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  1. Ishak WS, Zhao F, Rajenderkumar D, Arif M
    Int Tinnitus J, 2013;18(1):35-44.
    PMID: 24995898 DOI: 10.5935/0946-5448.20130006
    The general consensus on the roles of hearing loss in triggering tinnitus seems not applicable in patients with normal hearing thresholds. The absence of hearing loss on the audiogram in this group of patients poses a serious challenge to the cochlear theories in explaining tinnitus generation in this group of patients.
  2. Mukari SZ, Yu X, Ishak WS, Mazlan R
    Int J Audiol, 2015;54(12):951-7.
    PMID: 26378803 DOI: 10.3109/14992027.2015.1077399
    The aims of the present study were to determine the effects of language background on the performance of the pitch pattern sequence test (PPST) and duration pattern sequence test (DPST). As temporal order sequencing may be affected by age and working memory, these factors were also studied.
  3. Mah HY, Ishak WS, Abd Rahman MH
    Geriatr Gerontol Int, 2020 Oct;20(10):911-916.
    PMID: 32820857 DOI: 10.1111/ggi.14011
    The present study aimed to examine the prevalence of dual sensory impairment, and to identify its risk factors among community-dwelling older adults in Selangor.

    METHODS: Secondary analysis was carried out on data collected by the Grand Challenge Project among older adults aged ≥65 years from Selangor. Data on sociodemographic information, medical history, cognitive function and functional performance were obtained through face-to-face interviews using standardized questionnaires. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart while hearing was assessed using pure-tone audiometry. Descriptive analysis was used to measure the prevalence of the impairments, and logistic regression analysis was used to identify the risk factors.

    RESULTS: The prevalence of dual sensory impairment and hearing impairment were at 10.5% and 76.2% respectively. Multivariate logistic regression analysis revealed that participants with lower cognitive scores were associated with dual sensory impairment (odds ratio, 0.90; 95% confidence interval, 0.83-0.98), while smoking was found associated with hearing impairment (odds ratio, 6.58; 95% confidence interval, 1.51-28.65).

    CONCLUSION: Dual sensory impairment is common among older adults in Selangor. The association between dual sensory impairment and cognitive function suggests the need to have visual and hearing screening on older adults for early detection particularly those at risk of cognitive impairment. The prevalence of hearing impairment was reported high among older adults and smokers appeared to be at higher risk of the impairment. Geriatr Gerontol Int 2020; 20: 911-916.

  4. Mukari SZMS, Yusof Y, Ishak WS, Maamor N, Chellapan K, Dzulkifli MA
    Braz J Otorhinolaryngol, 2018 12 10;86(2):149-156.
    PMID: 30558985 DOI: 10.1016/j.bjorl.2018.10.010
    INTRODUCTION: Hearing acuity, central auditory processing and cognition contribute to the speech recognition difficulty experienced by older adults. Therefore, quantifying the contribution of these factors on speech recognition problem is important in order to formulate a holistic and effective rehabilitation.

    OBJECTIVE: To examine the relative contributions of auditory functioning and cognition status to speech recognition in quiet and in noise.

    METHODS: We measured speech recognition in quiet and in composite noise using the Malay Hearing in noise test on 72 native Malay speakers (60-82 years) older adults with normal to mild hearing loss. Auditory function included pure tone audiogram, gaps-in-noise, and dichotic digit tests. Cognitive function was assessed using the Malay Montreal cognitive assessment.

    RESULTS: Linear regression analyses using backward elimination technique revealed that had the better ear four frequency average (0.5-4kHz) (4FA), high frequency average and Malay Montreal cognitive assessment attributed to speech perception in quiet (total r2=0.499). On the other hand, high frequency average, Malay Montreal cognitive assessment and dichotic digit tests contributed significantly to speech recognition in noise (total r2=0.307). Whereas the better ear high frequency average primarily measured the speech recognition in quiet, the speech recognition in noise was mainly measured by cognitive function.

    CONCLUSIONS: These findings highlight the fact that besides hearing sensitivity, cognition plays an important role in speech recognition ability among older adults, especially in noisy environments. Therefore, in addition to hearing aids, rehabilitation, which trains cognition, may have a role in improving speech recognition in noise ability of older adults.

  5. Quar TK, Soli SD, Chan YF, Ishak WS, Abdul Wahat NH
    Int J Audiol, 2017 02;56(2):92-98.
    PMID: 27686009 DOI: 10.1080/14992027.2016.1210828
    OBJECTIVE: This study was conducted to evaluate the speech perception of Malaysian Chinese adults using the Taiwanese Mandarin HINT (MHINT-T) and the Malay HINT (MyHINT).

