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

Association between neutrophil to high-density lipoprotein cholesterol ratio and hearing loss: a cross-sectional study from NHANES

BACKGROUND

This study aimed to investigate the relationship between the neutrophil-to-HDL cholesterol ratio (NHR) and the risk of hearing loss, as well as to evaluate the potential of the NHR as a biomarker for hearing loss.

METHODS

The U.S. National Health and Nutrition Examination Survey (NHANES) data covering 2005-2012 and 2015-2020 were analyzed. A weighted multivariate logistic regression model assessed the correlation between NHR and speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL). Restricted cubic spline (RCS) regression analysis was utilized to investigate the nonlinear correlation. Additionally, subgroup analysis was performed to identify differences among subgroups. A receiver operating characteristic (ROC) analysis was conducted to evaluate the efficacy of NHR in predicting hearing loss.

RESULTS

A total of 10,436 participants were involved. After comprehensive adjustments for confounding factors, NHR was linearly correlated with SFHL and HFHL. Subgroup analysis revealed that race and the poverty index ratio (PIR) significantly modified the association between NHR and hearing loss. ROC analysis demonstrated the predictive capability of NHR for hearing loss.

CONCLUSION

NHR is positively correlated with the risk of hearing loss. This study suggests that NHR may serve as a potential biomarker for predicting and assessing hearing loss, demonstrating significant clinical application value. However, this cross-sectional study limits the ability to establish causality. Future longitudinal studies are needed to confirm these findings and explore potential mechanisms.

Lipidomics profiling identifies β-oxidation as a key process in noise-induced hearing loss

Noise-induced hearing loss (NIHL) is the second leading cause of hearing loss worldwide, and the most common cause in young adults. Despite this burden, the molecular mechanisms by which noise causes damage are poorly understood, and there are no pharmacologic therapies to prevent or reduce noise-induced damage to the inner ear. Here, using targeted and untargeted lipidomics, we show that noise exposure induces changes in fatty acid (FA) and acylcarnitine (CAR) species in the inner ear, a metabolic profile indicative of noise-induced increases in β- oxidation. This conclusion is validated through treatment with Etomoxir, an inhibitor of carnitine palmitoyltransferase 1A, the rate-limiting enzyme of long-chain β-oxidation. Furthermore, we demonstrate that blocking β-oxidation with Etomoxir does not affect hearing in a normal acoustic environment but reduces the extent of hearing loss induced by an intense noise exposure (2 hours, 112 dB SPL, 8-16kHz). Together, our findings provide insights into cochlear energy metabolism and suggest that its modulation could be targeted to reduce NIHL.

Machine learning analysis of cardiovascular risk factors and their associations with hearing loss

Hearing loss poses immense burden worldwide and early detection is crucial. The accurate models identify high-risk groups, enabling timely intervention to improve quality of life. The subtle changes in hearing often go unnoticed, presenting a challenge for early hearing loss detection. While machine learning shows promise, prior studies have not leveraged cardiovascular risk factors known to impact hearing. As hearing outcomes remain challenging to characterize associations, we evaluated a new approach to predict current hearing outcomes through machine learning models using cardiovascular risk factors. The National Health and Nutrition Examination Survey (NHANES) 2012-2018 data comprising audiometric tests and cardiovascular risk factors was utilized. Machine learning algorithms were trained to classify hearing impairment thresholds and predict pure tone average values. Key results showed light gradient boosted machine performing best in classifying mild or greater impairment (> 25 dB HL) with 80.1% accuracy. It also classified > 16 dB HL and > 40 dB HL thresholds, with accuracies exceeding 77% and 86% respectively. The study also found that CatBoost and Gradient Boosting performed well in classifying hearing loss thresholds, with test set accuracies around 0.79 and F1-scores around 0.79-0.80. A multi-layer neural network emerged as the top predictor of pure tone averages, achieving a mean absolute error of just 3.05 dB. Feature analysis identified age, gender, blood pressure and waist circumference as key associated factors. Findings offer a promising direction for a clinically applicable tool, personalized prevention strategies, and calls for prospective validation.

Serum homocysteine is a biomarker for hearing loss associated with or without cardiovascular risk: a cross-sectional study in men

PURPOSE

Hearing loss (HL) represents a major health problem worldwide, and increasingly so due to population ageing and new leisure activities, such as video gaming or virtual reality experiences. HL has a multifactorial origin including both genetic and environmental issues with nutrition status emerging as a new contributing factor. In fact, certain micronutrient deficiencies, along with excessive consumption of specific macronutrients, have been related to HL This study aimed to examine the association of HL with dietary fat intake, nutritional status biomarkers, and serum metabolic signature in aviation pilots and controls.

METHODS

A cohort of aviation pilots, chronically exposed to noise pollution at work, was compared to a cohort of non-exposed university workers (controls). Hearing function was determined by tonal audiometry and dietary fat intake was assessed by three 24-h recalls. In addition, lipoprotein profiles as well as serum homocysteine (Hcy), folate, vitamins B12 and D were analysed. Two multiple linear regression models adjusted for age were constructed to explain HL variability.

RESULTS

HL prevalence was similar and elevated in both cohorts (controls: 64% vs. noise-exposed: 65%), when compared to the American Speech-Language-Hearing Association (ASHA) classification. When comparing both cohorts, although no significant differences were found in Hcy and folate levels, controls had significantly lower vitamins B12 and D concentrations and, conversely, higher serum lipids and lipoprotein values (triglycerides, total cholesterol, HDL-cholesterol and LDL-cholesterol subfractions), suggesting the possible involvement of CV risk in HL in the control cohort. In the noise-exposed cohort, HL was associated with flight hours, Hcy, and folate (r2 = 0.439), while in controls, HL was associated with Hcy and vitamin D (r2 = 0.474). After adjusting for CV profile, the positive association between HL and Hcy was maintained (β = 0.444; p < 0.001), evidencing the strong involvement of this metabolite not only in CV risk, but also in HL.

CONCLUSION

Folate insufficiency together with hyperhomocysteinemia increased susceptibility to noise-induced HL. However, the role of Hcy in HL without noise exposure at work seems to be partially masked by an altered CV profile.

Hearing and cognitive scores measured with the Montreal Cognitive Assessment Scale in The HUNT Study, Norway

INTRODUCTION

Hearing impairment is associated with dementia. We aimed to clarify the association between hearing impairment and future cognitive test performance measured by the Montreal Cognitive Assessment Scale (MoCA), adjusted for confounders, avoiding reverse causation through long follow-up.

METHODS

We used the Norwegian population-based longitudinal cohort study, The Trøndelag Health Study (HUNT). At baseline, we invited all residents 20+ for an audiometric hearing assessment, and at 20+ years follow-up, we cognitively assessed all persons 70+ including MoCA adjusted for hearing impairment. We analyzed the association using linear regression.

RESULTS

We included 6879 persons (mean 56.1 years, standard deviation 6.2). At follow-up, the MoCA score was -0.25 (95% confidence interval [CI] -0.35, -0.14), per 10 dB increase in hearing threshold and for persons < 85 years, -0.31 (95% CI -0.42, -0.20).

DISCUSSION

This study finds a long-term association between hearing impairment and dose related reduced cognitive performance, particularly in those aged < 85.

CLINICAL TRIAL REGISTRATION

ID NCT04284384, hearing impairment as a risk factor for dementia in older adults.

HIGHLIGHTS

Hearing loss predicts long-term cognitive decline measured by MoCA over 20+ years. Long follow-up is crucial to avoid reverse causation in the hearing-cognition relationship. A 10 dB hearing threshold increase is linked to a 0.25-point reduction in MoCA score. Strongest cognitive decline associations are seen in people aged below 85 years. The association remained after excluding hearing-dependent tasks in the MoCA.

Developing and validating a risk assessment method for noise-induced hearing loss in workers

Various risk factors can affect noise-induced hearing loss (NIHL) among employees. This research sought to establish and validate a risk assessment method for NIHL using these risk factors. This cross-sectional research was carried out with 220 workers from a steel manufacturing facility. At first, their demographic characteristics and information related to the studies' items were gathered by the researcher-made questionnaire. In the next step, the noise exposure values of the participants were measured by the sound pressure level meter based on the ISO 9612 standard. Moreover, a pure tone audiometric test of bone and air conduction was used to measure hearing loss in people. Ultimately, a new index for risk assessment was created. Indirect effect coefficients of individual factors such as work experience, age, smoking, and effective diseases were 0.266, 0.227, 0.056, and 0.064, respectively. The coefficients of noise exposure items including occupational noise and leisure noise were obtained as 0.687 and 0.660. The personal protective equipment (PPE) items including use of PPE, noise reduction rating of PPE, and awareness of PPE were 0.194, 0.147, and 0.127, respectively. These coefficients were utilized to create a new index. The overall score of the index was divided into four categories using optimal cut-off values of 4.85, 6.84, and 7.59. According to the findings, the OHLRA methods were able to account for 74 percent of the hearing loss values. The results showed that the novel index for risk assessment had proper validity in the prediction of NIHL.

