Hearing impairment, psychological distress, and incident heart failure: a prospective cohort study

BACKGROUND

The relationship between objectively measured hearing ability and the risk of incident heart failure (HF) remains unclear. This study aimed to assess this association, explore potential modifying factors, and examine whether psychological factors mediate this relationship.

METHODS

We included 164 431 participants from the UK Biobank without HF at baseline. Speech-in-noise hearing ability was measured using the Digit Triplets Test and quantified by the speech-reception-threshold (SRT). Incident HF was identified through hospital admission and death records. Mediation analyses assessed the role of social isolation, psychological distress, and neuroticism.

RESULTS

Over a median follow-up of 11.7 years, 4449 (2.7%) participants developed incident HF. Higher SRT levels were associated with an increased risk of HF (adjusted HR per SD increment 1.05, 95% CI 1.02 to 1.08). Compared with those with normal hearing, participants with insufficient hearing, poor hearing, or hearing aid use had higher HF risks (adjusted HRs 1.15, 1.28, and 1.26, respectively). Psychological distress mediated 16.9% of the association between SRT levels and HF, while social isolation and neuroticism mediated 3.0% and 3.1%, respectively. The association was stronger in participants without coronary heart disease or stroke at baseline.

CONCLUSIONS

Poor hearing ability is associated with an increased risk of incident HF, with psychological distress playing a notable mediating role. These findings suggest that hearing health and psychological well-being should be considered in cardiovascular risk assessment and prevention strategies.

Audiological Profile in Patients of Chronic Stable Angina with Hearing Loss

Cardiovascular disease can affect cochlear blood flow and hearing, yet research on hearing loss in chronic stable angina patients is limited. This study aimed to investigate the relationship between hearing loss and chronic stable angina and establish association between the type and extent of hearing loss with the severity and duration of chronic stable angina. A cross-sectional study was conducted at GSVM Medical College, Kanpur, U.P. for a duration of 12 months, to examine the relationship between chronic stable angina and hearing loss. The study involved 150 patients aged 35-55 years, predominantly men with a mean age of 50 years. Participants underwent otoscopic examination and pure-tone audiometry to assess hearing. Using the NYHA criteria, patients were classified based on the severity of angina. Statistical analysis was performed with chi-square tests to identify association. 14% of patients (n=21) had bilateral hearing loss, ranging from mild to moderately severe, while 6% (n=10) had unilateral hearing loss, predominantly affecting the right ear. Notably, 80% (n=119) had normal hearing sensitivity in both ears. The hearing loss observed was sensorineural type characterized by low frequency loss. Additionally, the duration of chronic stable angina influenced hearing thresholds and hearing loss was not related to drug therapy for chronic stable angina. These findings highlight the association between chronic stable angina and hearing loss, underscoring the importance of early detection and prevention. Integrating audiologists into cardiovascular care teams could be beneficial for managing audiological concerns in patients with cardiovascular disease.

Cardiovascular Diseases and Sensorineural Hearing Loss-A Systematic Review of the Literature

OBJECTIVES

To assess the relationship of cardiovascular disease (CVD) and sensorineural hearing loss (SNHL).

DATABASES REVIEWED

Ovid MEDLINE, Web of Science, Scopus, and Cochrane.

METHODS

A systematic review was performed. Studies were identified using Ovid MEDLINE, Web of Science, Scopus, and Cochrane from 1946 to 2023. Per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, abstracts were screened for primary review. Full texts were reviewed for secondary review.

RESULTS

There were 3,440 unique abstracts screened. After primary review of abstracts and secondary full text review, 68 articles were included. The relationship between SNHL and the following CVDs, risk factors, and interventions were ascertained: coronary artery bypass graft (CABG) surgery, coronary artery disease (CAD), carotid stenosis (CS), myocardial infarction (MI), percutaneous coronary intervention (PCI), other arteriosclerosis, cerebral small vascular disease, cerebrovascular accident (CVA), transient ischemic attack (TIA), peripheral vascular disease (PVD), hyperlipidemia (HLD), hypertension (HTN), and diabetes mellitus (DM). CABG and CAD were consistently associated with SNHL. DM was associated with SNHL, but HTN and HLD were not consistently associated.

CONCLUSIONS

There is a complex relationship between CVDs and SNHL. CABG and CAD were consistently associated with SNHL. DM was associated with SNHL, but other CVD risk factors (HTN and HLD) did not appear to consistently correlate with SNHL, raising consideration that SNHL is a later finding in those with CVD.

White Matter Hyperintensity in Patients with Sudden Sensorineural Hearing Loss

OBJECTIVE

To compare white matter hyperintensities (WMHs) on T2-weighted magnetic resonance imaging (MRI) of patients with sudden sensorineural hearing loss (SSNHL) and analyze subpopulations with age-matched controls.

METHODS

T2-weighted MRI scans of 150 patients with SSNHL were assessed for WMHs and compared with the data of 148 healthy age-matched adults. Assessments of WMHs included independent grading of deep white matter hyperintensities (DWMHs) and periventricular hyperintensities (PVHs). WMH severity was visually rated using the Fazekas and Mirsen scales by two independent observers.

RESULTS

Fazekas grades for PVHs (p < 0.001) and DWMHs (p < 0.001) of SSNHL patients were found to be significantly greater than those of healthy participants. The average Mirsen grades for DWMHs of healthy and SSNHL patients were evaluated to be 0.373 ± 0.550 and 2.140 ± 0.859, respectively. Mirsen grades for DWMHs of SSNHL patients were found to be significantly greater (p < 0.001) than those of healthy participants. The Mirsen scale was found to have higher sensitivity (p < 0.001) than the Fazekas scale in grading PVHs and DWMHs. No significant difference (p = 0.24) was found in specificities between the two scales.

CONCLUSIONS

Patients with sudden hearing loss have a much higher likelihood of having periventricular and deep white matter hyperintensities compared to age-matched controls. These findings indicate that sudden hearing loss patients are more likely to have microvascular changes in the brain, which may indicate a vascular and/or migraine origin to sudden sensorineural hearing loss.

Relationship Between Hypertension and Hearing Loss: Analysis of the Related Factors

Purpose

The impact of hypertension extends to hearing loss, aging, and mental Health. The purpose of this study was to investigate the characteristics of hearing loss and hearing thresholds at different frequencies in individuals with hypertension. Through a comprehensive analysis, in the present study, it aimed to uncover the contributing factors that underlie hearing loss in this patient cohort, shedding light on the complex relationship between hypertension and auditory impairment.

Patients and Methods

This was a single-center population-based observational study, and clinical, biological, and hospital data were collected from the inpatient ward. In the present study, 517 patients (1034 ears) with or without hypertension were included, and the proportion of patients with hearing loss, mean pure-tone average hearing threshold, low-frequency pure-tone average hearing threshold (LFPTA), medium-frequency pure-tone average hearing threshold (MFPTA) and high-frequency pure-tone average hearing threshold (HFPTA) were evaluated. Risk factors related to hearing loss and hearing threshold were also estimated at different frequencies.

Results

The proportion of patients with hearing loss was higher in the hypertensive group than in the nonhypertensive group (P<0.05). After including risk factors for cardiovascular disease that can have an impact on the parameters of hearing and ambulatory blood pressure in the regression model, factors related to hearing loss included the albumin-to-creatinine ratio (ACR) and the standard deviation of the 24-hour systolic blood pressure (24h-SSD). ACR, 24h-SSD, and day systolic blood pressure (Day SBP) were associated with the mean pure-tone average hearing threshold, LFPTA, MFPTA, and HFPTA. The area under the receiver operating characteristic curve of ACR + 24h-SSD for hearing loss was 0.873, with a sensitivity of 86.73%, specificity of 90.52%, and a 95% confidence interval of 0.821-0.914.

Conclusion

Hypertension is correlated with hearing loss, and the combination of ACR and 24h-SSD demonstrates an improved predictive capacity for hearing loss in hypertensive patients.

