Evaluation of the relationship between osteoporosis, balance, fall risk, and audiological parameters

Dual- and Single-Task Training in Older Adults With Age-Related Hearing Loss: A Randomized Controlled Study

We aimed to investigate the effects of dual- and single-task training in older adults with age-related hearing loss. Intervention groups included single-, dual-task training, and control groups. The dual- and single-task trainings were held 2 days a week for 40 min for a total of 10 sessions for 5 weeks. We evaluated physical, cognitive, and auditory functions, quality-of-life, balance, concerns about falling, independence in activities of daily living, and dual-task performance. A total of 42 patients fully participated in this study. Statistically significant differences were observed in chair stand, chair sit-and-reach, global cognitive function, and delayed recall between the intervention groups and control group (p < .05). There was no statistically significant difference in quality-of-life, balance, falling concerns, independence in activities of daily living, and dual-task performance between all groups (p > .05). In conclusion, single- and dual-task training had a positive effect on physical and cognitive functioning in older adults with age-related hearing loss.

Association Between Early-Onset Osteoporosis With Hearing Loss and Benign Paroxysmal Positional Vertigo (BPPV): A Systematic Review and Meta-Analysis

OBJECTIVE

Osteoporosis is a chronic systemic disease characterized by low bone mass, progressive microarchitectural deterioration and increased bone fragility. Hearing loss and benign paroxysmal positional vertigo (BPPV) have been found in patients diagnosed with osteoporosis over 65 years, however, there is lack of information about these conditions in young patients. Herein, we conducted a systematic review and meta-analysis to provide evidence of the association between osteoporosis and audio-vestibular findings in young subjects.

METHODS

Systematic review and meta-analysis were performed according to PRISMA guidelines. Searches were conducted in PubMed, Embase, and Web of Science Core Collection. Mean age, proportion of patients with low mineral density, hearing loss, and BPPV were calculated for the systematic review and meta-analysis. Odds Ratio (OR) with their corresponding 95% confidence intervals (CI) were calculated.

RESULTS

A total of 26 articles were reviewed. Only 10 studies met inclusion criteria for the meta-analysis. Six were assessed pursuing the association between osteoporosis and hearing loss. Pooled evidence suggested in patients with osteoporosis, an increased risk for developing hearing loss (OR = 1.52, 95% CI 1.06-2.19; P = .02) compared to controls. Another 6 studies reported the association between osteoporosis and BPPV. A significant increased risk for BPPV was found in individuals with osteoporosis (OR = 1.58, 95% CI 1.02-2.4; P = .04). There was no publication bias.

CONCLUSION

Subjects younger than 65 years with osteoporosis have an increase odds for hearing loss and BPPV compared to controls. These conditions could be associated with early inner or middle ear bone morphologic changes.

Sintomas vestibulares encaminhados ao otorrinolaringologista pela atenção primária da cidade do Recife