Associations of hearing and visual loss with cognitive decline and dementia risk: a 25-year follow-up of the Maastricht Aging Study

BACKGROUND

Hearing loss (HL) and visual loss (VL) are recently identified as promising dementia risk factors, but long-term studies with adequate control of other modifiable dementia risk factors are lacking. This 25-year follow-up study investigated the association between objectively measured HL and VL with cognitive decline and incident dementia.

METHODS

1823 participants (age 24-82 years) of the Maastricht Aging Study were assessed at baseline, 6, 12 and 25 years. Baseline HL was defined as pure-tone hearing loss ≥20 dB at frequencies of 1, 2 and 4 kHz and VL as binocular, corrected visual acuity <0.5. Associations with cognitive decline (verbal memory, information processing speed, executive function) and incident dementia were tested using linear mixed models and Cox proportional hazard models, respectively. Analyses were adjusted for demographics and 11 modifiable dementia risk factors (LIfestyle for BRAin health index).

RESULTS

Participants with HL (n = 520, 28.7%) showed faster decline in all cognitive domains than participants without HL. No consistent association was found for VL (n = 58, 3.2%), but below-average visual acuity (<1) showed significant associations with information processing speed and executive function. No significant associations with dementia risk were found. Findings were independent of demographics and modifiable dementia risk factors.

CONCLUSIONS

HL predicts faster cognitive decline but not dementia risk in adults aged 24-82 years. VL shows no consistent associations, though below-average visual acuity is linked to faster cognitive decline. This study supports HL as an independent risk factor for cognitive decline. Future studies should further evaluate the roles of HL and VL in dementia risk reduction.

A Nationwide, Population-Based Study of Intelligence and Hearing Loss among 3,104,670 Adolescents

PURPOSE

Epidemiological studies have demonstrated a relationship between general intelligence (GI) in youth and hearing loss (HL). However, no large-scale study assessed the relations of GI in late adolescence with conductive HL (CHL) and sensorineural HL (SNHL), stratified by severity. This study examined the connection between HL and GI in late adolescence.

METHODS

Cross-sectional study on mandatory premilitary recruitment data recorded during 1967-2019 of patients aged 17-19. We compared GI between SNHL, CHL, and those with normal hearing. In addition, we used logistic regression to measure the associations between HL and GI after adjuring for age, sex, education, and socioeconomic status.

RESULTS

Among 3,104,851 adolescents assessed, 20,075 (0.6%) exhibited HL. We categorized GI into three levels for analysis: low (lowest category), medium, and high (reference category). Adjusted odds ratios (ORs) revealed that SNHL was associated with lower GI levels, with ORs ranging from 1.3 (95% confidence interval [CI] 1.4-1.2) for the lowest GI category to 1.1 (95% CI 1.15-0.04) for the medium category. CHL (CHL) also demonstrated significant associations, with ORs from 1.8 (95% CI 1.9-1.6) for the lowest GI level to 1.1 (95% CI 1.2-0.9) for medium. Further analysis revealed a statistically significant, severity-dependent relationship between SNHL and the odds of being in the lowest GI quartile (Q1). Specifically, the ORs for SNHL ranged from 1.2 (95% CI 1.1-1.3) to 1.3 (95% CI 1.1-1.5) as severity increased, indicating a strong link between greater SNHL severity and reduced cognitive performance. In contrast, CHL did not show a consistent correlation between its severity and GI outcomes, with an OR of 1.6 (95% CI 1.2-2.3) across severity levels.

CONCLUSION

We report a strong relationship between HL and GI in late adolescence. SNHL, but not CHL, demonstrated a severity-based decline in GI. The results highlight the value of early, specifically targeted therapies for HL that consider its etiology and degree.

Longitudinal urinary neopterin is associated with hearing threshold change over time in independent older adults

Low-grade chronic inflammation is associated with many age-related conditions. Non-invasive methods to monitor low-grade chronic inflammation may improve the management of older people at risk of poorer outcomes. This longitudinal cohort study has determined baseline inflammation using neopterin volatility in monthly urine samples of 45 independent older adults (aged 65-75 years). Measurement of neopterin, an inflammatory metabolite, enabled stratification of individuals into risk categories based on how often in a 12-month period their neopterin level was raised. Hearing was measured (pure-tone audiometry) at baseline, 1 year and 3 years of the study. Results show that those in the highest risk category (neopterin raised greater than 50% of the time) saw greater deterioration, particularly in high-frequency, hearing. A one-way Welch's ANOVA showed a significant difference between the risk categories for change in high-frequency hearing (W (3, 19.6) = 9.164, p = 0.0005). Despite the study size and duration individuals in the highest risk category were more than twice as likely to have an additional age-related morbidity than those in the lowest risk category. We conclude that volatility of neopterin in urine may enable stratification of those at greatest risk of progression of 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.

Differences in Oral Health According to the Presence of Hearing Loss: Data from the 2021 Korea National Health and Nutrition Examination Survey

BACKGROUND

The prevalence of hearing loss is increasing annually and has a strong relationship with oral health. However, existing research on hearing loss is limited to children, making it necessary to expand the analysis to adults. Therefore, this study aims to identify differences in oral health-related factors according to hearing loss in adults over 40 years of age using the Korea National Health and Nutrition Examination Survey.

METHODS

This study analyzed survey data from 2021. The study participants were divided into 1738 individuals in the nonhearing loss group and 1384 in the hearing loss group. Complex sample chi-square and complex sample independent t-tests were performed to determine differences in the sociodemographic characteristics, systemic diseases, hearing loss-related factors, and oral health status between the two groups.

RESULTS

Compared to the nonhearing loss group, the hearing loss group was older and had lower income and education levels. In terms of oral health, the hearing loss group had fewer existing natural teeth, poorer prosthesis conditions, and a higher number of implants than the nonhearing loss group. The hearing loss group also experienced comparatively more problems with chewing and speaking (P < 0.05).

CONCLUSIONS

Individuals with hearing loss exhibited poorer oral health status than those without hearing loss. Therefore, dental professionals in clinical practice should develop their communication skills to interact effectively with patients with hearing loss and strive to improve their oral health.

A qualitative study assessing the barriers and facilitators to physical activity in adults with hearing loss

OBJECTIVES

Growing epidemiological evidence has shown hearing loss is associated with physical inactivity. Currently, there is a dearth in evidence investigating why this occurs. This study aimed to investigate the barriers and facilitators to physical activity in middle-aged and older adults with hearing loss.

DESIGN

Individual semi-structured qualitative interviews.

METHODS

A phenomenological approach was taken. Ten adults (≥40 years) were interviewed via videoconferencing. The interview schedule was underpinned by the capability, opportunity, motivation and behaviour (COM-B) model. Reflexive thematic analysis was used to generate themes, which were subsequently mapped onto the COM-B model and behaviour change wheel.

RESULTS

Nine hearing loss specific themes were generated, which included the following barriers to physical activity: mental fatigue, interaction with the environment (acoustically challenging environments, difficulties with hearing aids when physically active) and social interactions (perceived stigma). Environmental modifications (digital capabilities of hearing aids), social support (hearing loss-only groups) and hearing loss self-efficacy were reported to facilitate physical activity.

CONCLUSIONS

Middle-aged and older adults with hearing loss experience hearing-specific barriers to physical activity, which has a deleterious impact on their overall health and well-being. Interventions and public health programmes need to be tailored to account for these additional barriers. Further research is necessary to test potential behaviour change techniques.

Recent Therapeutic Progress and Future Perspectives for the Treatment of Hearing Loss

Up to 1.5 billion people worldwide suffer from various forms of hearing loss, with an additional 1.1 billion people at risk from various insults such as increased consumption of recreational noise-emitting devices and ageing. The most common type of hearing impairment is sensorineural hearing loss caused by the degeneration or malfunction of cochlear hair cells or spiral ganglion nerves in the inner ear. There is currently no cure for hearing loss. However, emerging frontier technologies such as gene, drug or cell-based therapies offer hope for an effective cure. In this review, we discuss the current therapeutic progress for the treatment of hearing loss. We describe and evaluate the major therapeutic approaches being applied to hearing loss and summarize the key trials and studies.

Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study

Background

Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap.

Methods

This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984-1986), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4 (2017-2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384).