The Impact of Cardiovascular Risk Factors on the Incidence, Severity, and Prognosis of Sudden Sensorineural Hearing Loss (SSHL): A Systematic Review

Sudden sensorineural hearing loss (SSHL) is believed to be mainly idiopathic since the cause is not usually identified. Several recent studies have examined the role of cardiovascular risk factors in this disease. The aim of this systematic literature review is to investigate the possible association between acquired and inherited cardiovascular risk factors and the incidence, severity, and prognosis of SSHL. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the PubMed database for the period between February 2010 and January 2023 was performed in order to retrieve eligible articles. The analytic cohort included 24 studies. Overall, this systematic review includes a total of 61,060 patients that were encompassed in these studies. According to most studies, the prevalence of dyslipidaemia, diabetes, and ultrasound indices of atherosclerosis was significantly higher in SSHL patients compared to controls. On the other hand, obesity, hypertension, and smoking did not seem to influence the risk of SSHL. Most studies suggest the presence of a correlation between a high cardiovascular risk profile and the risk of developing SSHL. The theory of microvascular impairment in the development of SSHL is indirectly supported by the findings of this review.

Individual Patient Comorbidities and Effect on Cochlear Implant Performance

OBJECTIVE

To examine the association between preoperative comorbidities and cochlear implant speech outcomes.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary referral center.

PATIENTS

A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included.

EXPOSURE

Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes.

MAIN OUTCOME MEASURES

Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months.

RESULTS

A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC.

CONCLUSIONS

Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.

A Comprehensive Study on Sudden Deafness for Analyzing Their Clinical Characteristics and Prognostic Factors

Background: To study the factors associated with the prognosis of patients with sudden deafness to facilitate clinical treatment and improve efficacy. Methods: A total of 414 patients with sudden deafness treated in Zhenjiang First People's Hospital from January 2020 to December 2022 were chosen. Relevant data were gathered and the effectiveness of treatment was assessed by comparing hearing test results before and after hospital admission and divided into effective and ineffective groups, and the effectiveness of each factor was analyzed using univariate analysis, Spearman's correlation analysis, and multifactor logistic regression. Results: The 2 groups had significant differences in age, presence of tinnitus, degree of hearing loss, and triglyceride levels. Spearman's rank correlation analysis showed a negative correlation between hearing threshold of at least 81 dB at 250 to 8000 Hz, the low-density lipoprotein (LDL), triglyceride levels, and the prognosis (r < 0, P < .001). A positive correlation exists between high-density lipoprotein levels and prognosis (r > 0, P < .001). Receiver operating characteristic curve showed LDL level, age, and time since disease onset appears to be highly predictive. Multivariable logistic regression analysis showed that age >47 years, LDL >2.93 mmol/L, and time to presentation >10 days after disease onset are at higher risk for poor prognosis. Conclusion: Factors that influence the prognosis of patients with sudden deafness include age, tinnitus symptoms, high LDL levels, and the type of hearing curve. Early intervention and targeted treatment should be given to high-risk patients to improve the outcome of sudden deafness in clinical practice.

The Association between Serum Lipid Levels and Tinnitus Prevalence and Severity in Korean Elderly: A Nationwide Population-Based Cross-Sectional Study

PURPOSE

We aimed to investigate the association between serum lipid level and tinnitus risk in Korean older adults.

MATERIALS AND METHODS

This study used data from the 2016-2018 Korea National Health and Nutrition Examination Survey. Overall, 6021 subjects aged ≥60 years were included. Hypertriglyceridemia was defined as a serum triglyceride level of ≥200 mg/dL. The high-risk threshold of the total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio was defined as above 5.0. The presence of tinnitus was assessed via health interviews. Tinnitus severity was classified as "not annoying," "irritating," and "severely annoying and causing sleep problems." Multivariate logistic regression analysis was performed to examine the association between serum lipid level and tinnitus risk.

RESULTS

The odds ratio (OR) of tinnitus was 1.27-times higher in the group with hypertriglyceridemia than in the group without hypertriglyceridemia after adjusting for age, sex, hypertension, diabetes, dyslipidemia, anemia, current smoking, obesity, noise exposure, stress cognition, and depressive mood or anxiety [95% confidence interval (CI) 1.04-1.56, p=0.022]. The OR of tinnitus was 1.21-times higher in the group with a high TC/HDL-C ratio than in the group without a high TC/HDL-C ratio after adjusting for the same variables as above (95% CI 1.02-1.44, p=0.025).

CONCLUSION

This study revealed that hypertriglyceridemia and high TC/HDL-C ratio were significantly associated with an increased OR of tinnitus in Korean older adults.

Association Between Hearing Loss and Cardiovascular Disease: A Meta-analysis

OBJECTIVE

Hearing loss (HL) has been postulated to be linked to cardiovascular diseases (CVDs) via vascular mechanisms, but epidemiological associations remain unclear. The study aims to clarify the association between HL and stroke, coronary artery disease (CAD), and any CVD.

DATA SOURCES

PubMed, Embase, and SCOPUS from inception until April 27, 2022.

REVIEW METHODS

Three blinded reviewers selected observational studies reporting stroke, CAD, and any CVD in patients with HL, compared to individuals without HL. We extracted data, evaluated study bias using the Newcastle-Ottawa scale, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and a PROSPERO-registered protocol (CRD42022348648). We used random-effects inverse variance meta-analyses to pool the odds ratios (ORs) for the association of HL with stroke, CAD, and any CVD.

RESULTS

We included 4 cohort studies (N = 940,771) and 6 cross-sectional studies (N = 680,349). Stroke, CAD, and any CVD were all strongly associated with HL. The overall pooled OR of the association between HL and stroke was 1.26 (95% confidence interval [CI] = 1.16-1.37, I2  = 78%), and was 1.33 (95% CI = 1.12-1.58) and 1.29 (95% CI = 1.14-1.45) for low- and high-frequency HL, respectively. Minimal publication bias was observed, with minimal change to pooled effect size following trim and fill. Similarly, the pooled OR of the association between HL and CAD was 1.36 (95% CI = 1.13-1.64, I2  = 96%), while that between HL and any CVD was 1.38 (95% CI = 1.07-1.77, I2  = 99%).

CONCLUSION

Our findings suggest that HL and CVD are closely related. Physicians treating patients with HL should be cognizant of this association and view HL in the broader context of general health and aging.

Predicting Atrophy of the Cochlear Stria Vascularis from the Shape of the Threshold Audiogram

Several lines of evidence have suggested that steeply sloping audiometric losses are caused by hair cell degeneration, while flat audiometric losses are caused by strial atrophy, but this concept has never been rigorously tested in human specimens. Here, we systematically compare audiograms and cochlear histopathology in 160 human cases from the archival collection of celloidin-embedded temporal bones at the Massachusetts Eye and Ear. The dataset included 106 cases from a prior study of normal-aging ears, and an additional 54 cases selected by combing the database for flat audiograms. Audiogram shapes were classified algorithmically into five groups according to the relation between flatness (i.e., SD of hearing levels across all frequencies) and low-frequency pure-tone average (i.e., mean at 0.25, 0.5, and 1.0 kHz). Outer and inner hair cell losses, neural degeneration, and strial atrophy were all quantified as a function of cochlear location in each case. Results showed that strial atrophy was worse in the apical than the basal half of the cochlea and was worse in females than in males. The degree of strial atrophy was uncorrelated with audiogram flatness. Apical atrophy was correlated with low-frequency thresholds and basal atrophy with high-frequency thresholds, and the former correlation was higher. However, a multivariable regression with all histopathological measures as predictors and audiometric thresholds as the outcome showed that strial atrophy was a significant predictor of threshold shift only in the low-frequency region, and, even there, the contribution of outer hair cell damage was larger.SIGNIFICANCE STATEMENT Cochlear pathology can only be assessed postmortem; thus, human cochlear histopathology is critical to our understanding of the mechanisms of hearing loss. Dogma holds that relative damage to sensory cells, which transduce mechanical vibration into electrical signals, versus the stria vascularis, the cellular battery that powers transduction, can be inferred by the shape of the audiogram, that is, down-sloping (hair cell damage) versus flat (strial atrophy). Here we quantified hair cell and strial atrophy in 160 human specimens to show that it is the degree of low-frequency hearing loss, rather than the audiogram slope, that predicts strial atrophy. Results are critical to the design of clinical trials for hearing-loss therapeutics, as current drugs target only hair cell, not strial, regeneration.

