Evidence for an Association Between Hearing Impairment and Disrupted Sleep: Scoping Review

The Impact of Cigarette Smoking, Water-Pipe Use on Hearing Loss/Hearing Impairment: A Cross-Sectional Study

OBJECTIVE

The aim of the present study was to determine the association between cigarette smoking, waterpipe smoking, and co-morbidity diseases on hearing loss.

METHODS

A cross-sectional study was conducted among 1015 patients [386 males (38%) and 629 females (62%)] who were aged are between 25 and 65 years. The study used clinical, physical examinations and Pure-Tone Audiometry (PTA) to assess hearing. Univariate and multivariate stepwise logistic regression analyses were used for the statistical analysis.

RESULTS

Out of 1015 patients assessed, 199 were cigarette smokers with hearing loss (21.6%) and 111 waterpipe smokers with hearing loss (12%). There were statistically significant differences between cigarette smokers with hearing loss regarding (p<0.001), gender (p<0.001), BMI (p<0.001), hypertension (p<0.001), tinnitus (p<0.001), vertigo and/or dizziness (p<0.001), and migraine/headaches (p<0.001). Also there were statistically significant differences between waterpipe smokers with hearing loss, none smokers concerning age groups (p<0.001), BMI (p<0.001), using MP3 players (p=0.004), family history of hypertension (p=0.026), ATP III metabolic syndrome (p=0.010), IDF metabolic syndrome (p=0.012), tinnitus (p<0.001), vertigo/dizziness (p<0.001), and migraine/headaches (p=0.025). Multivariate stepwise logistic regression analysis indicated that tinnitus (p<0.001), dizziness (p<0.001), nausea (p=0.001), headaches and migraine (p<=0.003), fatigue (p=0.004), and vertigo (p=0.022) were considered as risk predictors risk hearing loss related cigarette smokers. Also, analysis revealed that tinnitus (p<0.001), nausea (p=0.001), headaches and migraines (p<0.001), Type 2 diabetes mellitus (p<0.001), and vertigo (p=0.021), were considered as risk predictors for hearing loss related waterpipe smokers.

CONCLUSION

The present study suggests cigarette smoking and waterpipe smoking, life-style factors are possible risk factors for hearing loss among smoker participants.

Associations between medical conditions and auditory dysfunction in US Veterans

OBJECTIVE

To examine associations between non-otologic medical conditions and auditory dysfunction.

DESIGN

Cross-sectional analysis of baseline data from the Noise Outcomes in Service members Epidemiology (NOISE) study. Logistic regression was used to estimate the association between medical conditions (0, 1, and 2 or more conditions) and auditory dysfunction (hearing loss pure tone average ≥20 dB HL and tinnitus), adjusting for key confounders including noise exposure. Secondarily, the association between specific medical conditions and auditory dysfunction was examined. All variables were self-reported.

STUDY SAMPLE

United States military Veterans (n = 580) with mean age 34.1 years (standard deviation = 9.2), who were within approximately 2.5 years of separation from service.

RESULTS

Compared to Veterans reporting no medical conditions, Veterans reporting two or more had increased odds on low-frequency hearing loss and on tinnitus but not on high or extended-high frequency hearing loss. Furthermore, specific conditions sleep disorder and arthritis were associated with auditory dysfunction.

CONCLUSIONS

Non-otologic medical conditions were associated with low-frequency hearing loss and tinnitus in this sample of young Veterans. This suggests medical conditions may play a role in Veterans' hearing health. Whether management of medical conditions earlier in life reduces the risk of hearing loss and tinnitus requires further study.

Associations among hearing loss, multiple co-occurring symptoms, and quality of life outcomes in cancer survivors

PURPOSE

Evaluate for differences in demographic and clinical characteristics, occurrence of common symptoms, symptom severity scores, and quality of life (QOL) outcomes in survivors with (n = 155) and without (n = 118) audiometrically confirmed hearing loss.

METHODS

Survivors, who were recruited from throughout the San Francisco Bay area, completed the self-report questionnaires to obtain the information of demographic and clinical characteristics; the occurrence and severity of depression, anxiety, fatigue, decrements in energy, sleep disturbance, pain, and cognitive impairment; and the general and cancer-specific QOL outcomes. Parametric and non-parametric tests were used to evaluate for differences between the two survivor groups.

RESULTS

Survivors with audiometrically confirmed hearing loss were older, more likely to be male, were more likely to be unemployed, report a lower annual household income, and had a higher comorbidity burden. Except for the severity of worst pain, no between-group differences were found in the occurrence rates for or severity of any of the symptoms. Survivors with hearing loss reported worse physical function and general health scores.

CONCLUSIONS

While no between-group differences in symptom occurrence rates and severity scores were found, across the total sample, a relatively high percentage of survivors who were over 6 years from their cancer diagnosis reported clinically meaningful levels of depression (25%), anxiety (50%), fatigue (40%), decrements in energy (70%), sleep disturbance (58%), cognitive impairment (57%), and pain (60%).

IMPLICATIONS FOR CANCER SURVIVORS

Clinicians need to perform routine assessments of hearing loss, as well as common co-occurring symptoms and initiate individualized symptom management interventions.