Findings

At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00-1.09) per 10 dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05-1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years.

Interpretation

We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes.

Funding

The Norwegian National Centre for Ageing and Health with a grant from Health South-East.

Hearing Loss: Insights for Home Care Clinicians

Hearing loss is a common problem caused by aging, noise exposure, ototoxic medications, and illness. Given their frequent contact with older adults, home care clinicians are uniquely positioned to recognize the adverse effects of hearing loss on physical, social, and cognitive health. This article explores the factors that contribute to hearing loss, highlighting their cumulative effects on overall hearing ability. The consequences of untreated hearing loss support the urgency of early identification, prompt intervention, and proper management of hearing disability. This article also provides an overview of available treatment options, including traditional prescription hearing aids and recently approved over-the-counter devices. By incorporating components of awareness, treatment, and effective communication strategies, healthcare clinicians can take an integrated approach to improve the overall well-being and quality of life of individuals struggling with hearing loss.

How are hearing loss and physical activity related? Analysis from the English longitudinal study of ageing

Although cross-sectional studies suggest that hearing loss in middle- and older-aged adults is associated with lower physical activity, longitudinal evidence is limited. This study aimed to investigate the potential bi-directional association between hearing loss and physical activity over time. Participants were from the English Longitudinal Study of Ageing (N = 11,292) who were 50-years or older at baseline assessment (1998-2000). Individuals were followed-up biannually for up to 20-years (2018-2019) and were classified as ever reporting hearing loss (n = 4946) or not reporting hearing loss (n = 6346). Data were analysed with Cox-proportional hazard ratios and multilevel logistic regression. The results showed that baseline physical activity was not associated with hearing loss over the follow-up. Time (i.e., wave of assessment) by hearing loss interactions showed that physical activity declined more rapidly over time in those with hearing loss, compared to those without (Odds Ratios = 0.94, 95% Confidence Intervals; 0.92-0.96, p < .001). These findings highlight the importance of addressing physical activity in middle- and older-aged adults with hearing loss. As physical activity is a modifiable behaviour that can reduce the risk of developing chronic health conditions, individuals with hearing loss may need additional, tailored support to be more physically active. Mitigating the decline in physical activity could be essential to support healthy ageing for adults with hearing loss.

The Association Between Midlife Leisure-Time Physical Activity and Hearing Loss in Late Life in the Atherosclerosis Risk in Communities Study

BACKGROUND

Hearing loss is highly prevalent in older ages and has several health consequences. Some cardiovascular risk factors are associated with worse hearing at older ages. Still, the role of midlife leisure-time physical activity (PA) as a risk factor for hearing loss is yet to be investigated.

METHODS

Among 3 198 participants of the Atherosclerosis Risk in Communities study, we investigated the associations of midlife and change from mid- to late-life PA (assessed via modified Baecke questionnaire) with hearing loss (audiometric battery [worse-ear pure-tone average, and speech-in-noise test]) at older ages. We used regression analyses, adjusted for demographics, medical conditions, and noise exposure, to estimate differences in hearing between those who met and did not meet PA recommendations at midlife and at late life.

RESULTS

A total of 1 386 (43.3%) participants met PA recommendations at midlife. These participants, compared to those who did not meet recommendations, had lower (better) pure-tone average by 1.51 (0.46, 2.55) decibels, identified 0.37 (0.01, 0.74) more words (better score) in the speech-in-noise test, and had a lower relative risk of having hearing loss at older ages (eg, relative risk ratio for severe hearing loss vs normal hearing = 0.70 [0.52, 0.95]). Similarly, those who persistently met PA recommendations from mid- to late life had, compared with those who did not, a better hearing at older ages.

CONCLUSIONS

Meeting PA public health recommendations in midlife and mid- to late life was associated with better hearing at older ages and reduced risk of hearing loss. Promoting adequate levels of PA may be an essential component of hearing care.

Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players: A Cross Sectional Comparative Study

BACKGROUND

Previous studies based on death certificates have found professional soccer players were more likely to die with neurodegenerative diseases, including dementia. Therefore, this study aimed to investigate whether retired professional male soccer players would perform worse on cognitive tests and be more likely to self-report dementia diagnosis than general population control men.

METHODS

A cross-sectional comparative study was conducted between August 2020 and October 2021 in the United Kingdom (UK). Professional soccer players were recruited through different soccer clubs in England, and general population control men were recruited from the East Midlands in the UK. We obtained self-reported postal questionnaire data on dementia and other neurodegenerative diseases, comorbidities and risk factors from 468 soccer players and 619 general population controls. Of these, 326 soccer players and 395 general population controls underwent telephone assessment for cognitive function.

RESULTS

Retired soccer players were approximately twice as likely to score below established dementia screening cut-off scores on the Hopkins Verbal Learning Test (OR 2.06, 95%CI 1.11-3.83) and Verbal Fluency (OR 1.78, 95% CI 1.18-2.68), but not the Test Your Memory, modified Telephone Interview for Cognitive Status, and Instrumental Activities of Daily Living. Analyses were adjusted for age, education, hearing loss, body mass index, stroke, circulatory problems in the legs and concussion. While retired soccer players were younger, had fewer cardiovascular diseases and other morbidities and reported healthier lifestyles, 2.8% of retired soccer players reported medically diagnosed dementia and other neurodegenerative disease compared to 0.9% of controls (OR = 3.46, 95% CI 1.25-9.63) after adjustment for age and possible confounders.

CONCLUSIONS

UK male retired soccer players had a higher risk of performing below established cut-off scores of dementia screening tests and were more likely to self-report medically diagnosed dementia and neurodegenerative diseases, despite having better overall physical health and fewer dementia risk factors. Further study is needed to determine specific soccer-related risk factors.

Hearing loss increases all-cause and cardiovascular mortality in middle-aged and older Chinese adults: the Dongfeng-Tongji Cohort Study

We aimed to investigate the association between hearing loss and all-cause and cardiovascular disease (CVD) mortality, and whether the relationship could be modified by chronic conditions in middle-aged and older Chinese adults. We selected 18,625 participants who underwent audiometry in 2013 from the Dongfeng-Tongji Cohort conducted in China, and followed them until December 2018. Hearing loss was grouped as normal, mild, and moderate or severe by pure-tone hearing threshold at speech (0.5, 1, and 2 kHz) and high frequency (4 and 8 kHz). We applied Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and CVD mortality. Among the 18,625 participants, the mean age was 64.6 (range: 36.7-93.0) years, and 56.2% were women. A total of 1185 died, with 420 CVD deaths during a mean follow-up period of 5.5 years. The adjusted HR for all-cause and CVD mortality increased gradually with the increasing hearing threshold (All p for trend < 0.05). Compared to participants with normal hearing at speech frequency, the adjusted HRs (95% CIs) of moderate or severe hearing loss were 1.42 (1.21-1.67), 1.44 (1.10-1.89), and 1.92 (1.21-3.04) for all-cause, CVD, and stroke mortality, respectively. While moderate or severe hearing loss at high frequency was only related to an increased risk of all-cause mortality (HR, 1.60; 95% CI, 1.18-2.17). The associations were generally consistent across subgroups (All p for interaction > 0.05). Additionally, individuals with a combination of moderate or severe hearing loss and occupational noise exposure, diabetes, or hypertension had higher risk of all-cause or CVD mortality, ranging from 1.45 to 2.78. In conclusion, hearing loss was independently associated with an increased risk of all-cause and CVD mortality, in a dose-response manner. Meanwhile, hearing loss and diabetes or hypertension could jointly increase the risk of all-cause and CVD mortality.

Probability Distributions for Associations Between Cognitive Screening and Pure-tone Thresholds in Older Adults

OBJECTIVES

Lower general cognitive function is frequently reported in older adults with elevated pure-tone thresholds. Here, we examined reason(s) for this association, including whether this relationship is dependent on the frequency range or extent of hearing loss and cognitive screening performance.

DESIGN

Linear regression was used to examine associations between better-ear pure-tone thresholds and Mini-Mental Status Exam (MMSE) performance in a cross-sectional sample of relatively healthy older adults (N = 508; 68% women, 60-89+ years; M age = 72). Quantile regression was also used to identify the ranges of 0.5 and 4.0 kHz thresholds and MMSE scores where these variables exhibited significant associations.

RESULTS

MMSE scores and pure-tone thresholds exhibited small but significant associations, particularly for better-ear 0.5 kHz thresholds. This hearing threshold and cognitive screening association was present among participants with better hearing, including the oldest older adults. There was limited evidence for mediating health condition effects on this association. An item analysis of the MMSE revealed that the MMSE and pure-tone threshold associations were largely due to the delayed recall item of the MMSE.

