Alcohol as a risk factor for hearing loss: A systematic review and meta-analysis

Clinical and audiological profile of patients with sudden sensorineural hearing loss after exposure to recreational noise

According to the World Health Organization, significant hearing loss in young people exposed to recreational acoustic trauma has become a public health issue.

OBJECTIVE

To describe the clinical and audiological profile of individuals with Sudden Sensorineural Hearing Loss (SSNHL) exposed to recreational noise.

METHODS

A prospective cohort study was conducted involving outpatients with SSNHL and a history of exposure to acute recreational noise. Follow-up occurred weekly in the first month, then monthly for up to six months of follow-up. All were treated with oral corticosteroids with prednisone 1 mg/kg/day, followed by a gradual dose reduction of 20 mg every 7-days until complete withdrawal of the medication.

RESULTS

Twelve individuals were included, 8 (66.7%) males, with a mean age of 24.16-years. 58.3% of the individuals had binaural involvement. Only one patient had permanent profound hearing loss, with no sign of recovery after treatment. All had associated tinnitus. Half of the participants reported having used recreational drugs, and the type of exposure varied from New Year's Eve parties, funk and electronic music, concerts and games in stadiums. Regarding the duration of exposure and the distance from the sound source, most reported a time of 3-5 h, with a short distance from the source.

DISCUSSION

Recreational noise exposures have the potential to increase the risk of hearing loss in individuals outside of the workplace. Data such as sex, age group and the most prevalent type of noise exposure in these cases reported in this study corroborate the findings in the literature. Regarding the persistence of hearing loss after treatment, the outcome was varied, and the studies are still controversial.

CONCLUSION

There is an association between exposure to recreational noise and SSNHL, and the epidemiological profile of patients affected by this condition is marked by adolescents and young male adults with unilateral and binaural involvement, severe degree of hearing loss at onset, and commonly associated with the use of recreational drugs, risking permanent hearing damage.

LEVEL OF EVIDENCE

3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").

Environmental ototoxicants: an update

Approximately 5 years ago, we proposed the establishment of a new category of ototoxicants: environmental ototoxicants, in addition to the recognized categories of occupational and drug-related ototoxicants. Since the publication of our review, the scientific literature has confirmed the potential for hearing impairment (HI) caused by the general population's exposure to various chemicals. However, the extent of this exposure's contribution to the global incidence of hearing loss (HL) has yet to be estimated. Due to the growing health, financial, and social challenges related to HL in the general population, we have reviewed the literature on HL in individuals exposed to environmental chemicals. Additionally, we have broadened the list of environmental ototoxicants to include several previously recognized as occupational ototoxicants. These substances include the following: organophosphate insecticides (OPIs), organochlorine pesticides (OCPs): hexachlorocyclohexane (HCH), dieldrin, dichlorodiphenyldichloroethylene (DDE), and hexachlorobenzene (HCB); pyrethroids, bisphenol A (BPA), benzophenone-3 (BP-3), triclosan (TCS), parabens (PBs), per- and polyfluorinated compounds (PFCs), metals and trace elements (such as cadmium (Cd), lead (Pb), manganese (Mn), iron (Fe), mercury (Hg), selenium (Se), barium (Ba), and arsenic (As)), polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), styrene. Additionally, we have included alcohol, which is widely consumed and known for its ototoxic effects.

Association between NF-E2-related factor 2 polymorphism and age-related hearing loss in the general Japanese population from the Iwaki health promotion project

BACKGROUND

Single-nucleotide polymorphisms (SNPs) of the NF-E2-related factor 2 (NRF2) gene might be associated with several diseases. In the animal models, NRF2 has been reported to be associated with the age-related hearing loss (ARHL). However, the effect of NRF2 SNPs on ARHL in the general population has not been reported.

OBJECTIVES

This study aimed to evaluate the effect of NRF2 SNP-617 on ARHL in the general Japanese population.

METHODS

This study included participants from the Iwaki Health Promotion Project. The genotypes of NRF2 SNP-617 were determined via whole-genome sequencing, and the hearing level of the CC homozygote + CA heterozygote carrier group was compared with that of the AA homozygote carrier group.

RESULTS

Among the 306 CC+CA and 31 AA group male subjects, 22 (7.2%) and six (19.4%), respectively, had hearing loss, with a significant difference. Multiple logistic regression analysis showed that the risk of hearing loss in the male subjects was significantly higher in the AA group than that in the CC+CA group (p = .031, odds ratio = 3.437, 95% confidence interval = 1.116-10.580).

CONCLUSION

The genotypes of NRF2 SNP-617 AA carriers were significantly associated with the development of ARHL among the males aged 30-59 years.