Differences in Unfavorable Lifestyle Changes during the COVID-19 Pandemic between People with and without Disabilities in Finland: Psychological Distress as a Mediator

We investigated whether people with disabilities—cognition, vision, hearing, mobility, or at least one of these disabilities—report more COVID-19-related negative lifestyle changes than those without disabilities, and whether psychological distress (MHI-5) mediates the association between disabilities and negative lifestyle changes. Information about COVID-related lifestyle changes among people with disabilities is scarce. We analyzed population-based data from the 2020 FinSote survey carried out between September 2020 and February 2021 in Finland (n = 22,165, aged 20+). Logistic regressions were applied to investigate the effect of the COVID-19 pandemic and related restrictions on negative lifestyle changes—sleeping problems or nightmares, daily exercise, vegetable consumption, and snacking. To test for a mediation effect of psychological distress, the Karlson–Holm–Breen method was used. People with all disability types reported increased sleeping problems or nightmares, and decreased vegetable consumption during the pandemic more frequently than those without. People with mobility and cognitive disabilities more frequently reported decreased daily exercise. People with cognitive disabilities more often reported increased snacking. Psychological distress mediated associations between disabilities and negative lifestyle changes, with the highest association between cognitive disabilities and increased sleeping problems or nightmares (B = 0.60), and the lowest between mobility disabilities and decreased daily exercise (B = 0.08). The results suggest that strategies to promote healthy lifestyles should consider people with disabilities. Alleviating their psychological distress during crisis situations could be one approach.

Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms

OBJECTIVES

The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population.

DESIGN

This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9.

RESULTS

Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with highest overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%.

CONCLUSIONS

The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis.

The Relationship Between Blast-related Hearing Threshold Shift and Insomnia in U.S. Military Personnel

INTRODUCTION

Hearing loss and insomnia emerged as preeminent sources of morbidity among military service members and veterans who served in the recent Iraq and Afghanistan conflicts. Significant threshold shift (STS), an early indicator of hearing loss, has not been studied in relation to insomnia. This study's objective was to examine the co-occurrence of STS and insomnia among U.S. military personnel with blast-related injury.

MATERIALS AND METHODS

A total of 652 service members who were blast-injured during military operations in Iraq or Afghanistan between 2004 and 2012 were identified from the Blast-Related Auditory Injury Database. Pre- and post-injury audiometric data were used to ascertain new-onset STS, defined as 30 dB or greater increase for the sum of thresholds at 2,000, 3,000, and 4,000 Hz for either ear. Insomnia diagnosed within 2 years post-injury was abstracted from electronic medical records. Multivariable logistic regression analysis examined the relationship between STS and insomnia, while adjusting for age, year of injury, occupation, injury severity, tinnitus and concussion diagnosed in-theater, and PTSD.

RESULTS

A majority of the study sample was aged 18-25 years (79.9%) and sustained mild-to-moderate injuries (92.2%). STS was present in 21.1% of service members. Cumulative incidence of diagnosed insomnia was 22.3% and 11.1% for those with and without STS, respectively. After adjusting for covariates, those with STS had nearly 2-times higher odds of insomnia (odds ratio (OR) = 1.91, 95% CI = 1.12-3.24) compared with those without STS. In multivariable modeling, the strongest association was between PTSD and insomnia (OR = 5.57, 95% CI = 3.35-9.26). A secondary finding of note was that military personnel with STS had a significantly higher frequency of PTSD compared with those without STS (28.1% vs. 15.2%).

CONCLUSIONS

Hearing threshold shift was associated with insomnia in military personnel with blast-related injury and could be used to identify service members at risk. Multidisciplinary care is needed to manage the co-occurrence of both conditions during the post-deployment rehabilitation phase. Future research should evaluate the specific mechanisms involved in this relationship and further explore the association between hearing threshold shift and PTSD.

Factors related to difficulty sleeping in adults and older people registered with the Family Health Strategy

OBJECTIVE: To identify the factors related to difficulty sleeping in adults and older people registered on the Family Health Strategy at Primary Care Health Centers. METHODOLOGY: This is a cross-sectional, quantitative study conducted in the town of Três Lagoas (MS, Brazil), with 300 people of both sexes, aged 45 years and over, registered on the town’s Family Health Strategy. Data were collected using a structured questionnaire containing questions on sociodemographics, health, and social support networks. The dependent variable difficulty sleeping was assessed using the question: “Do you have difficulty sleeping?” Data were analyzed with binomial logistic regression. RESULTS: The prevalence of difficulty sleeping was 43% (95% confidence interval 37 – 49). According to the adjusted analyses, the following variables were associated with the outcome: female sex (Odds Ratio = 2.08; 95% confidence interval 1.21 – 3.60); number of medications per day (Odds Ratio = 1.18; 95% confidence interval 1.05 – 1.33); self-report of visual impairment (Odds Ratio = 3.56; 95% confidence interval 1.54 – 8.25); self-report of hearing loss (Odds Ratio = 2.28; 95% confidence interval 1.18 – 4.41); and social isolation (Odds Ratio = 2.01; 95% confidence interval 1.14 – 3.54). CONCLUSIONS: Identification of the principal factors related to complaints of insomnia is of relevance to support planning of care and of public policies, targeting improved sleep quality in people going through the aging process and beyond.