CONCLUSIONS

Together, the small effect results are consistent with the extant literature and suggest that there are multiple reasons for modest pure-tone threshold and cognitive screening performance associations.

Jackson Heart Study: Aggregate cardiovascular disease risk and auditory profiles

Objectives

Evaluate the relationship between cardiovascular disease (CVD) risk factors and cochlear function in African Americans.

Methods

Relationships between hearing loss, cochlear function, and CVD risk factors were assessed in a cross-sectional analysis of 1106 Jackson Heart Study participants. Hearing loss was defined as puretone average (PTA0.5,1,2,4) > 15 dB HL. Distortion product otoacoustic emissions (DPOAEs) were collected for f 2 = 1.0-8.0 kHz. Two amplitude averages were computed: DPOAElow (f 2 ≤ 4 kHz) and DPOAEhigh (f 2 ≥ 6 kHz). Based on major CVD risk factors (diabetes, current smoking, total cholesterol ≥240 mg/dL or treatment, and systolic blood pressure [BP]/diastolic BP ≥ 140/≥90 mmHg or treatment), four risk groups were created: 0, 1, 2, and ≥3 risk factors. Logistic regression estimated the odds of hearing loss and absent/reduced DPOAElow and DPOAEhigh by CVD risk status adjusting for age, sex, education, BMI, vertigo, and noise exposure.

Results

With multivariable adjustment, diabetes was associated with hearing loss (OR = 1.48 [95% CI: 1.04-2.10]). However, there was not a statistically significant relationship between CVD risk factors (individually or for overall risk) and DPOAEs.

Conclusion

Diabetes was associated with hearing loss. Neither individual CVD risk factors nor overall risk showed a relationship to cochlear dysfunction.

Level of Evidence

2b.

The association of food intake on the development of hearing impairment after middle age among Japanese community dwellers

OBJECTIVES

This study aimed to determine whether food intake modifies the risk of developing hearing impairment (HI) in Japanese adults in their 40s.

METHODS

Data for individuals who were in their 40s with no HI at baseline and had participated in the survey multiple times were extracted from the National Institute for Longevity Sciences, Longitudinal Study of Aging. A total of 1846 samples observed for up to 11.5 years in 421 participants were included in the analyses. The average 3-day food intake was calculated. HI is defined as a pure-tone average of the better ear at frequencies of 0.5, 1, 2, and 4 kHz greater than 25 dB. The risk of developing HI in the 18 food groups was calculated longitudinally using multivariable cumulative data analyses.

RESULTS

Even after adjusting basic confounding factors, food groups, and baseline hearing level, significant associations were found between beverage consumption and risk increments for HI (odds ratio [OR] = 2.374, 95% confidence interval [CI]:1.141-4.940) and also between mushroom intake and risk reduction (OR = 0.215, 95% CI:0.069-0.667). Other foods did not consistently show significant results when the combination of analysis variables were changed.

CONCLUSIONS

Although the effect of food on hearing is modest to the extent that the significance varies with the variables used in the analysis, the intake of beverages and mushrooms could potentially modify the risk of developing HI after middle age.

The longitudinal relationship between hearing loss and cognitive decline in tonal language-speaking older adults in China

Introduction

Previous longitudinal studies indicate that hearing loss and cognitive impairment are associated in non-tonal language-speaking older adults. This study aimed to investigate whether there is a longitudinal association between hearing loss and cognitive decline in older adults who speak a tonal language.

Methods

Chinese-speaking older adults aged 60 years and above were recruited for baseline and 12 month follow-up measurements. All participants completed a pure tone audiometric hearing test, Hearing Impaired-Montreal Cognitive Assessment Test (HI-MoCA), and a Computerized Neuropsychological Test Battery (CANTAB). The De Jong Gierveld Loneliness Scale was used to measure loneliness, and the 21-item Depression Anxiety Stress Scale (DASS-21) was used to measure aspects of mental health. Associations between baseline hearing loss and various cognitive, mental and psychosocial measures were evaluated using logistic regression.

Results

A total of 71 (29.6%) of the participants had normal hearing, 70 (29.2%) had mild hearing loss, and 99 (41.2%) had moderate or severe hearing loss at baseline, based on mean hearing thresholds in the better ear. After adjusting for demographic and other factors, baseline moderate/severe audiometric hearing loss was associated with an increased risk of cognitive impairment at follow-up (OR: 2.20, 95% CI: 1.06, 4.50). When pure-tone average (PTA) was modeled continuously, an average difference of 0.24 in HI-MoCA scores for every 10 dB increase in BE4FA existed, and an average difference of 0.07 in the change of HI-MoCA scores in a 12 month period.

Discussion

The results revealed a significant longitudinal relationship between age-related hearing loss and cognitive decline in this cohort of tonal language-speaking older adults. Steps should also be taken to incorporate hearing assessment and cognitive screening in clinical protocols for older adults 60 years and above in both hearing and memory clinics.

Peripheral Neuropathy and Vision and Hearing Impairment in US Adults With and Without Diabetes

We aimed to assess the associations of peripheral neuropathy (PN) with vision and hearing impairment among adults aged ≥40 years who attended the lower-extremity disease exam for the National Health and Nutrition Examination Survey (United States, 1999-2004). Overall, 11.8% (standard error (SE), 0.5) of adults had diabetes, 13.2% (SE, 0.5) had PN (26.6% (SE, 1.4) with diabetes, 11.4% (SE, 0.5) without diabetes), 1.6% (SE, 0.1) had vision impairment, and 15.4% (SE, 1.1) had hearing impairment. The prevalence of vision impairment was 3.89% (95% CI: 2.99, 5.05) among adults with PN and 1.29% (95% CI: 1.04, 1.60) among adults without PN (P < 0.001). After adjustment, PN was associated with vision impairment overall (odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.03, 2.13) and among adults without diabetes (OR = 1.80, 95% CI: 1.17, 2.77) but not among adults with diabetes (P for interaction = 0.018). The prevalence of hearing impairment was 26.5% (95% CI: 20.4, 33.7) among adults with PN and 14.2% (95% CI: 12.4, 16.3) among adults without PN (P < 0.001). The association of PN with moderate/severe hearing impairment was significant overall (OR = 2.55, 95% CI: 1.40, 4.64) and among adults without diabetes (OR = 3.26, 95% CI: 1.80, 5.91). Overall, these findings suggest an association between peripheral and audiovisual sensory impairment that is unrelated to diabetes.

Comprehensive association analysis of speech recognition thresholds after cisplatin-based chemotherapy in survivors of adult-onset cancer

PURPOSE

Deficits in speech understanding constitute one of the most severe consequences of hearing loss. Here we investigate the clinical and genetic risk factors for symmetric deterioration of speech recognition thresholds (SRT) among cancer survivors treated with cisplatin.

METHODS

SRT was measured using spondaic words and calculating the mean of measurements for both ears with symmetric SRT values. For clinical associations, SRT-based hearing disability (SHD) was defined as SRT≥15 dB hearing loss and clinical variables were derived from the study dataset. Genotyped blood samples were used for GWAS with rank-based inverse normal transformed SRT values as the response variable. Age was used as a covariate in association analyses.

RESULTS

SHD was inversely associated with self-reported health (p = 0.004). Current smoking (p = 0.002), years of smoking (p = 0.02), BMI (p < 0.001), and peripheral motor neuropathy (p = 0.003) were positively associated with SHD, while physical activity was inversely associated with SHD (p = 0.005). In contrast, cumulative cisplatin dose, peripheral sensory neuropathy, hypertension, and hypercholesterolemia were not associated with SHD. Although no genetic variants had an association p value < 5 × 10-8 , 22 genetic variants were suggestively associated (p < 10-5 ) with SRT deterioration. Three of the top variants in 10 respective linkage disequilibrium regions were either positioned within the coding sequence or were eQTLs for genes involved in neuronal development (ATE1, ENAH, and ZFHX3).

CONCLUSION

Current results improve our understanding of risk factors for SRT deterioration in cancer survivors. Higher BMI, lower physical activity, and smoking are associated with SHD. Larger samples would allow for expansion of the current findings on the genetic architecture of SRT.