    DESIGN: The MHINT-T and the MyHINT were presented in quiet and noise (front, right and left) conditions under headphones. Results for the two tests were compared with each other and with the norms for each test.

    STUDY SAMPLE: Malaysian Chinese native speakers of Mandarin (N = 58), 18-31 years of age with normal hearing.

    RESULTS: On average, subjects demonstrated poorer speech perception ability than the normative samples for these tests. Repeated measures ANOVA showed that speech reception thresholds (SRTs) were slightly poorer on the MHINT-T than on the MyHINT for all test conditions. However, normalized SRTs were poorer by 0.6 standard deviations for MyHINT as compared with MHINT-T.

    CONCLUSIONS: MyHINT and MHINT-T can be used as norm-referenced speech perception measures for Mandarin-speaking Chinese in Malaysia.

  6. Harithasan D, Mukari SZS, Ishak WS, Shahar S, Yeong WL
    Int J Geriatr Psychiatry, 2020 04;35(4):358-364.
    PMID: 31736109 DOI: 10.1002/gps.5237
    OBJECTIVES: The objective of this study was to evaluate the relationship between sensory impairment (hearing loss only, vision loss only, and dual sensory impairment [DSI]) and depression, loneliness, quality of life, and cognitive performance in older adults.

    METHODS: A total of 229 community-dwelling older adults aged 60 years or older participated in this study. Variables were measured using the Geriatric Depression Scale (GDS-15), Revised University of California at Los Angeles Loneliness Scale (R-UCLA), Satisfaction with Life Scale (SWLS), and Mini-Mental State Examination (MMSE).

    RESULTS: There was an independent association between DSI and quality of life (P < .05) and between DSI and hearing loss alone and cognitive function (P < .05) in older adults. In addition, higher education was associated with better quality of life and cognitive function.

    CONCLUSIONS: DSI is a significant factor affecting the quality of life and cognitive function in older adults. Sociodemographic factors such as education play an important role in improving quality of life and cognitive function. Thus, increasing the awareness of this disability is important to ensure that older adults receive the necessary support services and rehabilitation to improve their level of independence.

  7. Yusof Y, Mukari SZS, Dzulkifli MA, Chellapan K, Ahmad K, Ishak I, et al.
    Geriatr Gerontol Int, 2019 Aug;19(8):768-773.
    PMID: 31237107 DOI: 10.1111/ggi.13710
    AIM: To evaluate the efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognition among older adults with normal cognition (NC) and with neurocognitive impairment (NCI).

    METHODS: A double-blind quasi-experiment was carried out on NC (n = 43) and NCI (n = 33) groups. Participants in each group were randomly assigned into treatment and control programs groups. The treatment group underwent auditory-cognitive training, whereas the control group was assigned to watch documentary videos, three times per week, for 8 consecutive weeks. Study outcomes that included Montreal Cognitive Assessment, Malay Hearing in Noise Test, Dichotic Digit Test, Gaps in Noise Test and Pitch Pattern Sequence Test were measured at 4-week intervals at baseline, and weeks 4, 8 and 12.

    RESULTS: Mixed design anova showed significant training effects in total Montreal Cognitive Assessment and Dichotic Digit Test in both groups, NC (P 

  8. Mukari SZS, Ishak WS, Maamor N, Wan Hashim WF
    Ann Otol Rhinol Laryngol, 2017 Oct;126(10):697-705.
    PMID: 28845678 DOI: 10.1177/0003489417727547
    OBJECTIVES: Studies in cognitive aging demonstrated inconsistent association between hearing and cognition in older adults. Furthermore, it is still unclear if hearing loss at high frequencies, which is the earliest to be affected, is associated with cognitive functioning. This study aimed to determine the association between global cognitive status and pure tone average (PTA) at 0.5, 1, and 2 kHz (PTA low) and PTA at 4 and 8 kHz (PTA high).

    METHODS: This study involved 307 adults aged 60 years and older. Participants had their hearing and cognition measured using pure tone audiometry and Mini Mental State Examination (MMSE), respectively.

    RESULTS: Pure tone average (low) accounted for significant but minimal amount of variance in measure of MMSE. Multiple regression analyses were also performed on normal and impaired hearing cohorts and cohorts with younger (60-69 years) and older (≥70 years) groups. The results revealed a significant relationship between PTA (low) and MMSE only in the younger age group. In contrast, no significant relationship was found between PTA (high) and cognition in any of the cohorts.

    CONCLUSION: Pure tone average (low) is significantly but minimally related to measure of general cognitive status. Similar relationship is not observed between high-frequency hearing and cognition. Further research using a more comprehensive cognitive test battery is needed to confirm the lack of association between high-frequency hearing and cognition.

