CDC/NIOSH for Audiometric Support for 3 NIDCD-Sponsored, Population-Based Surveys

这项协议的目的是为NIDCD资助的三项大型听力检查调查的科学和技术支持以及质量保证提供资金。这些健康调查是：(I)国家健康和营养检查调查(NHANES)，(Ii)年龄、基因/环境易感性研究-雷克雅未克研究(AGES-RS)，以及(Iii)幼儿纵向研究--2010/2011幼儿园班(ECLS-K：2010/2011)。所有三项健康检查调查的测听部分都是由NIDCD与NIOSH和其他顾问合作开发的。NIOSH合作设计了实验方案，并为NHANES提供了设备规格、维护和校准监督、技术人员培训和监督、操作手册开发以及质量保证。此外，NIOSH还向AGES和ECLS-K：2010/2011提供了类似的支持，包括举办培训班和观察/监测获得听力测量的技术能力、必要的技术援助和有限的质量保证。NHANES的科学目标是为美国人口的总体健康(包括听力健康)建立一个统计上准确的、具有人口统计学代表性的基线。NHANES现在是一项持续的调查，尽管身高、体重和血压等一般健康问题一直在调查中，但也有一些元素跟踪随着NHANES的周期进出NHANES的个人健康结果。NHANES由两个主要部分组成：家庭访谈和在全国各地设立的NHANES流动考试中心(MEC)进行的体检。来自NHANES元素的数据被收集、加权，并作为数据库提供给政府和公众，可以在其上进行分析。最近，数据每两年发布一次，合作机构在数据集公开发布前六个月收到数据。AGES-RS的科学目标是：1)确定选定疾病的遗传和新的危险因素，包括动脉粥样硬化、认知障碍、痴呆症、中风、听力损失、视力损害、骨质疏松症和肥胖症；2)表征这些疾病和条件的表型；以及3)确定与这些条件相关的分子标记。 拟议的ECLS：K-2011三年级数据收集测听方案包括四个部分：(1)测试前问题：儿童将被问及一系列关于可能影响测试结果的条件(寒冷或耳痛、过去24小时内暴露于噪音中、是否有PE管，以及一个耳朵是否比另一个耳朵更好)的简短问题；(2)耳镜检查：儿童将接受简短的耳朵视觉检查，主要是为了确保声音路径清晰。此外，技术人员将注意到脑脊液过多或任何其他严重异常的存在，这可能会影响听力测量结果的解释。耳镜检查不是诊断性的；它只是观察性的；(3)宽带反射术，包括鼓室导纳：将进行双侧中耳的自动宽带反射/鼓室导纳评估。结果的分析和解释将远程进行；(4)纯音测听：在时间和儿童注意力允许的情况下，将在1000、2000、3000、4000、6000和8000赫兹获得双边纯音气导阈值。作为测试可靠性的衡量标准，将在两只耳朵中获得2000赫兹的重测阈值。阈值将使用改进的休森-韦斯特莱克技术手动获得。第一个测试耳将被交替，以避免学习效果在阈值上的偏差。频率将按指定的顺序进行测试，以获得更重要的频率数据，以防时间或儿童的注意力在所有频率完成之前耗尽。所有三项健康调查都有类似的听力检查部分，由NIDCD、NIOSH、NCHS、Westat、冰岛心脏协会研究所和国家教育统计中心教育部共同开发。听力部分包括：1)一组关于听力、噪音暴露和其他与听力有关的因素的问卷，以及2)听力检查，包括耳镜、声导抗(双侧鼓室导纳测量或宽带反射测量和1000和2000赫兹同侧声反射的筛查)，以及纯音、空气传导测听，以确定每只耳朵在几个频率上的听力阈值，如500、1000、2000、3000、4000、6000和8000赫兹。重复阈值测试是在1000赫兹或2000赫兹获得的，作为测试可靠性的衡量标准。当发现显著的耳间差异时，则可以使用插入耳机来执行重新测试以最大化耳间衰减，而不是使用非测试耳的噪声掩蔽器来获得测试耳中的被称为掩蔽阈值，以避免记录来自较好的非测试耳的阴影听力图。

The purpose of this agreement is to provide funding for scientific and technical support as well as quality assurance of three large audiometric examination surveys funded by NIDCD. These health surveys are: (i) The National Health and Nutrition Examination Survey (NHANES), (ii) Age, Gene/Environment Susceptibility Study-Reykjavik Study (AGES-RS), and (iii) the Early Childhood Longitudinal Study - Kindergarten Class of 2010/2011 (ECLS-K:2010/2011). The Audiometry Components of all three health examination surveys were previously developed by NIDCD in collaboration with NIOSH and other consultants. NIOSH collaborated on the design of the experimental protocol and provided the equipment specifications, oversight of maintenance and calibration, technician training and oversight, operations manual development, and quality assurance for the NHANES. As well, NIOSH provided similar support to AGES and ECLS-K:2010/2011, including setting-up training sessions and observing/monitoring technical competence in obtaining audiometric measurements, technical assistance as needed, and limited quality assurance. The NHANES scientific goals are to establish a statistically accurate, demographically representative baseline on the general health (including Hearing Health) of the U.S. population. NHANES is now a continuous survey and while general health issues are always under investigation such as height, weight and blood pressure, there are also elements that track individual health outcomes that move in and out of the NHANES as it cycles. NHANES consists of two major components: the household interview and the physical examination in the NHANES Mobile Examination Centers (MECs) that are set up in various areas around the country. The data from the NHANES elements are collected, weighted, and made available to the government and the