Relationship of cardiovascular disease risk and hearing loss in a clinical population

Hearing loss has been associated with individual cardiovascular disease (CVD) risk factors and, to a lesser extent, CVD risk metrics. However, these relationships are understudied in clinical populations. We conducted a retrospective study of electronic health records to evaluate the relationship between hearing loss and CVD risk burden. Hearing loss was defined as puretone average (PTA_0.5,1,2,4) > 20 dB hearing level (HL). Optimal CVD risk was defined as nondiabetic, nonsmoking, systolic blood pressure (SBP) < 120 and diastolic (D)BP < 80 mm Hg, and total cholesterol < 180 mg/dL. Major CVD risk factors were diabetes, smoking, hypertension, and total cholesterol ≥ 240 mg/dL or statin use. We identified 6332 patients (mean age = 62.96 years; 45.5% male); 64.0% had hearing loss. Sex-stratified logistic regression adjusted for age, noise exposure, hearing aid use, and body mass index examined associations between hearing loss and CVD risk. For males, diabetes, hypertension, smoking, and ≥ 2 major CVD risk factors were associated with hearing loss. For females, diabetes, smoking, and ≥ 2 major CVD risk factors were significant risk factors. Compared to those with no CVD risk factors, there is a higher likelihood of hearing loss in patients with ≥ 2 major CVD risk factors. Future research to better understand sex dependence in the hearing loss-hypertension relationship is indicated.

Association between individual, household, and area-level socioeconomic status indicators and sensorineural hearing loss in adults in southwest Iran: a population-based study

Introduction

Hearing loss is the fourth most common chronic disease, but studies on the relationship between hearing loss and socioeconomic factors are limited. We aimed to examine the association between hearing loss and socioeconomic factors among 35-70 year adults in southwest Iran.

Materials and methods

This population-based cross-sectional study was conducted in the baseline of Hoveyzeh cohort study in adults aged 35-70 in southwest Iran between 2017 and 2021. Information on socioeconomic factors, demographic characteristics, comorbidities, family history of hearing loss, and noise exposure was collected. We assessed the relationship between three levels of socioeconomic factors (individual, household, and area level) with sensorineural hearing loss (SNHL). Multiple logistic regression was used to adjust the potential confounders.

Results

Among a total of 1,365 assessed participants, 485 patients were diagnosed as having hearing loss, and the other 880 individuals were diagnosed without hearing loss, which is considered the case and the control group, respectively. At the individual level of socioeconomic, the odds of having hearing loss in the participants with high school education and diploma, [OR = 0.51 (95%CI:0.28-0.92)], and the individuals with university education [OR = 0.44 (95%CI:0.22-0.87)] were significantly lower than the illiterate participants. At the household socioeconomic level, the odds of having hearing loss were lower for those with poor [OR = 0.63 (95%CI:0.41-0.97)] and moderate [OR = 0.62 (95%CI:0.41-0.94)] wealth status vs. those with the poorest wealth status. In the area level socioeconomic, although the odds of hearing loss in the residents of affluent areas were slightly lower than the residents of deprived areas, there was no significant difference among the groups.

Conclusion

The individuals with hearing loss may have insufficient education and income.

Hearing Loss and Cardiovascular Disease Risk Profiles: Data from the Hispanic Community Health Study/Study of Latinos

BACKGROUND

 Individual cardiovascular disease (CVD) risk factors (RFs) have been associated with hearing loss (HL). The relationship to aggregate risk is poorly understood and has not been explored in the Hispanic/Latino population.

PURPOSE

 The aim of this study was to characterize the association between aggregate CVD RF burden and hearing among Hispanics/Latinos.

RESEARCH DESIGN

 Cross-sectional examination.

STUDY SAMPLE

 Participants (18-74 years; n = 12,766) in the Hispanic Community Health Study/Study of Latinos.

DATA COLLECTION AND ANALYSIS

 Thresholds (0.5-8 kHz) were obtained, and HL was defined dichotomously as pure-tone average (PTA0.5,1, 2,4) > 25 dB HL. Optimal CVD risk burden was defined as follows: systolic blood pressure (SBP) < 120 mm Hg and diastolic blood pressure (DBP) < 80 mm Hg; total cholesterol < 180 mg/dL; nonsmoking; and no diabetes. Major CVD RFs were diabetes, currently smoking, SBP >160 or DBP > 100 mm Hg (or antihypertensives), and total cholesterol > 240 mg/dL (or statins). Thresholds were estimated by age (18-44 and ≥45 years) and sex using linear regression. The association between CVD risk burden and HL was assessed using multivariable logistic regression. Models were adjusted for age, sex, Hispanic/Latino background, center, education, income, alcohol use, body mass index, and noise exposure.

RESULTS

 In the target population, 53.03% were female and 18.81% and 8.52% had all RFs optimal and ≥2 major RFs, respectively. Elevated BP (SBP 120-139 mm Hg or DBP 80-89 mm Hg) was associated with HL in females < 45 years (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.14-4.16). Diabetes (OR, 1.37; 95% CI, 1.01-1.84) and tobacco smoking (OR, 1.44; 95% CI, 1.03-2.01) were associated with HL in females ≥ 45 years. The odds of HL were higher for females ≥ 45 years with ≥2 RFs versus those with all RFs optimal (OR, 1.99; 95% CI, 1.12-3.53). Elevated BP (SBP 140-159 mm Hg or DBP 90-99 mm Hg), but not aggregate risk burden, was associated with HL in males ≥ 45 years (OR, 1.49; 95% CI, 1.02-2.19). No relationships with major CVD RFs were significant in males < 45 years.

CONCLUSIONS

 HL is associated with elevated BP in females < 45 years, with diabetes and hypertension in males ≥ 45 years, and with diabetes, smoking, and having ≥2 major CVD RFs in females ≥ 45 years. Future studies are needed to examine if these factors are associated with incident HL.

Subclinical Hearing Deficits in Noise-Exposed Firefighters

Noise-induced hearing loss (NIHL) is the most prevalent occupational disease in the world and firefighters are at increased risk of NIHL due to their frequent exposure to hazardous levels of noise during service. Adverse effects of NIHL include acceleration of age-related hearing loss and an increased risk of cognitive decline. A critical challenge in addressing NIHL is the delayed clinical presentation of symptoms and lack of sensitive tools for early detection. To study the early clinical symptoms of NIHL in this high-risk group, we collected hearing function data including behavioral audiometric thresholds and distortion product otoacoustic emissions (DPOAEs) in 176 firefighters during annual physical assessments. Results revealed significant deficits in cochlear outer hair cell function in the presence of normal audiograms. Additionally, 55% of firefighters self-reported changes in hearing, while 20% self-reported concerns about their balance. This study is the first to characterize DPOAEs in firefighters who display decreased DPOAE amplitudes with increasing years in the fire service. These effects were observed even when controlling for hearing loss and age and are suggestive of a link between hearing loss and occupational exposure to hazardous noise.

Hearing Problems in Indonesia: Attention to Hypertensive Adults

Known as a silent disability, hearing loss is one of the major health burdens worldwide. Evidence implies that those suffering from hypertension can experience hearing disturbances. Self-reporting of hearing problems and self-reporting of hypertension may be useful in providing an alarm for detecting hearing problems. However, in the Indonesian population, this matter has not been properly reported. The aim of this study was to explore the prevalence of hearing problems and their relationships with other demographic factors. In total, 28,297 respondents of productive age from the Indonesian Family Life Survey 5th wave were assessed. A questionnaire and physical examination data were included in this survey. Self-reported hearing problems and their predictors were analyzed using univariate and multivariate logistic regressions. Hypertension awareness was a significant predictor of having a hearing problem (odds ratio (OR) [95% confidence interval (CI)], p value: 2.715 [1.948~3.785], <0.001). Having a general check-up was also crucial for detecting hearing problems (2.192 [1.54~3.121], <0.001). There was a significant link between hearing problems and early adults who have isolated systolic hypertension. Hypertension awareness and having a general check-up had predictive value for detecting hearing problems in adults in the age range of 26~35 years. Therefore, public health strategies for hearing loss prevention might target this group by detecting and treating hypertension.

Investigating the characteristics of genes and variants associated with self-reported hearing difficulty in older adults in the UK Biobank

BACKGROUND

Age-related hearing loss is a common, heterogeneous disease with a strong genetic component. More than 100 loci have been reported to be involved in human hearing impairment to date, but most of the genes underlying human adult-onset hearing loss remain unknown. Most genetic studies have focussed on very rare variants (such as family studies and patient cohort screens) or very common variants (genome-wide association studies). However, the contribution of variants present in the human population at intermediate frequencies is hard to quantify using these methods, and as a result, the landscape of variation associated with adult-onset hearing loss remains largely unknown.

RESULTS

Here we present a study based on exome sequencing and self-reported hearing difficulty in the UK Biobank, a large-scale biomedical database. We have carried out variant load analyses using different minor allele frequency and impact filters, and compared the resulting gene lists to a manually curated list of nearly 700 genes known to be involved in hearing in humans and/or mice. An allele frequency cutoff of 0.1, combined with a high predicted variant impact, was found to be the most effective filter setting for our analysis. We also found that separating the participants by sex produced markedly different gene lists. The gene lists obtained were investigated using gene ontology annotation, functional prioritisation and expression analysis, and this identified good candidates for further study.