Association between hearing loss and high-sensitivity C-reactive protein: the Kangbuk Samsung Cohort Study

Background

Hearing loss (HL) is linked to an elevated risk of cardiovascular diseases (CVDs). The pathogeneses of HL and CVD commonly involve inflammatory responses. Previous studies investigated elevated levels of inflammatory biomarkers in subjects with HL, however, their findings did not demonstrate statistical significance. In our cross-sectional and longitudinal study, we investigated the correlation between HL and increased high-sensitivity C-reactive protein (hsCRP) levels to determine how HL is associated with CVDs.

Methods

We conducted a cross-sectional study with workers aged over 18 years who underwent health check-ups at our institution between 2012 and 2018 (n = 566,507), followed by conducting a longitudinal study of workers aged > 18 who underwent health checkups at least twice at our institution between 2012 and 2018 (n = 173,794). The definition of HL was as an average threshold of ≥ 20 dB in pure-tone air conduction at 0.5, 1.0, and 2.0 kHz in both ears. The incidence of increased hsCRP levels throughout the follow-up period was defined as a level exceeding 3 mg/L. Logistic regression and generalized estimating equations were performed to estimate the risk of increased hsCRP levels according to the occurrence of HL in groups stratified by age.

Results

In the cross-sectional study, the multivariate-adjusted odds ratio (OR) was 1.17 (95% confidence interval [CI]: 1.02-1.34); the OR was 0.99 (95% CI: 0.80-1.22) in those under 40 and 1.28 (1.08-1.53) in those over 40. In the longitudinal study, the multivariable-adjusted OR was 1.05 (95% CI: 0.92-1.19); the OR was 1.10 (95% CI: 0.90-1.35) in those under 40 and 1.20 (1.01-1.43) in those over 40.

Conclusions

This cross-sectional and longitudinal study identified an association between HL and increased hsCRP levels in workers aged over 40 years.

Subclinical Atherosclerosis Could Increase the Risk of Hearing Impairment in Males: A Community-Based Cross-Sectional Survey of the Kailuan Study

Objective

The relationship between subclinical atherosclerosis and hearing impairment (HI) has not been widely considered. Brachial ankle pulse wave velocity (baPWV) is a good indicator of muscular artery elasticity and could be a feasible method to screen for subclinical atherosclerosis. Our study aimed to elucidate the relationship between baPWV and HI.

Methods

This cross-sectional study was based on the Kailuan cohort. All participants completed a standardized questionnaire and underwent physical examinations and laboratory assessments at recruitment. Since 2010, some participants received additional baPWV testing during follow-up visits, and some who were exposed to occupational hazards such as noise received a pure-tone average hearing threshold (PTA) test after 2014. Male subjects with a complete physical examination, baPWV, and PTA data were recruited for this study. HI was defined as PTA > 25 dB. Multivariate linear and multivariate logistic regression analyses were used to evaluate the relationship between baPWV and PTA or HI.

Results

Among 11,141 subjects, the age range was 18–65 years, with mean age of 43.3 ± 8.9 years, the average PTA was 20.54 ± 10.40 dB, and the detection rate of HI was 1,821/11,141 (16.3%). Subjects were divided into four subgroups according to baPWV quartile. As the baPWV quartile increased, age, systolic blood pressure, diastolic blood pressure, body mass index, total cholesterol, high-density-lipoprotein cholesterol, fasting blood glucose, PTA, and proportions of subjects reporting smoking, alcohol consumption, hypertension, and diabetes increased significantly (p < 0.05 for trend). The odds of HI were higher in the fourth quartile group [adjusted odds ratio (aOR): 1.33, 95% CI: 1.10–1.62] than in the first quartile group. For every 100 m/s increase in baPWV, the PTA increased by 13 dB (95% CI: 4–23). When we divided the subjects into young (5,478 subjects; age range 22–44 years; mean age 35.6 ± 5.5 years) or non-young subgroups (5,663 subjects; age range 45–65 years; mean age 50.7 ± 3.7 years) based on a cut-off age of 45 years, the aOR of the fourth quartile group increased to 2.65 (95% CI: 1.68–4.19), and the PTA increment increased to 18 dB (95% CI: 10–27) for every 100 m/s increase in baPWV in the young subgroup. However, this relationship became statistically insignificant in the non-young subgroup.

Conclusion

Our study revealed the quantitative relationship between baPWV and HI in the Kailuan cohort subjects, although the results are not universally consistent in different populations.

Association Between Sensorineural Hearing Loss and Vitiligo: A Nationwide Population-Based Cohort Study

BACKGROUND

Vitiligo is an acquired depigmentation disease of the skin due to melanocyte destruction. A shared pathogenesis affecting melanocytes in the cochlea has been postulated. However, the association between vitiligo and sensorineural hearing loss (SNHL) is unclear.

OBJECTIVE

To identify the association between vitiligo and SNHL.

METHODS

This retrospective, nationwide cohort study included patients with vitiligo and age-, sex-, and comorbidities-matched controls (propensity score matching; 1:4 ratio) from the National Health Insurance Research Database in Taiwan from January 1, 2000 to December 31, 2013.

RESULTS

In total, 13048 patients with vitiligo and 52192 controls were included. SNHL developed in 0.61% patients with vitiligo and 0.29% controls. After adjusting for sex, age, and comorbidities, a significant association between vitiligo and SNHL was found (adjusted hazard ratio, 2.18; 95% CI, 1.66-2.86). The other risk factors for developing SNHL included increased age, male sex, hyperlipidemia, coronary artery disease, and diffuse connective tissue diseases. In subgroup analysis, the association between vitiligo and SNHL remained significant in almost all the subgroups.

CONCLUSION

A 2.2-fold increased risk of developing SNHL was found in patients with vitiligo. Proper referral to otologists for early screening and closer follow-up of SNHL should be considered for patients with vitiligo, especially for patients with older age.

Hearing loss is associated with increased risk of incident stroke but not coronary heart disease among middle-aged and older Chinese adults: the Dongfeng-Tongji cohort study

Hearing loss has been associated with increased risk of cardiovascular disease (CVD) prevalence in cross-sectional studies. However, little is known about the prospective association between hearing loss and CVD incidence. We aimed to examine the associations of hearing loss with risk of incident CVD, coronary heart disease (CHD), and stroke in a Chinese population. We included 13,880 individuals aged 63.3 years from the Dongfeng-Tongji cohort study (2013-2018). Hearing loss was categorized into normal, mild, moderate, severe, or greater by the pure-tone average of thresholds at speech and high frequency in both ears. Cox proportional hazard models and linear regression models were used for multivariate longitudinal analyses. After multivariate adjustments, we observed suggestive dose-response associations of increased high-frequency hearing loss with elevated risk of CVD and stroke incidence. Compared with normal hearing loss at high frequency, those with moderate and severe or greater hearing loss had a 4% (95% CI: 0.92, 1.18) or 13% (95% CI: 0.98, 1.30) higher risk of CVD and 52% (95% CI: 1.06, 2.17) or 51% (95% CI: 1.03, 2.20) higher risk of stroke, while the associations were almost consistent across most subgroups. No significant associations were observed for CHD and high-frequency hearing loss, as well as CVD and speech-frequency hearing loss. In addition, higher high-frequency hearing loss was related to unfavorably altered lipid profiles and fasting glucose. Our data suggested that increased hearing loss might increase the risk of incident CVD and stroke among middle-aged and older Chinese, which was partially explained by altered CVD-related biomarkers.

Self-Reported Sensory Impairments in Older Adults and their Association with Self-Rated Health and Mortality Outcomes

OBJECTIVES

This study assessed the relationship between self-reported impairments of vision, hearing, and dual sensory impairment, and change in self-rated health/mortality status over a 5-year period.

METHODS

Data came from the National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries ages 65 and older. Analyses consisted of a series of ordinal logistic regressions stratified by sex.

RESULTS

For both women and men, self-reported sensory impairments were not statistical predictors of self-rated health/mortality, when other dimensions of health, such as physical functioning, participation, and activities of daily living functioning were included in models.

DISCUSSION

Understanding how self-reported sensory impairments impact self-rated health could assist in targeting rehabilitation strategies to older adults who experience sensory impairments.

Chronic Obstructive Pulmonary Disease is a Risk Factor for Sensorineural Hearing Loss: A US Population Study

OBJECTIVES

The goal of this study is to determine if chronic obstructive pulmonary disease (COPD) is associated with sensorineural hearing loss (SNHL) in a national database.