  9. Quar TK, Rashid MFN, Rosdi MYM, Ishak WS, Chong FY
    Am J Audiol, 2023 Mar;32(1):59-69.
    PMID: 36446036 DOI: 10.1044/2022_AJA-22-00033
    OBJECTIVE: This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic.

    DESIGN: A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services.

    STUDY SAMPLE: One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey.

    RESULTS: Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important.

    CONCLUSIONS: Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.

  10. Ooi TC, Ishak WS, Sharif R, Shahar S, Rajab NF, Singh DKA, et al.
    Clin Interv Aging, 2021;16:2033-2046.
    PMID: 34949916 DOI: 10.2147/CIA.S340432
    Purpose: This study evaluates the prevalence of and the multidimensional risk factors associated with age-related hearing loss (ARHL) among community-dwelling older adults in Malaysia.

    Patients and Methods: A total of 253 participants aged 60 years and above participated in this cross-sectional study. The participants were subjected to pure tone audiometric assessment. The hearing threshold was calculated for the better ear and classified into pure-tone average (PTA) for the octave frequencies from 0.5 to 4 kHz and high-frequency pure-tone average (HFA) for the octave from 2 to 8kHz. Then, the risk factors associated with PTA hearing loss (HL) and HFAHL were identified by using multivariate logistic regression analysis.

    Results: The prevalence of ARHL based on PTA and HFA among the community-dwelling older adults was 75.5% and 83.0%, respectively. Following multifactorial adjustments, being older (OR: 1.239; 95% CI: 1.062-1.445), having higher waist circumference (OR: 1.158; 95% CI: 1.015-1.322), lower intake of niacin (OR: 0.909; 95% CI: 0.831-0.988) and potassium (OR: 0.998; 95% CI: 0.996-1.000), and scoring lower in RAVLT T5 (OR: 0.905; 95% CI: 0.838-0.978) were identified as the risk factors of PTAHL. Meanwhile, being older (OR: 1.117; 95% CI: 1.003-1.244), higher intake of carbohydrate (OR: 1.018; 95% CI: 1.006-1.030), lower intake of potassium (OR: 0.998; 95% CI: 0.997-0.999), and lower scores on the RAVLT T5 (OR: 0.922; 95% CI: 0.874-0.973) were associated with increased risk of having HFAHL.

    Conclusion: Increasing age, having higher waist circumference, lower intake of niacin and potassium, higher intake of carbohydrates and having lower RAVLT T5 score were associated with increased risk of ARHL. Modifying these risk factors may be beneficial in preventive and management strategies of ARHL among older persons.

  11. Mohd Rosnu NS, Ishak WS, Abd Rahman MH, Shahar S, Musselwhite C, Mat Ludin AF, et al.
    Front Public Health, 2023;11:1153822.
    PMID: 37275505 DOI: 10.3389/fpubh.2023.1153822
    INTRODUCTION: Aging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults.

    METHODS: One hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants' physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking).

    RESULTS: Further information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs.

    DISCUSSION: The majority (51%) of participants were in the 'using only private vehicles' group, followed by the 'flexibles' (25%) and the 'restricted' (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86-23.39, p 

  12. Lau H, Shahar S, Hussin N, Kamarudin MZ, Hamid TA, Mukari SZ, et al.
    Geriatr Gerontol Int, 2019 Mar;19(3):233-239.
    PMID: 30618211 DOI: 10.1111/ggi.13598
    AIM: The 36-month Long-Term Research Grant Scheme project: Towards Usual Aging - Neuroprotective Model for Healthy Longevity among Malaysian Elderly was designed to address multidimensional aspects including psychosocial, biophysical health, nutrition and dietary pattern, and auditory and visual function to highlight the magnitude of these associations in a single study.

    METHODS: A total of 2322 respondents aged ≥60 years were recruited at baseline using the multistage sampling method, followed up at 18 months and 36 months.

    RESULTS: Response rates at baseline, 18 months and 36 months were 87.8%, 77.3% and 67.1%, respectively. At baseline, the prevalence of successful aging, usual aging and mild cognitive impairment was 11%, 73% and 16%, respectively. The prevalence of single and multimorbidity at baseline were 25.9% and 50.3%, respectively. The incidence rates of mild cognitive impairment at 18 months and 36 months were 6.5 and 5.6 per 100 person-years. The incidence rates of multimorbidity at 18 months and 36 months were 23.7 and 21.5 per 100 person-years, respectively.

    CONCLUSIONS: The Long-Term Research Grant Scheme project: Towards Usual Aging study provides an opportunity to investigate the interactions between wide ranges of aspects of the older population in a nationally representative sample of the older population. Geriatr Gerontol Int 2019; 19: 233-239.

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