CONCLUSIONS

Our results suggest that relatively common as well as rare variants with a high predicted impact contribute to age-related hearing impairment and that the genetic contributions to adult hearing difficulty may differ between the sexes. Our manually curated list of deafness genes is a useful resource for candidate gene prioritisation in hearing loss.

Test Your Health at Home: Comparing Online Screening Tests of Hearing, Cognition, and Cardiovascular Health

PURPOSE

The purpose of this study was to investigate the extent to which validated online screening measures of cognitive impairment, psychosocial well-being, and cardiovascular health are associated with a validated hearing screener in a sample of adults based in the United Kingdom.

METHOD

Sixty-one adults (43 female; M _age = 44.7 years) participated in a cross-sectional study delivered remotely. Participants completed the hearWHO smartphone application, a digits-in-noise hearing screener, and the Modified Telephone Interview for Cognitive Status (TICS-M), a screening tool for cognitive impairment. Psychosocial well-being (social isolation and loneliness) and cardiovascular health were assessed through self-report.

RESULTS

Separate independent analyses of variance, with age, gender, and education as covariates, demonstrated participants who failed the hearWHO screener had poorer scores on the TICS-M, engaged in less physical activity, and reported more sedentary behavior and greater social isolation. Multivariate regression analyses revealed that lower TICS-M scores, having obtained less education, identifying as female, and reporting greater sedentary behavior and social isolation were the strongest predictors of lower hearWHO scores.

CONCLUSIONS

The results from this study suggest that poorer hearing, as measured by the hearWHO screener, is independently associated with having worse cognitive function, more time spent being sedentary, and greater social isolation. Thus, this study demonstrates the potential of online screening measures to identify additional health conditions that confer risk to chronic disease as hearing loss manifests. This could help to inform the development of tailored treatment and support to improve an individual's readiness to seek help for and manage both their general and hearing health.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19251956.

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.

The Risk of Hearing Impairment From Ambient Air Pollution and the Moderating Effect of a Healthy Diet: Findings From the United Kingdom Biobank

The link between hearing impairment and air pollution has not been established, and the moderating effect of a healthy diet has never been investigated before. The purpose of this study was to investigate the association between air pollution and hearing impairment in British adults aged 37-73 years, and whether the association was modified by a healthy diet. We performed a cross-sectional population-based study with 158,811 participants who provided data from United Kingdom Biobank. A multivariate logistic regression model was used to investigate the link between air pollution and hearing impairment. Subgroup and effect modification analyses were carried out according to healthy diet scores, gender, and age. In the fully adjusted model, we found that exposure to PM₁₀, NO_X, and NO₂ was associated with hearing impairment [PM₁₀: odds ratio (OR) = 1.15, 95% confidence interval (95% CI) 1.02-1.30, P = 0.023; NO_X: OR = 1.02, 95% CI 1.00-1.03, P = 0.040; NO₂: OR = 1.03, 95% CI 1.01-1.06, P = 0.044], while PM_2.5 and PM_2.5 absorbance did not show similar associations. We discovered an interactive effect of age and air pollution on hearing impairment, but a healthy diet did not. The findings suggested that exposure to PM₁₀, NO_X and NO₂ was linked to hearing impairment in British adults, whereas PM_2.5 and PM_2.5 absorbance did not show similar associations. These may help researchers focus more on the impact of air pollution on hearing impairment and provide a basis for developing effective prevention strategies.

Relationship between ideal cardiovascular health metrics and hearing loss: A 10-year retrospective cohort study

OBJECTIVE

The role of ideal cardiovascular health (CVH) metrics in developing hearing loss remains uncertain. Thus, our objective was to analyse the connection between hearing loss and ideal CVH metrics in a 10-year retrospective cohort.

STUDY DESIGN

Retrospective cohort study.

SETTING

A health management centre in Taiwan.

PARTICIPANTS

Participants who underwent the first annual health check-up between 2000 and 2006 and with a follow-up check-up more than ten years later.

MAIN OUTCOME MEASURES

Hearing thresholds were measured at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Individuals with a best ear pure-tone audiometry four-frequency average of >25 dB HL were defined as having hearing loss. The ideal CVH metrics were classified into 7 categories based on the American Heart Association's definition. The associations of hearing loss with the sum of the ideal CVH metrics and each ideal CVH metric were examined by multiple logistic regression analysis.

RESULTS

The present study consisted of 6974 participants. The 10-year follow-up showed that the odds ratio (OR) of hearing loss was .74 for participants with 5-7 ideal CVH metrics (95% CI, .59-.93, p = .01) compared with those with 0-2 ideal CVH metrics. Among the CVH metrics, participants with an ideal smoking status might have reduced odds of developing hearing loss; the OR was .72 (95% CI, .58-.89, p = .003).

CONCLUSIONS

Participants with an increased number of ideal CVH metrics and better performance on the smoking metric had a significantly protective effect regarding hearing loss development.

The impact of cardiovascular diseases on hearing deterioration: a 13-year follow-up study

OBJECTIVE

To study the impact of cardiovascular diseases (CVDs) on hearing deterioration among ageing adults in a longitudinal setting. Furthermore, to describe the pure tone threshold changes at the 0.125-8 kHz frequency range over 13 years.

DESIGN

A population-based follow-up study.

STUDY SAMPLE

A random sample of 850 adults, of whom 559 participated in the follow-up study. Otological examination, a structured interview, and pure tone audiometry were conducted. Multivariate regression models were used to estimate the effect of CVD (participants had at least one cardiovascular condition) on hearing deterioration of the better ear hearing level (BEHL), defined as a change in the pure-tone average (PTA) of the frequencies 0.5, 1, 2, and 4 kHz and separately at the lower (0.125, 0.25, and 0.5 kHz) and higher (4, 6, and 8 kHz) frequencies.

RESULTS

In the multivariable-adjusted analysis, the BEHL change at 13 years was 0.7 dB greater among participants with CVD (p = 0.3). The mean BEHL change during the 13-year follow-up was 12.0 dB (95% CI 11.4-12.6) among all participants.

CONCLUSIONS

No significant association between CVD and hearing threshold changes was found.

The Association Between Hearing Loss and Surgical Complications in Older Adults

OBJECTIVES

In this study, we sought to evaluate whether older patients with hearing loss who underwent surgery were at greater risk of postsurgical complications, increased inpatient length-of-stay (LOS), and hospital readmission.

DESIGN

This was a retrospective cohort study of patients receiving surgery at a tertiary medical center. Utilizing electronic health record data from two merged datasets, we identified patients 65 years and older, undergoing major surgery between January 1, 2014 and January 31, 2017, and who had audiometric evaluation before surgery. Patients were classified as having either normal hearing or hearing loss based on pure-tone average in the better ear. A Generalized Estimating Equations approach was used to fit multivariable regression models for outcome variables of interest.

RESULTS

Of patients ≥65 years undergoing major surgery in our time frame, a total of 742 surgical procedures were performed on 621 patients with available audiometric data. After adjusting for age, sex, race, and comorbidities, hearing loss was associated with an increase in the odds of developing postoperative complications. Every 10 dB increase in hearing loss was associated with a 14% increase in the odds of developing a postoperative complication (odds ratio = 1.14, 95% confidence interval = 1.01-1.29, p = 0.031). Hearing loss was not significantly associated with increased hospital LOS, 30-day readmission, or 90-day readmission.

CONCLUSION

Hearing loss was significantly associated with developing postoperative complications in older adults undergoing major surgery. Screening for hearing impairment may be a useful addition to the preoperative assessment and perioperative management of older patients undergoing surgery.

Electrocochleography and Auditory Brainstem Responses in Persons with Non-Optimal Blood Pressure

BACKGROUND

Numerous cardiometabolic factors may underlie risk of hearing loss. Modifiable risk factors such as non-optimal blood pressure (BP) are of interest.

PURPOSE

To investigate early auditory evoked potentials (AEPs) in persons with nonoptimal BP.

RESEARCH DESIGN

A cross-sectional nonexperimental study was performed.

STUDY SAMPLE

Fifty-two adults (18-55 years) served as subjects. Individuals were classified as having optimal (systolic [S] BP < 120 and diastolic [D] BP < 80 mm Hg, n = 25) or non-optimal BP (SBP ≥=120 or DBP ≥=80 mm Hg or antihypertensive use, n = 27). Thirteen subjects had hypertension (HTN) (SBP ≥130 or DBP ≥80 mm Hg or use of antihypertensives).