Prevalence of Noise-Induced Hearing Loss among Truck Drivers: a Cross-Sectional Study in Lucknow

BACKGROUND

Noise pollution is a significant occupational hazard for heavy-vehicle drivers. This study aimed to determine the prevalence of hearing loss, specifically noise-induced hearing loss, among truck drivers.

METHODS

A total of 200 long-distance truck drivers based in Lucknow City were selected for this study. Pure tone audiometry was used to measure air conduction thresholds in each ear at frequencies ranging from 250 to 8000 Hz. The association of risk factors, such as sleep duration, work experience, age, alcohol drinking, and diabetes, with the prevalence of hearing loss among truck drivers was examined. Participants completed a structured questionnaire addressing hearing health and noise exposure. Data were analyzed using Python software, employing statistical tests such as the chi-square test, rank-sum test, and Wilcoxon signed-rank test.

RESULTS

Based on the World Health Organization guideline, the overall prevalence of hearing loss among 200 drivers was 50.5% in their better ear, with a higher hearing loss rate in the right ear (73.5%) than in the left ear (59.5%). The average hearing thresholds at 500, 1000, 2000, and 4000 Hz of the drivers' right and left ears were 32.61 ± 9.85 and 28.66 ± 8.88 dB, respectively. The audiometric analysis identified key risk factors for hearing loss, including shorter sleep duration (≤6 h), extended work experience (>10 years), older age (>40 years), and alcohol drinking, which were further confirmed as significant predictors through multivariate logistic analysis.

CONCLUSION

Hearing loss is highly prevalent among truck drivers, with the right ear being more affected. The study underscores the need for regular hearing assessments and protective measures to mitigate hearing impairment risks.

Age-Related Hearing Loss: A Cross-Sectional Study of Healthy Older Australians

INTRODUCTION

Hearing loss is common in ageing populations, but thorough investigation of factors associated with objective hearing loss in otherwise healthy, community-dwelling older individuals is rare. We examined prevalence of age-related hearing loss (ARHL) in healthy, community-dwelling older adults, and determined whether sociodemographic, lifestyle, or health factors associate with hearing thresholds. Audiometry assessment was investigated with self-reports of hearing loss and hearing handicap.

METHODS

Australian participants (n = 1,260) of median age 73 years (IQR 71-76) joined ASPirin in Reducing Events in the Elderly (ASPREE)-Hearing, a sub-study of the ASPREE trial with exclusions including cognitive impairment, cardiovascular disease, independence-limiting physical disability, and uncontrolled hypertension. ASPREE collected demographics, anthropometrics, lifestyle, and health data. Audiometry measured better ear pure-tone average (PTA) across four frequencies (0.5-4 kHz) to establish hearing thresholds, categorised as normal or mild, moderate, and severe hearing loss. Questionnaires collected perceived hearing problems and noise exposure.

RESULTS

ARHL prevalence by audiometry was 49.7%, affecting men (59%) more than women (41%). A majority (54.5%) self-reported some hearing problems which mostly aligned with objective assessments; 45.6% self-reported a "little trouble" with hearing, while 35% had objective mild hearing loss; 8.3% reported having a "lot of trouble" hearing, while 13% had moderate hearing loss; and 0.6% reported being "deaf," while 2% demonstrated severe hearing loss. There was a significant association (p < 0.001) between self-reported hearing handicap and audiometric measures of hearing loss. In multivariate analysis of health, demographics, and lifestyle risk factors, only age, gender (men), and education years (<12) remained associated (p < 0.05) with hearing loss. Hearing thresholds were not associated with smoking, living situation, alcohol use, hypertension, diabetes, or chronic kidney disease.

CONCLUSION

ARHL robustly assessed by audiometry is common among healthy older Australians with men more likely to have abnormal hearing thresholds than women. Hearing loss was associated with fewer years of formal education, but not with a range of chronic conditions or alcohol use. Self-reported hearing loss correlates well with higher PTA hearing threshold levels in this healthy cohort where prevalence was lower than previously reported for the age group 70+ years. Hearing health education remains an important public health tool for this age. Targeting hearing in older patient health checks could be beneficial to mitigate the cognitive, social, and mental health consequences of ARHL, even if patients do not report a problem or handicap.

Joint Association of Combined Healthy Lifestyle Factors and Hearing Loss With Cognitive Impairment in China

BACKGROUND

Hearing loss and lifestyle factors have been associated with cognitive impairment. We aimed to explore the joint association of combined healthy lifestyle factors and hearing loss with cognitive impairment, which has been scarcely studied.

METHODS

This baseline study used data from the CHOICE-Cohort study (Chinese Hearing Solution for Improvement of Cognition in Elders). Hearing loss was assessed by the better-ear pure-tone average. A composite healthy lifestyle score was built based on never smoking, never drinking, regular physical activity, and a balanced diet. Cognitive impairment was diagnosed by the Mini-Mental State Examination score of less than 24.