Introdução: A Atenção Primária é a “porta de entrada” do usuário ao Sistema Único de Saúde. Caso o médico tenha dificuldade em conduzir o caso, ele encaminha-o a um especialista. A otorrinolaringologia é uma das especialidades que mais recebe referências, com longo tempo de espera em nosso meio. Objetivo: Estimar a frequência das queixas de tontura e suspeita de doença vestibular nos encaminhamentos dos pacientes que aguardam consulta com otorrinolaringologista. Há poucos estudos semelhantes na literatura, e esse levantamento é importante para traçar o perfil desses pacientes e planejar ações de saúde pública. Métodos: Estudo observacional, longitudinal, descritivo, baseado na coleta de dados secundários do Sistema de Regulação da Secretaria de Saúde da Prefeitura do Recife. Foram incluídas as solicitações dos médicos da Estratégia Saúde da Família para o serviço de otorrinolaringologia em outubro-novembro de 2019, que estavam na fila de espera desde junho–julho de 2018. Resultados: A frequência dos encaminhamentos por tontura e suspeita de doença vestibular foi 22,5% de todas as solicitações para otorrinolaringologia. O tempo de espera foi um ano e quatro meses. A maioria era de mulheres (74,7%) e idosos acima de 60 anos (48,3%). Os motivos dos encaminhamentos foram: zumbido (43,2%), labirintite (20%), múltiplos sintomas (17,3%), tontura (11,6%), vertigem (3,9%), labirintopatia (3,6%) e vertigem posicional paroxística benigna (0,6%). Os sintomas aumentam com a idade. Conclusão: A taxa de encaminhamento foi compatível com a literatura. O zumbido é um sintoma muito incômodo, comum tanto nas doenças do labirinto quanto em outras patologias, por isso a alta frequência de solicitação. O termo labirintite nem sempre se refere à neuronite vestibular, mas erroneamente pode ser usado para qualquer síndrome vertiginosa, o que pode justificar a alta taxa de encaminhamento em detrimento de outras vestibulopatias. A educação continuada na Atenção Primária é importante tanto para o diagnóstico correto quanto para a solicitação apropriada da interconsulta. É preciso novas estratégias para diminuir o tempo de espera, como o aumento da oferta de serviços de especialistas, a qualificação da demanda e a otimização do sistema de regulação.

Are weight shifting and dynamic control strategies different in postmenopausal women with and without type-I osteoporosis?

OBJECTIVE

Tracking postural control processes at dynamic conditions might help develop an appropriate rehabilitation program in osteoporotic women. This study aimed to investigate the differences in center of pressure (COP) control at weight shifting and dynamic tasks between postmenopausal women with and without type-I osteoporosis. Also, we investigated the correlations between bone mineral density (BMD), the activity-specific balance confidence questionnaire (ABC-Q) score, and postural control parameters.

METHOD

A total of 62 volunteer postmenopausal women participated in this study. The participants were classified into non-osteoporotic (NOP, T-score >1, n = 35, age = 60.04± 5.33 years) and osteoporotic (OP, T-score < -2.5, n = 27, age = 61.88 ± 5.34 years) groups. The COP sway was recorded using a Kistler force plate during performance-based Limits of Stability (LOS), Curve Tracking (CT), Sit to Stand (STS), and Turn tasks. In addition, the level of balance confidence in daily activities was evaluated by ABC-Q.

RESULTS

In the LOS task, COP sway velocity in the anterior direction (P = 0.02) and COP maximum excursion in the side-to-side direction (right-side P = 0.027 and left-side P = 0.044) were significantly lower in the OP than the NOP group. In the CT task, all the quantified parameters, including errors and area, showed significantly lower values in the OP group than the NOP group (P < 0.05). In the STS task, the rising index score was significantly higher in the OP group than the NOP group (P = 0.014). The two groups had an equal ABC-Q score (P = 0.175). The COP sway variables correlated significantly with the lumbar and femoral neck T-score (P < 0.05).

CONCLUSION

BMD decline can change weight shifting and dynamic postural control in postmenopausal women.

The role of vitamin D in subjective tinnitus-A case-control study

Regarding the high prevalence of vitamin D (25(OH)D) deficiency in the population and its possible association with ear diseases, we aimed to investigate the 25(OH)Dserum level in patients with subjective, nonpulsating tinnitus and its effect on tinnitus severity. The study included 201 tinnitus patients and 99 controls. Patient clinical information, including tinnitus characteristics and severity according to Tinnitus Handicap Inventory (THI), loudness assessed by Visual Analogue Scale (VAS), audiometry, and the blood level of vitamin D, was recorded. The level of 25(OH)D in tinnitus patients was significantly decreased compared with the controls (19.86 ± 7.53 and 27.43 ± 8.85 ng/ml, respectively; P value < 0.0001). More patients in the tinnitus group were deficient in vitamin D, compared with the controls (50.7% vs. 22.2% respectively, p < 0.0001). Tinnitus patients with a lower serum level of 25(OH)D (≤15 ng/dl) were significantly younger, had a higher degree of tinnitus severity measured with THI and VAS scales, had higher triglyceride and TSH levels, and a lower HDL level compared with individuals who had higher 25(OH)D level (>15 ng/dl). There was a strong correlation between the 25(OH)D level and THI. Our findings suggest that a large proportion of tinnitus patients suffers from vitamin D deficiency and that the vitamin D level correlates with tinnitus impact. We recommend a vitamin D assessment for all tinnitus patients.

