A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs
Authors: Billings Curtis J. , Dillard Lauren K. , Hoskins Zachary B. , Penman Tina M. , Reavis Kelly M. 
Published: November 2017

Background:Department of Veterans Affairs (VA) audiologists have anecdotally reported examining numerous Veterans with normal pure-tone thresholds; however, the prevalence of these patients within the VA is unknown. The VA audiological data repository provides an ideal dataset
to examine this group of Veterans. Knowing the prevalence of normal-hearing Veterans within the VA system is the first step to understanding the underlying referral patterns and clinical complaints of Veterans. Data repositories which capture data from both normal and impaired populations
provide an indispensable view into hearing health care which can help to improve diagnosis and treatment of Veterans’ hearing difficulties.Purpose:Using the VA audiological data repository, this study aimed to (1) determine the prevalence of normal hearing thresholds among Veterans
seeking hearing health care within the VA health care system and (2) determine the prevalence of abnormal clinical audiology test results among Veterans with normal hearing thresholds.Research Design:This study was a large-scale retrospective, descriptive observational analysis of uploaded
audiological records from the VA Denver Acquisition and Logistics Center audiological data repository encompassing visits that took place between April 1991 and June 2015.Study Sample:At the time of data extraction, there were 3,641,326 audiological records in the repository, with 2,322,771
unique individual records. The study sample was further restricted to include only individuals with normal hearing (n = 235,091), which was defined as pure-tone thresholds better than, or equal to, 25 dB HL at octave frequencies from 250 to 8000 Hz, bilaterally. Patients ranged from 19 to
90+ years of age.Data Collection and Analysis:We describe the data using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. In addition to hearing thresholds, the occurrence of abnormal results on other tests in the audiological
test battery is also reported. We estimate the prevalence of normal hearing among all Veterans with records in the VA audiological data repository.Results:Veterans with normal hearing were on average 37 yr old. The prevalence of Veterans with normal hearing thresholds visiting VA audiology
clinics in the current hearing repository dataset was 10.12%. Overall, 41% of Veterans with normal pure-tone thresholds had other clinically abnormal audiological test results; for example, contralateral acoustic reflex thresholds (31.7%) and tympanometry (21.5%) had the highest rate of abnormal
test results.Conclusions:Approximately one in ten Veterans seeking care within the VA healthcare system, and reported to the VA audiological data repository, has normal pure-tone hearing thresholds. This may be an underestimate of the true underlying prevalence of normal-hearing Veterans
seeking audiology services at the VA because records with normal results were not consistently submitted to the repository. In addition, 41% of Veterans with normal pure-tone thresholds nonetheless presented with other audiological abnormalities. This study suggests that future work directed
toward understanding referral patterns and clinical complaints of individuals who present to VA audiology clinics with normal hearing thresholds may be fruitful in the cause of improving diagnosis and treatment of Veterans’ hearing difficulties.