public as a database on which analysis may be performed. Recently, the data have been released every two years with collaborating agencies receiving the data six months prior to the public release of the data sets. The AGES-RS scientific goals are: 1) to identify genetic and new risk factors for selected diseases including atherosclerosis, cognitive impairment, dementia, stroke, hearing loss, visual impairment, sarcopenia, osteoporosis, and obesity, 2) to characterize phenotypes for these diseases and conditions, and 3) to identify contributory molecular markers associated with these conditions. The proposed ECLS:K-2011 audiometry protocol for the third-grade data collection includes four components: pre-test questions, otoscopy, wideband reflectometry with tympanometry, and pure tone audiometry: (1) Pre-Test Questions: Children will be asked a series of short questions regarding conditions which could affect the test results (cold or earaches, noise exposure within past 24 hours, presence of pe tubes, and whether one ear is better than the other); (2) Otoscopy: Children will receive a brief visual examination of the ear, primarily to assure a clear sound path. In addition, the technicians will note the presence of excessive cerumen or any other gross abnormality which could affect interpretation of audiometric findings. The otoscopic exam will not be diagnostic; it will simply be observational; (3) Wideband Reflectometry, including Tympanometry: An automated wideband reflectometric/tympanometric evaluation of the middle ear will be conducted bilaterally. Analysis and interpretation of the results will be done remotely; (4) Pure Tone Audiometry: Pure tone air conduction thresholds will be obtained bilaterally at 1000, 2000, 3000, 4000, 6000, and 8000 Hz insofar as time and the child's attention permits. A retest threshold will be obtained in both ears at 2000 Hz as a measure of test reliability. The thresholds will be obtained manually using a modified Hughson-Westlake technique. The first test ear will be alternated to avoid learning effect bias in the thresholds. Frequencies will be tested in a specified order to obtain the more important frequency data first in case time or the child's attention runs out before all frequencies are completed. All three health surveys share similar hearing exam components, developed collaboratively by NIDCD, NIOSH, NCHS, WESTAT, the Icelandic Heart Association Research Institute, and the Department of Educations, National Center for Education Statistics. The hearing component consists of: 1) a set of questionnaires relating to hearing, noise exposure, and other factors relating to hearing, and 2) audiometric examinations consisting of otoscopy, acoustic immittance (bilateral tympanometry or wide-band reflectometry and screening for ipsilateral acoustic reflexes at 1000 and 2000 Hz), and pure-tone, air-conduction audiometry to determine the hearing thresholds in each ear at several frequencies, such as 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. A repeat threshold test is obtained at 1000 Hz or 2000 Hz as a measure of test reliability. When significant inter-ear differences are found, then retests may be performed using insert earphones to maximize the inter-aural attenuation rather than using a noise masker of the non-test ear to obtain what is referred to as masked threshold in the in the test ear to avoid recording of a shadow audiogram from the better non-test ear.