STUDY DESIGN

Cross-sectional study.

SETTING

National sample of the United States population.

PATIENTS

Adults with audiometric and spirometry data from the National Health and Nutrition Examination Study (NHANES) database.

INTERVENTIONS

None.

METHODS

A total of 2,464 adults with spirometry and audiometry data from the NHANES database (2009-2012) were studied. Outcome measures included hearing, measured by high-frequency pure tone average (HFPTA; 3, 4, 6, 8 kHz) and low-frequency pure tone average (LFPTA; .5, 1, 2 kHz) frequencies. SNHL was defined as a HFPTA or LFPTA threshold more than 25 decibels (dB) in the better ear. Multivariable regression analyses explored the association between hearing loss and COPD.

RESULTS

The prevalence of COPD was 19.8% in individuals with SNHL in the better ear and 4.7% in individuals with normal hearing (p < 0.001). Presence of COPD was associated with elevated hearing thresholds (worse hearing) at each individual frequency. The presence of COPD was independently associated with a 3.29 dB (95% CI: 1.48, 5.09) increase in HFPTA (p < 0.001), and 2.32 dB (1.13, 3.50) increase in LFPTA (p < 0.001) after controlling for medical, social, and environmental covariates. The presence of COPD was independently associated with a 1.85-fold (1.12, 3.06) increased odds of isolated low-frequency SNHL (p = 0.017).

CONCLUSIONS

COPD was independently associated with sensorineural hearing loss after controlling for multiple confounding factors. These results contribute to the evidence that COPD and pulmonary dysfunction can be comorbid with hearing decline.

Association Between Hypertension and Hearing Loss

Introduction

Hypertension (HTN) is a common health problem, diagnosed in every one out of four individuals. It is associated with various complications; however, its impact on hearing loss is not well studied. In this study, we will determine the impact of HTN on hearing.

Methods

This cross-sectional study was conducted in Jinnah Sindh Medical University from August 2020 to March 2021. Three hundred (300) patients with documented diagnosis of HTN, between the ages of 21 and 50 years, were enrolled in the study. Another 300 non-hypertensive participants were enrolled as a reference group. Participants were sent to trained otolaryngologist technicians, who performed audiometry at six different frequencies for each year (0.5, 1.0, 2.0, 3.0, 4.0, and 6.0 kilohertz (kHz)). The final hearing level was calculated by taking mean of hearing levels of both ears. 

Results

The hearing levels in audiometry were significantly higher in hypertensive participants compared to non-hypertensive participants (23.4 ± 8.67 dB vs 18.3 ± 6.02 dB; p-value: <0.0001). Participants who had been diagnosed with HTN for more than five years had higher hearing levels in audiometry test compared to participants with less than five years of HTN (24.21 ± 8.92 dB vs. 22.6 ± 8.02 dB; p-value 0.0001).

Conclusion

Based on our study, HTN is positively correlated with hearing loss. Therefore, longstanding hypertensive patients should be screened regularly in order to assess the status of their hearing abilities.

Effectiveness of a Self-Fitting Tool for User-Driven Fitting of Hearing Aids

Hearing aids can be effective devices to compensate for age- or non-age-related hearing losses. Their overall adoption in the affected population is still low, especially in underdeveloped countries in the subpopulation experiencing milder hearing loss. One of the major reasons for low adoption is the need for repeated complex fitting by professional audiologists, which is often not completed for various reasons. As a result, self-fitting procedures have been appearing as an alternative. Key open questions with these digital tools are linked to their effectiveness, utilized algorithms, and achievable end-results. A digital self-fitting prototype tool with a novel quick four-step fitting workflow was evaluated in a study on 19 individuals with moderate hearing loss. The tool was evaluated in a double-blinded, randomized study, having two study aims: comparing traditional audiological fitting with the new self-fitting tool, which can also be used as a remote tool. The main reported results show moderately high usability and user satisfaction obtained during self-fitting, and quasi-equivalence of the performance of the classical audiological fitting approach. The digital self-fitting tool enables multiple sessions and easy re-fitting, with the potential to outperform the classical fitting approach.

Abnormal hearing patterns are not associated with endothelium-dependent vasodilation and carotid intima-media thickness: The Framingham Heart Study

INTRODUCTION

Prior data suggest associations between hearing loss, cardiovascular (CV) risk factors, and CV disease. Whether specific hearing loss patterns, including a strial pattern associated with inner ear vascular disease, are associated with systemic endothelial dysfunction and carotid intima-media thickness (IMT) remains unclear.

METHODS

We evaluated participants without prevalent CVD in the Framingham Offspring Study who underwent formal audiogram testing and brachial and carotid artery ultrasounds. Audiograms were categorized as normal or as belonging to one of four abnormal patterns: cochlear-conductive, low-sloping, sensorineural, or strial. Endothelial function as measured by brachial artery flow-mediated dilation (FMDmm and FMD%). Internal and common intima-media thicknesses (icIMT and ccIMT, respectively) were compared between audiogram patterns.

RESULTS

We studied 1672 participants (mean age 59 years, 57.6% women). The prevalence of each hearing pattern was as follows: 43.7% normal; 20.3% cochlear-conductive; 20.3% sensorineural; 7.7% low-sloping; and 8.0% strial. Strial pattern hearing loss was nearly twice as prevalent (p = 0.001) in those in the highest quartile of ccIMT and nearly 50% higher in those in the highest icIMT quartile (p = 0.04). There were no statistically significant differences between the prevalence of the strial pattern comparing the lowest quartiles of FMDmm and FMD% with the upper three quartiles. Age- and sex-adjusted linear regression models did not show significant associations between the vascular measures and hearing patterns.

CONCLUSION

Abnormal hearing patterns were not significantly associated with impaired brachial FMD and increased carotid IMT after adjusting for age and sex effects, which may reflect age and sex-related distributional differences based on hearing loss pattern.

Hearing loss and increased gait variability among older adults

BACKGROUND

The influence of age-related hearing loss on slow gait has been suggested; however, whether it is associated with increased gait variability, an important predictor of fall risk, remains unclear.

RESEARCH QUESTION

Is poor auditory acuity associated with increased gait variability, and does this gait change relate to accidental falls among older adults with hearing loss?

METHODS

We studied 107 older adults (mean age, 76.5 years; 80.5 % women). Auditory acuity was measured using a pure tone average (PTA) of hearing thresholds for 0.5-4 kHz tones in the better-hearing ear. Hearing loss was defined as a PTA of >25 dB. Gait speed and spatiotemporal variability (i.e., stride length and time variabilities) were assessed using a 5-m electronic walkway. We also assessed the occurrence of multiple falls within the previous year.

RESULTS

Fifty-two participants (48.6 %) experienced hearing loss. Multiple regression analysis adjusted for potential covariates showed that poor PTA was associated with slower gait speed and stride length variability, but not stride time variability. Among older adults with hearing loss, fall occurrence was associated with an increased stride length variability and not a slow gait or increased stride time variability.

SIGNIFICANCE

The association between hearing loss and increased gait variability observed in the present study suggests that age-related hearing loss can jeopardize gait control during daily activities. This leads to increased gait variability and increased risk of accidental falls. Our results provide additional information on how age-related hearing loss increases the risk of falls.

Effect of Cigarette Smoking on Hearing Levels in Young and Middle-Aged Males

Introduction: Smoking is a well-recognized risk factor for many health issues; however, its association with hearing loss has been a debate. Some studies have shown a positive association while others did not. In this study, we aim to identify the effect of cigarette smoking on hearing in our population.

Methods: This cross-sectional study was conducted in a tertiary care hospital in Pakistan from August 2020 to March 2021. Five hundred male smokers (n = 500), with a history of smoking for more than three years between the ages of 21 and 50, were enrolled in the study via consecutive convenient non-probability sampling after informed consent. Five hundred male non-smokers (n = 500) were enrolled as a reference group. Audiometry was performed in a soundproof room.

Results: The hearing levels in audiometry were significantly higher in smokers compared to non-smokers (22.8 ± 8.12 decibels vs 18.7 ± 6.12; p-value < 0.0001). Participants who had been smoking for more than 10 years had higher hearing levels in the audiometry test compared to the participants with less than 10 years of smoking history (24.21 ± 8.91 decibels vs. 21.1 ± 8.01 decibels: p-value < 0.0001).

