisticsU.S. Public Health ServiceWashington, D.C. 20201