DATA COLLECTION AND ANALYSIS

Behavioral thresholds from 0.25 to 16 kHz were collected. Threshold auditory brain stem responses (ABRs) were recorded using rarefaction clicks (17.7/second) from 80 dB nHL to wave V threshold. Electrocochleograms were obtained with 90 dB nHL 7.1/second alternating clicks and assessed for summating and compound action potentials (APs). Outcomes were compared via independent samples t tests. Linear mixed effects models for behavioral thresholds and ABR wave latencies were constructed to account for potential confounders.

RESULTS

Wave I and III latencies were comparable between optimal and non-optimal BP groups. Wave I was prolonged in hypertensive versus optimal BP subjects at stimulus level 70 dB nHL (p = 0.016). ABR wave V latencies were prolonged in non-optimal BP at stimulus level 80 dB nHL (p = 0.048) and in HTN at levels of 80, 50, and 30 dB nHL (all p < 0.050). DBP was significantly correlated with wave V latency (r = 0.295; p = 0.039). No differences in ABR amplitudes were observed between optimal and non-optimal BP subjects. Electrocochleographic study showed statistically comparable action and summating potential amplitudes between optimal and non-optimal BP subjects. AP latencies were also similar between the groups. Analysis using a set baseline amplitude of 0 μV showed that hypertensive subjects had higher summating (p = 0.038) and AP (p = 0.047) amplitudes versus optimal BP subjects; AP latencies were comparable.

CONCLUSION

Elevated BP and more specifically, HTN was associated with subtle AEP abnormalities. This study provides preliminary evidence that nonoptimal BP, and more specifically HTN, may be related to auditory neural dysfunction; larger confirmatory studies are warranted.

Social observation increases the cardiovascular response of hearing-impaired listeners during a speech reception task

Certain cardiovascular measures allow for distinction between sympathetic and parasympathetic nervous system activity. Applied during listening, these measures may provide a novel and complementary insight into listening effort. To date, few studies have implemented cardiovascular measures of listening effort and seldom have these included hearing-impaired participants. These studies have generally measured changes in cardiovascular parameters while manipulating environmental factors, such as listening difficulty. Yet, listening effort is also known to be moderated by individual factors, including the importance of performing successfully. In this study, we aimed to manipulate success importance by adding observers to the traditional laboratory set-up. Twenty-nine hearing-impaired participants performed a speech reception task both alone and in the presence of two observers. Auditory stimuli consisted of Danish Hearing in Noise Test (HINT) sentences masked by four-talker babble. Sentences were delivered at two individually adapted signal-to-noise ratios, corresponding to 50 and 80% of sentences correct. We measured change scores, relative to baseline, of pre-ejection period, two indices of heart rate variability, heart rate and blood pressure (systolic, diastolic, and mean arterial pressure). After each condition, participants rated their effort investment, stress, tendency to give up and preference to change the situation to improve audibility. A multivariate analysis revealed that cardiovascular reactivity increased in the presence of the observers, compared to when the task was performed alone. More specifically, systolic, diastolic, and mean arterial blood pressure increased while observed. Interestingly, participants' subjective ratings were sensitive only to intelligibility level, not the observation state. This study was the first to report results from a range of different cardiovascular variables measured from hearing-impaired participants during a speech reception task. Due to the timing of the observers' presence, we were not able to conclusively attribute these physiological changes to being task related. Therefore, instead of representing listening effort, we suggest that the increased cardiovascular response detected during observation reveals increased physiological stress associated with potential evaluation.

High frequency hearing impairment and cardiovascular disease in Canada: Results from the Canadian Health Measures Survey

Noise-induced stress may precipitate cardiovascular diseases. This research assessed the association between sensorineural bilateral high frequency hearing loss (HFHL), as an indication of excessive noise exposure, and cardiovascular outcomes. Participants (n = 6318, ∼50% male) 20-79 years were recruited through the cross-sectional Canadian Health Measures Survey. Questionnaires included several demographic and health-related variables. Audiometry and blood/urine collection took place in a mobile examination centre. Average thresholds ≥25 dB averaged across 3, 4, and 6 kHz defined HFHL. Logistic or linear regression models explored associations between HFHL and cardiovascular-related risk factors/outcomes. Adjusted models indicated elevated diastolic blood pressure in respondents with normal hearing, X¯ = 72.52 (95% confidence interval: 71.85-73.18) compared to the group with bilateral HFHL, X¯ = 70.28 (95%CI: 69.13-71.43), p < 0.05. Average total cholesterol, high-density lipoprotein, low-density lipoprotein and apolipoprotein A1 were elevated in the normal hearing group (p < 0.05). Insulin, high-sensitivity C-reactive protein, and average resting heart rate were elevated in the group with bilateral HFHL, p < 0.05. A stratified analysis by sex- and age, or history of loud occupational noise exposure, did not change the overall results. Although some findings warrant further exploration, the overall analysis did not provide compelling evidence for an association between HFHL and cardiovascular-related biomarkers, or cardiovascular diseases among Canadians aged 20-79 years.

Association Between Nonoptimal Blood Pressure and Cochlear Function

OBJECTIVES

The association between hearing loss and risk factors for cardiovascular disease, including high blood pressure (BP), has been evaluated in numerous studies. However, data from population- and laboratory-based studies remain inconclusive. Furthermore, most prior work has focused on the effects of BP level on behavioral hearing sensitivity. In this study, we investigated cochlear integrity using distortion product otoacoustic emissions (DPOAEs) in persons with subtle elevation in BP levels (nonoptimal BP) hypothesizing that nonoptimal BP would be associated with poorer cochlear function.

DESIGN

Sixty individuals [55% male, mean age = 31.82 (SD = 11.17) years] took part in the study. The authors measured pure-tone audiometric thresholds from 0.25 to 16 kHz and computed four pure-tone averages (PTAs) for the following frequency combinations (in kHz): PTA0.25, 0.5, 0.75, PTA1, 1.5, 2, 3, PTA4, 6, 8, and PTA10, 12.5, 16. DPOAEs at the frequency 2f1-f2 were recorded for L1/L2 = 65/55 dB SPL using an f2/f1 ratio of 1.22. BP was measured, and subjects were categorized as having either optimal BP (systolic/diastolic <120 and <80 mm Hg) or nonoptimal BP (systolic ≥120 or diastolic ≥80 mm Hg or use of antihypertensives). Between-group differences in behavioral thresholds and DPOAE levels were evaluated using 95% confidence intervals. Pearson product-moment correlations were run to assess the relationships between: (1) thresholds (all four PTAs) and BP level and (2) DPOAE [at low (f2 ≤ 2 kHz), mid (f2 > 2 kHz and ≤10 kHz), and high (f2 > 10 kHz) frequency bins] and BP level. Linear mixed-effects models were constructed to account for the effects of BP status, stimulus frequency, age and sex on thresholds, and DPOAE amplitudes.

RESULTS

Significant positive correlations between diastolic BP and all four PTAs and systolic BP and PTA0.25, 0.5, 0.75 and PTA4, 6, 8 were observed. There was not a significant effect of BP status on hearing thresholds from 0.5 to 16 kHz after adjustment for age, sex, and frequency. Correlations between diastolic and systolic BP and DPOAE levels were statistically significant at the high frequencies and for the relationship between diastolic BP and DPOAE level at the mid frequencies. Averaged across frequency, the nonoptimal BP group had DPOAE levels 1.50 dB lower (poorer) than the optimal BP group and differences were statistically significant (p = 0.03).

CONCLUSIONS

Initial findings suggest significant correlations between diastolic BP and behavioral thresholds and diastolic BP and mid-frequency DPOAE levels. However, adjusted models indicate other factors are more important drivers of impaired auditory function. Contrary to our hypothesis, we found that subtle BP elevation was not associated with poorer hearing sensitivity or cochlear dysfunction. We consider explanations for the null results. Greater elevation in BP (i.e., hypertension itself) may be associated with more pronounced effects on cochlear function, warranting further investigation. This study suggests that OAEs may be a viable tool to characterize the relationship between cardiometabolic risk factors (and in particular, stage 2 hypertension) and hearing health.

Modifiable lifestyle-related risk factors for tinnitus in the general population: An overview of smoking, alcohol, body mass index and caffeine intake

INTRODUCTION

Tinnitus is a symptom and not a disease in its own right. A number of medical conditions are known to increase the risk of developing tinnitus. Most known risk factors are otological or neurological, but general health and lifestyle can also precipitate the condition. Understanding these modifiable risk factors can help to identify vulnerable groups and can inform preventive actions to reduce likelihood of developing tinnitus. Smoking, alcohol consumption, body mass index (BMI) and caffeine intake are all lifestyle risk factors hypothesized to be related to tinnitus. Nonetheless, research findings in support of those relationships are somewhat mixed.