Conclusion: In this study, smokers were associated with greater loss in hearing compared to non-smokers. In addition to other adverse events associated with smoking, smokers should be counselled about hearing loss related to it.

Cardiometabolic risk prediction algorithms for young people with psychosis: a systematic review and exploratory analysis

OBJECTIVE

Cardiometabolic risk prediction algorithms are common in clinical practice. Young people with psychosis are at high risk for developing cardiometabolic disorders. We aimed to examine whether existing cardiometabolic risk prediction algorithms are suitable for young people with psychosis.

METHODS

We conducted a systematic review and narrative synthesis of studies reporting the development and validation of cardiometabolic risk prediction algorithms for general or psychiatric populations. Furthermore, we used data from 505 participants with or at risk of psychosis at age 18 years in the ALSPAC birth cohort, to explore the performance of three algorithms (QDiabetes, QRISK3 and PRIMROSE) highlighted as potentially suitable. We repeated analyses after artificially increasing participant age to the mean age of the original algorithm studies to examine the impact of age on predictive performance.

RESULTS

We screened 7820 results, including 110 studies. All algorithms were developed in relatively older participants, and most were at high risk of bias. Three studies (QDiabetes, QRISK3 and PRIMROSE) featured psychiatric predictors. Age was more strongly weighted than other risk factors in each algorithm. In our exploratory analysis, calibration plots for all three algorithms implied a consistent systematic underprediction of cardiometabolic risk in the younger sample. After increasing participant age, calibration plots were markedly improved.

CONCLUSION

Existing cardiometabolic risk prediction algorithms cannot be recommended for young people with or at risk of psychosis. Existing algorithms may underpredict risk in young people, even in the face of other high-risk features. Recalibration of existing algorithms or a new tailored algorithm for the population is required.

Topic Modeling for Analyzing Patients' Perceptions and Concerns of Hearing Loss on Social Q&A Sites: Incorporating Patients' Perspective

Hearing loss is the most common human sensory deficit, affecting normal communication. Recently, patients with hearing loss or at risk of hearing loss are increasingly turning to the online health community for health information and support. Information on health-related topics exchanged on the Internet is a useful resource to examine patients' informational needs. The ability to understand the patients' perspectives on hearing loss is critical for health professionals to develop a patient-centered intervention. In this paper, we apply Latent Dirichlet Allocation (LDA) on electronic patient-authored questions on social question-and-answer (Q&A) sites to identify patients' perceptions, concerns, and needs on hearing loss. Our results reveal 21 topics, which are both representative and meaningful, and mostly correspond to sub-fields established in hearing science research. The latent topics are classified into five themes, which include "sudden hearing loss", "tinnitus", "noise-induced hearing loss", "hearing aids", "dizziness", "curiosity about hearing loss", "otitis media" and "complications of disease". Our topic analysis of patients' questions on the topic of hearing loss allows achieving a thorough understanding of patients' perspectives, thereby leading to better development of the patient-centered intervention.

Age-related Hearing Loss and Dementia

Dementia is a devastating disease and global health challenge that is highly prevalent worldwide. A growing body of research has shown an independent association between age-related hearing loss (ARHL) and dementia, identifying ARHL as a compelling potential target in preventive strategies for dementia. However, a causal linkage between ARHL and dementia needs to be investigated before making definitive clinical guidelines and treatment recommendations regarding ARHL as a modifiable risk factor. In this review, we discuss the association between ARHL and dementia, the importance of addressing this finding, as well as common mechanisms (eg, microvascular disease) and causal mechanisms (eg, depletion of cognitive reserve and social isolation) that may explain the nature of this relationship. Future directions for research are also highlighted, including randomized controlled trials, developing high-resolution microvascular imaging, and further refining audiometric testing.

Hearing Loss and Risk of Overall, Injury-Related, and Cardiovascular Mortality: The Kangbuk Samsung Health Study

Hearing loss (HL) has been related to cardiovascular risk factors as well as prevalence of cardiovascular disease itself. We evaluated the association of HL with overall, injury-related, and cardiovascular mortality. A cohort study included 580,798 Korean adults (mean age: 39.7) who attended a screening exam between 2002 and 2016 with a follow-up of up to 17 years. HL was defined as a pure-tone average of thresholds at 0.5, 1.0, and 2.0 kHz ≥25 dB (decibels) in the better ear and further categorized into mild (25–<40 dB) and moderate-to-severe (≥40 dB). Overall and cause-specific mortality was ascertained through linkage to national death records. During median follow-up of 8.4 years, 6581 overall deaths, 977 cardiovascular deaths, and 1161 injury-related deaths were identified. Compared to participants with normal hearing, multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for overall mortality among participants with mild and moderate-to-severe HL were 1.13 (1.05–1.21) and 1.30 (1.16–1.46), respectively. Corresponding HRs (95% CIs) for cardiovascular mortality were 1.32 (1.10–1.58) and 1.53 (1.16–2.01), respectively, and corresponding HRs (95% CIs) for injury-related mortality were 1.03 (0.81–1.31) and 1.64 (1.13–2.36), respectively. In this large cohort, HL was positively and independently associated with overall, cardiovascular, and injury-related mortality. A significantly elevated risk of cardiovascular mortality started from mild HL.

Hearing Loss and Physical Functioning Among Adults with Heart Failure: Data from NHANES

Background

Hearing loss (HL) is associated with poor physical functioning among older adults, yet this association has not been examined in heart failure (HF), a disease in which both hearing loss and poor physical functioning are highly prevalent. We investigated whether this association exists in HF since HL represents a potentially modifiable risk factor for poor physical functioning.

Methods

We studied adults aged ≥70 years with self-reported HF in the National Health and Nutrition Examination Survey (NHANES). HL was assessed and categorized using pure-tone averages. Activities of daily living (ADLs), instrumental ADLs (IADLs), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activity (GPA) were assessed. Negative binomial regression was used to examine the association between HL and physical functioning

Results

One hundred eighty-one participants comprised our population. Those with ≥ moderate HL had more difficulty with ADLs (37.0% vs 24.0%, p=0.02), IADLs (36.0% vs 23.0%, p=0.05), and LEM (37.3% vs 20.0%, p=0.009), compared to participants with none or mild HL. In multivariable models, ≥ moderate HL was significantly associated with difficulty in physical functioning across four of the five domains: ADLs: PR: 1.71 (95% CI: 1.07-2.72); IADLs: PR: 1.71 (1.24-2.34); LEM: PR: 1.51 (1.01-2.26); and GPA: PR: 1.19 (1.00-1.41).

Conclusion

Among older adults with HF, moderate or greater HL was associated with a higher prevalence of difficulty with ADLs, IADLs, and LEM, compared to mild or no HL.

Breaking Down Silos: Interprofessional Collaborative Practice in Humanitarian Audiology

The goal of humanitarian healthcare is to improve health outcomes and patient quality of life in under-resourced areas. One avenue for improvement may be via interprofessional collaborative practice, which allows providers from multiple specialties to work together to promote positive interventions for the communities they serve. The purpose of this article is to provide a general framework for incorporating interprofessional collaborative practice within a humanitarian audiology project.

Effects of Cardiovascular Health Factors and Personal Listening Behaviors on Hearing Sensitivity in College-Aged students

OBJECTIVES

This study examined the association between pure tone hearing sensitivity and music listening behaviors among traditional college-aged students and sought to determine factors that mediate hearing sensitivity, including health and fitness levels, gender, and personal listening device (PLD) use.

METHODS

A convenience sample of college students (N = 182; 133 females, 49 males, mean age = 19.8 ± 1.4 year, average PLD use = 1.52 ± 7.1 hours•day^-1) completed hearing assessments, music listening behavior questionnaires, and health and fitness tests.

RESULTS

Most students listened to music at safe intensity levels (<80 dBA), though 18% had higher hearing levels (≥25 dB HL at one of the measured frequencies). Longer listening duration behavior approached but did not reach a statistical association with compromised hearing sensitivity. Of all variables measured, including cardiovascular health, fitness, and music listening, two variables: total cholesterol: triglycerides (TC:TG) and total cholesterol: high-density lipoproteins (TC:HDL) significantly associated with hearing sensitivity at 2 kHz. The odds hearing loss occurring at 4 kHz was 59% lower in females compared with males.