Effectiveness of Rehabilitative Intervention on Pain, Postural Balance, and Quality of Life in Women with Multiple Vertebral Fragility Fractures: A Prospective Cohort Study

Patients with vertebral fragility fractures often experience chronic pain, postural and balance disorders, and poor quality of life (QoL). Although several studies have investigated the role of rehabilitation in severe osteoporosis, the effectiveness of this intervention in patients with multiple vertebral fractures is poorly known. The aim of our longitudinal cohort study is to evaluate the effectiveness of rehabilitation, including postural training, resistance exercises, and visual stabilization exercises, for a 7-week period, on the pain, postural balance, and QoL of subjects with at least two vertebral fragility fractures receiving denosumab and vitamin D. We investigated, before (T0) and after (T1, at 7 weeks) rehabilitation, the following outcome measures on 28 patients: pain (Numerical Rating Scale (NRS)), self-perceived QoL (36-Item Short Form Survey (SF-36) and Mini-Osteoporosis Quality of Life Questionnaire (Mini-OQOL)), dizziness (Dizziness Handicap Inventory (DHI-I)), mobility (Timed-Up and Go (TUG) test), and instrumental posturographic assessment (FreeMed posturography system). At the end of the treatment, improvements of pain and QoL were recorded. Pain relief was highly obtained in patients with more than two vertebral fractures. Moreover, a significant functional improvement (TUG test) was found in those with two vertebral fractures, without any statistically significant change reported for other outcomes. Our findings suggest that combined intervention, including anti-osteoporotic drugs and postural rehabilitation, should be proposed to osteoporotic patients with multiple vertebral fractures.

Low vitamin D status is associated with hearing loss in the elderly: a cross-sectional study

BACKGROUND

The elderly are at increased risk of both hearing loss (HL) and osteoporosis. Bone mineral density (BMD) has been putatively linked to HL. However, the roles of serum calcium concentrations and vitamin D status have yet to be elucidated.

OBJECTIVES

The purpose of this study was to examine the relation between vitamin D status, parathyroid hormone (PTH), total calcium, BMD, and HL in a nationally representative sample of elderly adults.

METHODS

Using the NHANES (2005-2010), audiometry and BMD data of 1123 participants aged ≥70 y were analyzed in a cross-sectional manner. HL was defined as pure tone averages >25 dB HL at 500, 1000, and 2000 Hz (low frequency); 500, 1000, 2000, and 4000 Hz (speech frequency); and 3000, 4000, 6000, and 8000 Hz (high frequency) in either ear. Multivariable logistic regression was used to examine the relation between HL and total 25-hydroxyvitamin D [25(OH)D], PTH, total calcium, and BMD, adjusting for covariates.

RESULTS

In multivariable analyses, total 25(OH)D < 20 ng/mL was found to be associated with greater odds of low-frequency HL (OR: 2.02; 95% CI: 1.28, 3.19) and speech-frequency HL (OR: 1.96; 95% CI: 1.12, 3.44). A 1-unit decrease in femoral neck BMD (OR: 4.55; 95% CI: 1.28, 16.67) and a 1-unit decrease in total spine BMD (OR: 6.25; 95% CI: 1.33, 33.33) were found to be associated with greater odds of low-frequency HL. Serum PTH and total calcium were not found to be associated with HL.

CONCLUSIONS

In the elderly, low vitamin D status was associated with low-frequency and speech-frequency HL. Low vitamin D status may be a potential risk factor for age-related HL.