METHODS

A systematic review was conducted to identify all relevant studies on the specific risk factors. Findings were summarized using a narrative synthesis and meta-analysis, where possible.

RESULTS

Overall 384 studies were included, mostly using cross-sectional designs. Findings indicated significantly increased risk of tinnitus among current (based on 26 studies) and ever smokers (based on 16 studies) and among obese people (based on seven studies), but no effect of alcohol consumption (based on 11 studies). With respect to caffeine intake or coffee drinking, only three studies examined this risk factor and so we were unable to draw conclusions.

CONCLUSION

Our results contribute to quantifying the relationship between tinnitus and specific lifestyle-related risk factors, and we highlight some of the gaps and inconsistencies across published studies.

Association between Speech Recognition in Noise and Risk Factors of Cardiovascular Disease

INTRODUCTION

Risk factors for cardiovascular disease (CVD) are associated with sensorineural hearing loss. CVD risk factors are known to cluster and interact, thereby increasing the cumulative risk for CVD. Previously, using the database of the Netherlands Longitudinal Study on Hearing (NL-SH), an association was found between a history of smoking and an increased decline in speech recognition in noise over 10 years of follow-up. Prospectively limited data are available on the association between CVD risk factors, interactions of these risk factors, and hearing loss. In this study, data from the NL-SH were used to study the association between CVD risk factors and speech recognition in noise longitudinally.

METHODS

Baseline, 5-year, and 10-year follow-up data of the NL-SH were included. The NL-SH is a web-based prospective cohort study which started in 2006. Participants were aged 18-70 years at baseline. Speech recognition in noise was determined with an online digit-triplet speech-in-noise test. In addition, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics. The association of the ability to recognize speech in noise with CVD risk factors (i.e., obesity, rheumatoid arthritis [RA], hypertension, diabetes mellitus, and dyslipidemia) was analyzed longitudinally. We also analyzed the interaction between these risk factors (including age, sex, and history of smoking) and speech recognition in noise.

RESULTS

None of the CVD risk factors or interactions of 2 CVD risk factors was significantly associated with a decline in SRT over time. Obesity (p = 0.016), RA (p = 0.027), and hypertension (p = 0.044) were associated with overall higher (more unfavorable) SRTs. No overall interactions between CVD risk factors were found.

CONCLUSION

Obesity, RA, and hypertension were overall associated with a higher SRT, but no longitudinal associations between these or other CVD factors with SRTs were found. Also, no interactions between 2 CVD risk factors and SRTs were found. Although no longitudinal associations between CVD risk factors and decline in SRTs were found, clinicians should be alert about the concurrent association between CVD risk factors and hearing loss.

Argumentum ad Ignorantiam: Smartphone-Connected Listening Devices

In this article, we review the current literature assessing the application and benefits of connected hearing technologies, as well as their potential to improve accessibility to and affordability of hearing healthcare. Over the past decade, there has been a proliferation of hearing devices that connect wirelessly to smartphone technologies via Bluetooth. These devices include (1) smartphone-connected hearing aids that must be obtained from a licensed audiologist or hearing aid dispenser; (2) direct-to-consumer devices, such as personal sound amplification products; and (3) smartphone-based hearing aid applications (or apps). Common to all these connected devices is that they permit the user to self-adjust and customize their device programs via an accompanying smartphone app. There has been a growing body of literature assessing connected hearing devices in adults living with hearing loss. Overall, the evidence to date supports the notion that all connected hearing devices can improve accessibility to and affordability of amplification. It is unclear, however, whether connected technologies are a clinically effective alternative to traditional hearing aids. Even so, the impact of connectivity is especially pertinent given the sudden disruption caused by the recent global COVID-19 pandemic, whereby connected technologies enable patients to receive treatment through mobile-based, tele-audiology platforms.

Hearing examinations in Southern Denmark (HESD) database: a valuable tool for hearing-related epidemiological research

OBJECTIVE

To introduce and document the recently established HESD (Hearing Examinations in Southern Denmark) database, including the necessary data preprocessing steps, and to describe the hearing loss (HL) characteristics of the study sample.

DESIGN

Clinical auditory information has been collected for approximately 20 years in the state-funded clinics of the Region of Southern Denmark. We reviewed these data and conducted extensive preprocessing through data selection, integration, cleaning, transformation, and classification. HL profiling was then assessed in terms of severity, asymmetry, configuration, site of lesion, and audiogram shape.

STUDY SAMPLE

The final number of complete audiograms available in the HESD database was 271,556, corresponding to detailed hearing information for 143,793 adults.

RESULTS

The distribution of HL characteristics differed significantly (p < 0.001) between men and women for all categories analysed. Clear differences were observed for asymmetry and audiogram configuration. However, both men and women had higher prevalence of unilateral, moderate, and sensorineural HL.

CONCLUSIONS

This work highlights the potential of the HESD database as a source of audiology-related epidemiological data. It can be used to evaluate the distribution of HL characteristics and also to investigate risk factors for HL and the associations between HL and other health outcomes.

Body mass index, waist circumference, and risk of hearing loss: a meta-analysis and systematic review of observational study

BACKGROUND

Emerging evidence implicates excess weight as a potential risk factor for hearing loss. However, this association remained inconclusive. Therefore, we aimed to systematically and quantitatively review the published observational study on the association between body mass index (BMI) or waist circumference (WC) and hearing loss.

METHODS

The odds ratios (ORs) or relative risks (RRs) with their 95% confidence intervals (CIs) were pooled under a random-effects model. Fourteen observational studies were eligible for the inclusion in the final analysis.

RESULTS

In the meta-analysis of cross-sectional studies, the ORs for prevalent hearing loss were 1.10 (95% CI 0.88, 1.38) underweight, 1.14 (95% CI 0.99, 1.32) for overweight, OR 1.40 (95% CI 1.14, 1.72) for obesity, 1.14 (95% CI 1.04, 1.24) for each 5 kg/m2 increase in BMI, and 1.22 (95% CO 0.88. 1.68) for higher WC. In the meta-analysis of longitudinal studies, the RRs were 0.96 (95% CI 0.52, 1.79) for underweight, 1.15 (95% CI 1.04, 1.27) for overweight, 1.38 (95% CI 1.07, 1.79) for obesity, 1.15 (95% CI 1.01, 1.30) for each 5 kg/m2 increase in BMI, and 1.11 (95% CI 1.01, 1.22) for higher WC.

CONCLUSIONS

In summary, our findings add weight to the evidence that elevated BMI and higher WC may be positively associated with the risk of hearing loss.

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.

Osteoporosis and hearing loss: findings from the Korea National Health and Nutrition Examination Survey 2009–2011

Introduction

Age-related hearing impairment is the most common sensory dysfunction in older adults. In osteoporosis, the mass of the ossicles will be decreased, affecting the bone density of the cochlea, and interfering with the sound transmission to the cochlea. Age related hearing loss might be closely related to osteoporosis.

Objective

To determine the relationship between age-related hearing impairment and osteoporosis by investigating the relationship between hearing loss and cortical bone density evaluated from femur neck bone mineral density.

Methods

We used data from the Korea National Health and Nutrition Examination Survey to examine the associations between osteoporosis and age-related hearing impairment from 2009 to 2011. Total number of participants was 4861 including 2273 men and 2588 women aged 50 years or older. Osteoporosis was defined as a bone mineral density 2.5 standard deviations below according to the World Health Organization diagnostic classification. Age-related hearing impairment was defined as the pure-tone averages of test frequencies 0.5, 1, 2, and 4 kHz at a threshold of 40 dB or higher on the more impaired hearing side.

Results

Total femur T-score (p < 0.001), lumbar-spine T-score (p < 0.001) and, femur neck T-score (p < 0.001) were significantly lower in the osteoporosis group compared to the normal group. Thresholds of pure-tone averages were significantly different in normal compared to osteopenia, and osteoporosis groups. In addition, there were significantly higher pure-tone averages thresholds in the osteoporosis group compared to other groups (p < 0.001). After adjusting for all covariates, the odds ratio for hearing loss was significantly increased by 1.7 fold with reduced femur neck bone mineral density (p < 0.01). However, lumbar spine bone mineral density was not statistically associated with hearing loss (p = 0.22).

Conclusion

Our results suggest that osteoporosis is significantly associated with a risk of hearing loss. In addition, femur neck bone mineral density was significantly correlated with hearing loss, but lumbar spine bone mineral density was not.