CONCLUSION

The majority of college students had healthy music listening behavior and fitness, contributing to normal hearing sensitivity in most. In cases where greater hearing threshold levels at one or more frequencies was detected, TC:HDL and TC:TG were statistically related and at 2 kHz, males were more likely to demonstrate higher listening levels compared with females of similar health and fitness level.

Age-Related Changes in Immune Cells of the Human Cochlea

Age-related hearing loss is a chronic degenerative disorder affecting one in two individuals above the age of 75. Current population projections predict a steady climb in the number of older individuals making the search for interventions to prevent or reverse this disorder even more critical. There is growing acceptance that aberrant activity of resident or infiltrating immune cells, such as macrophages, is a major factor contributing to the onset and progression of age-related degenerative diseases. However, how macrophage populations and their functionally-driven morphological characteristics change with age in the human cochlea remains largely unknown. In this study, we employed immunohistochemical approaches along with confocal and super-resolution imaging, three-dimensional reconstructions, and quantitative analysis to determine age-related changes in macrophage numbers and morphology as well as interactions with other cell-types and structures of the auditory nerve and lateral wall in the human cochlea. In the cochlea of human ears from young and middle aged adults those macrophages in the auditory nerve assumed a worm-like structure in contrast to those in the spiral ligament or associated with the dense microvascular network in the stria vascularis which exhibited a highly ramified morphology. Macrophages in both the auditory nerve and cochlear lateral wall showed morphological alterations with age. The population of activated macrophages in the auditory nerve increased in cochleas obtained from older donors. Dual-immunohistochemical staining with macrophage, myelin, and neuronal markers revealed increased interactions of macrophages with the glial and neuronal components of the aged auditory nerve. These findings implicate the involvement of abnormal macrophage-glia interactions in age-related physiological and pathological alterations in the human cochlea. There is clearly a need to further investigate the contribution of macrophage-associated inflammatory dysregulation in human presbyacusis.

Hearing loss is associated with increased CHD risk and unfavorable CHD-related biomarkers in the Dongfeng-Tongji cohort

BACKGROUND AND AIMS

The association between hearing loss and coronary heart disease (CHD) is inconsistent. We aimed to investigate the association of hearing loss with prevalent CHD and CHD-related biomarkers among a middle aged and elderly Chinese population.

METHODS

We included 14,755 Chinese aged 64.6 years from the Dongfeng-Tongji Cohort in 2013. Hearing loss was classified into normal, mild, moderate or greater levels by the pure tone average (PTA) at low frequency and high frequency, respectively. Logistic regression models were used to estimate the odds ratios (ORs) of CHD risk in relation to hearing loss. Linear regression models were used to evaluate the effect of hearing loss on CHD-related biomarkers.

RESULTS

The adjusted ORs for prevalent CHD increased gradually with the increasing hearing loss levels. Compared with normal hearing, individuals having mild- and moderate or greater-hearing loss had a higher CHD risk of 19% and 20% at low frequency, and 33% and 41% at high frequency, respectively (all p for trend < 0.05). The associations were more evident among subjects who were females, overweight, exposed to occupational noise and with hyperglycemia, hypertension or dyslipidemia at low frequency, and those with hyperglycemia at high frequency. Meanwhile, moderate or greater hearing loss combined with overweight, hyperglycemia, hypertension or dyslipidemia had joint effects on CHD. In addition, the majority of CHD-related biomarkers worsened with increasing hearing loss levels.

CONCLUSIONS

There may be a dose-response relationship between hearing loss and CHD prevalence, and the association could partially be explained by intermediate CHD-related biomarkers.

Hearing loss is associated with increased stroke risk in the Dongfeng-Tongji Cohort

BACKGROUND AND AIMS

The evidence concerning the association between hearing loss and stroke is limited. We aimed to investigate the association of hearing loss with risk of stroke and its subtypes among the middle-aged and older Chinese population.

METHODS

We included 19,238 participants aged 64.6 years from the Dongfeng-Tongji Cohort in 2013. Hearing loss was classified into normal, mild, moderate, severe or greater levels by the pure tone average at speech frequency and high frequency, respectively. We calculated the odds ratios of hearing loss and stroke by logistic regression models.

RESULTS

With the increase of hearing loss level, the prevalence risk of stroke has gradually increased. Compared with normal hearing, participants having severe or greater hearing loss had a higher stroke risk of 76% and 39% at speech frequency and at high frequency, respectively. Similarly, individuals with severe or greater hearing loss had an increased risk of ischemic stroke of 69% and 52% at speech frequency and high frequency, respectively; while severe or greater hearing loss was associated with about a 2-fold risk of hemorrhagic stroke than normal hearing only at speech frequency. Stratified analysis suggested that some high cardiovascular risk participants such as male, age ≥65, exposed to occupational noise, smoker and with diabetes, hypertension or hyperlipidemia had higher risk of stroke. Furthermore, severe or greater hearing loss combined with age, diabetes, hypertension and hyperlipidemia had joint effects on stroke.

CONCLUSIONS

The results have suggested a dose-response relationship between hearing loss and stroke risk in middle-aged and older adults.

The atherogenic index (ATH index) as a potential predictive marker of idiopathic sudden sensorineural hearing loss: a case control study

BACKGROUND

The importance of blood lipids in the pathogenesis of sudden sensorineural hearing loss (SSNHL) is widely discussed in the literature. However, the published results that hyperlipidaemia causes hearing problems are contradictory. The objective of this study was to establish whether increased lipid levels affect the risk of idiopathic SSNHL.

METHODS

A case-controlled study was conducted of 27 patients with idiopathic SSNHL and 24 healthy control subjects. All of the subjects underwent complete audiological examination. The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A-I, apoB and apoE were measured with commercially available kits (Chronolab Systems, Spain). Several clinical ratios and indices of lipid metabolism were calculated.

RESULTS

Detailed analysis of lipid metabolism in patients with idiopathic SSNHL has shown that disturbances in auditory function are associated with increased atherogenicity of the lipid profile. However, there were no significant differences in the conventional parameters of lipid metabolism (TC, TG and HDL-C) between patients with idiopathic SSNHL and subjects in the control group. Higher values of the apoB/apoA-I ratio, atherogenic index of plasma (AIP) and atherogenic index (ATH index) in patients with SSNHL indicated increased atherogenicity of the lipid profile. Binary logistic regression analysis showed that of these three indices, only higher values of the ATH index were significantly associated with an increased risk of idiopathic SSNHL.

CONCLUSIONS

The ATH index can be used as a marker indicating the risk of idiopathic SSNHL when the conventional lipid indices are still normal.

Blood Pressure Variability Is Associated with Hearing and Hearing Loss: A Population-Based Study in Males

Blood pressure (BP) has been well documented to be associated with hearing loss previously. However, the role of blood pressure variability (BPV, representing BP fluctuation over a time period) on hearing remains unknown. We aimed to evaluate the relationship between BPV and hearing in Chinese population. We included 8646 male subjects from a population-based study (the Kailuan study). BP was measured every two years at routine physical examinations from 2006 to 2015. Based on five annual BP measurements, BPV was estimated by standard deviation of BP (SD), coefficient of the variation of BP (CV), and variation independent of mean of BP (VIM). Hearing was estimated by pure-tone average threshold (PTA) at low, intermediate, and high frequencies in the year of 2014. Regression models were used to evaluate the relationship between BPV and hearing. The results showed that PTAs and percentages of hearing loss at low, intermediate, and high frequencies grew gradually with increasing systolic SD (SSD) (p<0.05). After adjusting for multiple covariates, multivariate regression analyses demonstrated that variations of SBP (SSD, SCV, and VIM_SBP) were all positively correlated with PTA at intermediate and high frequencies (p<0.05). Each SD increase in SSD, SCV, and VIM_SBP was also positively associated with hearing loss at intermediate and high frequencies. No significant correlation was observed between variations of DBP and hearing. These findings suggest that increase in long-term BPV is associated with hearing and hearing loss. Trial registration number: Kailuan study (ChiCTRTNC-11001489).

Association between audiometric patterns and probabilities of cardiovascular diseases

Objectives

The aim of this study was to analyze the progression of the audiometric pattern of serial screening tests in companies with hearing conservation program (HCP) to clinical audiometric tests to identify individuals more susceptible to develop cardiovascular diseases (CVDs). The procedure is based on the analysis of various audiometric patterns that have been demonstrated to have a statistically significant relation to certain CVDs. Identifying these individuals, based on pattern progression of hearing loss, could result in earlier detection to prevent disease or decrease its morbidity.

Study design

Using the data from the clinical and screening audiograms, pattern analysis was performed and statistical analysis using Fisher's exact test, odds ratios and P values were used to calculate the confidence intervals.

Methods

The analysis was based on potential risk factors related to CVD in 29 cohorts of 10,105 subjects. Of these, a total of 704 subjects also had clinical audiometric tests and examination by an ENT to verify the exactitude of the screening test questionnaire and pattern relation with the clinical audiogram.

Results

A first analysis was made on 704 subjects who had clinical evaluation and clinical audiometric tests showed results comparable to those of Friedland. A correlation between the questionnaire of the clinical and the self‐reporting screening tests questionnaires was performed and showed a correlation between the following risk factors: diabetes, hypertension, hyperlipidemia and smoking. Analysis of the progression of audiometric patterns suggested a relationship with the predictive probabilities of developing CVDs.

Conclusion

Progression toward low‐frequency hearing loss patterns provides early identification of patients whose audiometric pattern progression suggests increased probability of developing CVDs. The treating physician, by prescribing further investigations, could potentially prevent or reduce the morbidity of these diseases.

Level of Evidence

III

Age-Related Hearing Loss Associations With Changes in Brain Morphology

Age-related hearing loss has been associated with varied auditory cortex morphology in human neuroimaging studies. These findings have suggested that peripheral auditory system declines cause changes in brain morphology but could also be due to latent variables that affect the auditory periphery and brain. The current longitudinal study was designed to evaluate these explanations for pure-tone threshold and brain morphology associations. Thirty adults (mean age at Time 1 = 64.12 ± 10.32 years) were studied at two time points (average duration between visits = 2.62 ± 0.81 years). Small- to medium-effect size associations were observed between high-frequency pure-tone thresholds and auditory cortex gray matter volume at each time point. Although there were significant longitudinal changes in low- and high-frequency hearing measures and brain morphology, those longitudinal changes were not significantly correlated across participants. High-frequency hearing measures at Time 1 were significantly related to more lateral ventricle expansion, such that participants with higher measures exhibited larger increases in ventricle size. This ventricle effect was statistically independent of high-frequency hearing associations with auditory cortex morphology. Together, these results indicate that there are at least two mechanisms for associations between age-related hearing loss and brain morphology. Potential explanations for a direct hearing loss effect on brain morphology, as well as latent variables that likely affect both the inner ear and brain, are discussed.

Analysis of the audiogram shape in patients with idiopathic sudden sensorineural hearing loss using a cluster analysis

We performed a cluster analysis to classify the audiogram shape in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). We also investigated whether the audiogram shape is a prognostic indicator in the management of ISSNHL. A total of 115 inpatients with ISSNHL treated between 2001 and 2010 were analyzed. The data collected included age, sex, duration of hearing loss at the time of treatment, and the presence or absence of tinnitus, vertigo, diabetes, nystagmus, and canal paresis. A hierarchical cluster analysis was performed using the hearing threshold for each frequency on audiograms as variables. A logistic regression model was used for the prognostic analysis. The audiogram shape was classified into four clusters: (1) crossing horizontally pattern of all tones; (2) up-sloping pattern of low-tone loss; (3) deaf pattern; and (4) down-sloping pattern of high-tone loss. The age of the patient, presence of canal paresis, and audiogram shape showed statistically significant relationships with hearing improvement. The audiogram shape based on the cluster analysis demonstrated a significant relationship with hearing improvement in patients with ISSNHL. Further studies are needed to elucidate the underlying etiology of each audiogram shape.

Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old

Importance

In the United States, the population of individuals older than 80 years is expected to double in the next 40 years. Cardiovascular comorbidities are prevalent in this older old population, and their relationship with hearing loss has not been well characterized.

Objective

To investigate the association of cardiovascular disease (CVD)-related risk factors with auditory function among the older old (>80 years).

Design, Setting, and Participants

Audiological data and medical records from 2001 through 2014 of 433 patients aged 80 to 106 years at an academic medical center were analyzed in 2017.

Main Outcomes and Measures

The degree of low- and high-frequency hearing loss of participants with coronary artery disease, diabetes, hypertension, history of cerebrovascular accident, and smoking status was compared with that of disease-free individuals. Rate of hearing loss was also determined.

Results

Among the 433 patients (67% female; mean [SD] age, 89 [5.8] years), the presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Among the 96 patients with 2 audiograms performed at age 80 years or older from which the rate of hearing loss could be calculated, 32 patients had CVD or related risk factors and 64 were healthy controls. Those with at least 1 disease had accelerated hearing loss. Patients with cardiovascular morbidity experienced a faster mean (SD) decline in LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies tested and with poor word recognition score. Hearing loss was more strongly associated with CVD risk factors in men than in women.

Conclusions and Relevance

In this study of the older old, cardiovascular risk factors and disease were associated with worse hearing and a greater rate of hearing deterioration. Hearing loss in women was less associated with the presence of CVD, possibly owing to the cardioprotective effects of estrogen. The association of hearing with CVD severity and management remains to be determined.

Serum Methylarginines and Hearing Loss in a Population-based Cohort of Older Adults

OBJECTIVE

Age-related hearing loss is associated with endothelial dysfunction and increased cardiovascular risk, suggesting a vascular etiology. Methylarginines are endogenous nitric oxide synthase inhibitors that cause endothelial dysfunction and increase cardiovascular disease risk. This study is the first to examine the hypothesis that higher serum concentrations of methylarginines are associated with greater hearing loss prevalence.

STUDY DESIGN/PATIENTS

Cross-sectional audiometric data on hearing levels, and serum methylarginines were collected from a population-based sample of 630 older community-dwelling adults.

RESULTS

Linear regression analysis showed a statistically significant association between higher serum concentrations of asymmetric dimethylarginine (ADMA) and L-arginine and greater degrees of hearing loss for males, particularly over 75 years. Higher body mass index and previous history of stroke were also associated with hearing loss. For females, ADMA concentration was not associated with hearing loss, but higher serum L-arginine concentrations were associated with reduced hearing loss prevalence in older females. Antihypertensive medication use was also associated with reduced hearing loss prevalence. LDL cholesterol and previous myocardial infarction were associated with greater hearing loss.

CONCLUSION

This study showed a significant association between serum concentrations of ADMA and hearing loss for males, consistent with the association between endothelial dysfunction and hearing loss. The opposite effect of L-arginine on hearing loss in males versus females might reflect a different role of this precursor toward nitric oxide versus methylated arginines synthesis. These findings are potentially clinically significant if the association between ADMA and hearing loss is causal, as serum methylarginine levels are modifiable through pharmacotherapeutic/lifestyle interventions.

Sudden sensory neural hearing loss is not predictive of myocardial infarction: A longitudinal follow-up study using a national sample cohort

The aim of this study was to evaluate the risk of myocardial infarction (MI) in SSNHL subjects with differently matched control groups. The Korean Health Insurance Review and Assessment Service - National Sample Cohort recruited subjects from 2002 to 2013. We used two study designs. In study I, we matched 4,467 SSNHL participants with a control group (17,868 subjects with no history of SSNHL) based on demographic factors (age, sex, income, and region of residence) and medical history (diabetes, dyslipidemia, and hypertension). In study II, we matched 4,467 SSNHL participants with a control group based on only demographic factors. The crude (simple) and adjusted hazard ratios (HRs) of SSNHL with MI were analyzed using the Cox-proportional hazard model. In study I, SSNHL was not associated with increased risk of MI. However, in study II, SSNHL was associated with increased risk of MI (adjusted HR = 1.39 95% CI = 1.00–1.93, P = 0.048). The SSNHL group did not exhibit increased risk of MI when compared to the control group matched by both demographic factors and medical history. However, compared to the control group not matched by medical history, the relative risk of MI was increased in the SSNHL group.

Relationship of stroke risk and hearing loss in African Americans: The Jackson Heart Study

OBJECTIVES/HYPOTHESIS

To evaluate the relationships among measures of stroke risk and hearing in an African American cardiovascular study cohort.

STUDY DESIGN

Prospective cohort study.

METHODS

The relationships between stroke risk profiles and hearing of 1,107 individuals from a cohort of African Americans were assessed. Several different hearing pure-tone averages (PTAs) were constructed representing different frequency regions of hearing, namely PTA low, PTA mid, and PTA high. Stroke risk profiles were calculated using validated 10-year cardiovascular disease risk scores. Gamma regression analyses were performed for each PTA given as a continuous variable with change in stroke risk score. Logistic regression analyses, presented as odds ratios, were performed with hearing loss defined as any PTA >25 dB hearing level. Stratification models were analyzed for age quarterlies and among sex.

RESULTS

Single unit increases of stroke risk percentage were found to be predictive of increases in all PTA threshold levels in gamma regression analyses for the overall pooled sample. The relationship was influenced by age, where fewer significant relationships were observed at higher ages. When analyzed with respect to stroke risk categories, using low risk as the reference group, there was found to be a significant association between stroke risk and hearing loss in the medium- and high-risk groups, with a stronger relationship in the high-risk group for all PTA threshold levels.

CONCLUSIONS

This study provides evidence that stroke risk has a positive predictive relationship with hearing pure-tone threshold.

LEVEL OF EVIDENCE

2b. Laryngoscope, 128:1438-1444, 2018.

Associations between cardiovascular disease and its risk factors with hearing loss-A cross-sectional analysis

OBJECTIVES

To investigate the relationship between hearing loss and cardiovascular disease risk factors.

DESIGN

Cross-sectional study.

METHODS

Participants were recruited between May 2010 and December 2015 and answered a health and risk factor questionnaire. Physical and biochemical assessments were performed.

SETTING

A community-based population.

PARTICIPANTS

A total of 5107 participants born within the years 1946-1964 enrolled in the Busselton Healthy Ageing Study.

MAIN OUTCOME MEASURES

Hearing was assessed behaviourally through the best ear pure-tone average (500, 1000, 2000, 4000 Hz), low-frequency average (250, 500, 1000 Hz) and high-frequency average (4000, 8000 Hz). Self-reported hearing loss, tinnitus and hyperacusis were assessed via questionnaire. Cardiovascular risk factors were assessed via a patient-completed questionnaire and objective measurements including blood pressure, body mass index, waist circumference, lipid profile and glycated haemoglobin.

RESULTS

Of the participants, 54% were female, with the mean age of 58 years (range 45-69 years). Age, sex and family history of hearing loss were consistently strong determinants of hearing loss outcomes. After adjusting for these, obesity, current smoking, peripheral arterial disease and history of cardiovascular disease were significantly associated with pure-tone, low-frequency and high-frequency hearing loss. In addition, high blood pressure, triglyceride and glycated haemoglobin were significantly associated with low-frequency hearing loss. There was a graded association between hearing loss and Framingham Risk Score for cardiovascular risk (P<0.001).

CONCLUSIONS

Established cardiovascular disease and individual and combined cardiovascular disease risk factors were found to be associated with hearing loss. Future research should prospectively investigate whether targeting cardiovascular disease can prevent hearing loss.

Effects of obesity on protein kinase C, brain creatine kinase, transcription, and autophagy in cochlea

Diet-induced obesity (DIO) has been shown to exacerbate hearing degeneration via increased hypoxia, inflammatory responses, and cell loss via both caspase-dependent and caspase-independent apoptosis signaling pathways. This study aimed to investigate the effects of DIO on the mRNA expressions of protein kinase c-β (PKC-β), brain creatine kinase (CKB), transcription modification genes, and autophagy-related genes in the cochlea of CD/1 mice. Sixteen 4-week-old male CD/1 mice were randomly divided into 2 groups. For 16 weeks, the DIO group was fed a high fat diet (60% kcal fat) and the controls were fed a standard diet. Morphometry, biochemistry, auditory brainstem response thresholds, omental fat, and histopathology of the cochlea were compared. Results showed that body weight, body length, body-mass index, omental fat, plasma triglyceride, and auditory brainstem response thresholds were significantly elevated in the DIO group compared with those of the control group. The ratio of vessel wall thickness to radius in the stria vascularis was significantly higher in the DIO group. The cell densities in the spiral ganglion, but not in the spiral prominence, of the cochlea were significantly lower in the DIO group. The expression of histone deacetylation gene 1 (HDAC1) was significantly higher in the DIO group than the control group. However, the expressions of PKC-β, CKB, HDAC3, histone acetyltransferase gene (P300), lysosome-associated membrane protein 2 (Lamp2), and light chain 3 (Lc3) genes were not significantly different between two groups. These results suggest that DIO might exacerbate hearing degeneration possibly via increased HDAC1 gene expression in the cochlea of CD/1 mice.

Hypertension is associated with dysfunction of both peripheral and central auditory system

OBJECTIVES

Arterial hypertension negatively influences the peripheral auditory system, causing sensorineural hearing loss. Much less is known about the detrimental effects of hypertension on the central auditory functions.

METHODS

We tested 32 arterial hypertension patients and 32 age and sex-matched healthy volunteers with the expanded tonal audiometry (0.125-12.5 kHz), distortion product otoacoustic emissions (0.75-8 kHz), horizontal minimum audible angle test for eight azimuths with binaural stimulation and the random gap detection test.

RESULTS

Peripheral hearing of the hypertensive patients was impaired in comparison with the controls within all audiometric frequencies (0.125-12.5 kHz) and within specific groups of frequencies. Distortion product otoacoustic emission results were significantly lower for frequencies 4 (P = 0.04) and 6 kHz (P < 0.001). The sound localization ability in the horizontal minimum audible angle test was significantly worse in the hypertensive patients in the 0°, 45°, 90°, 135°, and 270° azimuth when the interaural pure tone average (0.5-1-2 kHz) was set less than 20 dB hearing level (P < 0.05), and in the 0°, 90°, 225°, and 270°azimuth when the binaural pure tone average (0.5-1-2 kHz) was set 20 dB or less hearing level (P < 0.05). Gap detection thresholds in the random gap detection test did not differ between the two groups.

CONCLUSION

Arterial hypertension is independently related to the damage of the peripheral part of the auditory system resulting in high-frequency hearing loss. Hypertensive disturbances of central auditory processing are more discrete and concern the spatial hearing resolution.

Evaluation of Audiometric Test Results to Determine Hearing Impairment in Patients with Rheumatoid Arthritis: Analysis of Data from the Korean National Health and Nutrition Examination Survey

This study aimed to evaluate the association between rheumatoid arthritis (RA) and hearing impairment in the Korean adult population. Audiometric and laboratory test data from the 2010–2012 Korean National Health and Nutrition Examination Survey (KNHANES) were used for analysis. The relationship between RA and hearing impairment was analyzed, adjusting for various known risk factors associated with hearing impairment. RA was defined in the questionnaire as “RA diagnosed by a physician (yes/no) through a standardized interview.” We defined hearing impairment according to 2 categories of frequency (low/mid and high) as follows (average values in kHz): low/mid frequency, 0.5, 1.0, and 2.0, and high frequency, 3.0, 4.0, and 6.0. Of the subjects, 15,158 (weighted n = 32,035,996) completed the audiometric tests. The overall weighted prevalence of RA was 1.5%. The prevalence of hearing impairment was higher in the subjects with RA than in those without RA, in both, the low/mid- and high-frequency categories (21.1% vs 7.5%, p < 0.001 and 43.3% vs. 26.2%, p < 0.001, respectively). In the multivariable logistic analysis, RA (odds ratios [OR] 1.47, 95% confidence interval [CI] 1.05–2.06, p = 0.025) was an independent risk factor of low/mid-frequency hearing impairment along with age (OR 1.12, 95% CI 1.12–1.13, p < 0.001), current smoking (OR 1.27, 95% CI 1.03–1.56, p = 0.026), and college graduation (OR 0.53, 95% CI 0.39–0.72, p < 0.001). In the multivariable analysis of high-frequency hearing impairment, RA did not show any association with hearing impairment. This study suggests that RA is associated with low/mid-frequency hearing impairment after adjustment for various known risk factors. Further study is needed to verify the hearing impairment in RA.