RESULTS

We included 17 057 participants aged 60 years or older in China (mean age 69.8 [standard deviation 6.2] years, 55.7% female). Among the participants, 48.3% (n = 8 234) had mild hearing loss, and 25.8% (n = 4 395) had moderate or greater hearing loss. The proportion of participants with healthy lifestyle scores of 0-1, 2, 3, and 4 was 14.9% (n = 2 539), 29.3% (n = 5 000), 37.4% (n = 6 386), and 18.4% (n = 3 132), respectively. About 29.6% (n = 5 057) participants had cognitive impairment. When compared to those with normal hearing and healthy lifestyle (scores of 3-4), participants with hearing loss plus unhealthy lifestyle (scores of 0-2) exhibited approximately twofold increased risk of cognitive impairment (odds ratio [OR] = 1.92, 95% confidence interval [CI] 1.70-2.18). Conversely, the risk was greatly attenuated by adherence to healthy lifestyle in individuals with hearing loss (OR = 1.57, 95% CI 1.40-1.76).

CONCLUSIONS

Our findings demonstrated adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of cognitive impairment among participants with hearing loss.

Risk factors for mild cognitive impairment in patients with age-related hearing loss: a meta-analysis

OBJECTIVES

One of the most common sensory impairments in the elderly is age-related hearing loss, and individuals with this condition have a higher risk of mild cognitive impairment than the overall aged population. The purpose of this study was to conduct a systematic review of the literature in order to evaluate the evidence supporting the hypothesis that mild cognitive impairment may be developed in patients with age-related hearing loss.

METHODS

The PRISMA principles were followed when searching the databases of the China Knowledge Network, Wanfang, China Biomedical Literature Database, Pub Med, Cochrane Library, Embase, and Web of Science. Two investigators independently carried out the quality assessment, data extraction, and literature review of the eligible studies. Stata 17.0 was used to finish the statistical analysis and descriptive results.

RESULTS

A total of 13 articles containing 2,222,036 individuals who were evaluated for demographic traits, factors associated with age-related hearing loss, vascular neurologic factors, and psychological factors were included after 2166 search records were found in the database. In patients with age-related hearing loss, eleven factors were found to be risk factors for the development of mild cognitive impairment: age (OR = 1.63; 95% CI 1.09-2.43), male (OR = 1.29; 95% CI 1.14-1.47), degree of hearing loss (OR = 1.35; 95% CI 1.03-1.75), not wearing hearing aids (OR = 1.56; 95% CI 1.37-1.79), cerebrovascular disease (OR = 1.41; 95% CI 1.17-1.69), cardiovascular disease (OR = 1.29; 95% CI 1.07-1.55), diabetes mellitus (OR = 1.28; 95% CI 1.20-1.35), head injury (OR = 1.22; 95% CI 1.13-1.33), alcohol consumption (OR = 1.28; 95% CI 1.14-1.43), and tobacco use (OR = 1.19; 95% CI 1.14-1.25), and depression (OR = 1.63; 95% CI 1.47-1.81).

CONCLUSION

Caregivers can customize care strategies to decrease the occurrence of mild cognitive impairment in elderly deaf patients by considering demographic traits, factors associated with age-related hearing loss, vascular-neurologic factors, and psychological factors.

Age-related hearing loss in older adults: etiology and rehabilitation strategies

Age-related hearing loss (ARHL) is a prevalent sensory organ disorder among elderly individuals that significantly impacts their cognitive function, psychological well-being, and ability to perform activities of daily living. As the population ages, the number of ARHL patients is increasing. However, the Audiological rehabilitation (AR) status of patients is not promising. In recent years, there has been an increasing focus on the health and rehabilitation of elderly individuals, and significant progress has been made in researching various age-related disorders. However, a unified definition of ARHL in terms of etiology and rehabilitation treatment is still lacking. This study aims to provide a reference for future research on ARHL and the development of AR strategies by reviewing the classification, etiology, and rehabilitation of ARHL.

Polygenic Risk Score-Based Association Analysis Identifies Genetic Comorbidities Associated with Age-Related Hearing Difficulty in Two Independent Samples

PURPOSE

Age-related hearing loss is the most common form of permanent hearing loss that is associated with various health traits, including Alzheimer's disease, cognitive decline, and depression. The present study aims to identify genetic comorbidities of age-related hearing loss. Past genome-wide association studies identified multiple genomic loci involved in common adult-onset health traits. Polygenic risk scores (PRS) could summarize the polygenic inheritance and quantify the genetic susceptibility of complex traits independent of trait expression. The present study conducted a PRS-based association analysis of age-related hearing difficulty in the UK Biobank sample (N = 425,240), followed by a replication analysis using hearing thresholds (HTs) and distortion-product otoacoustic emissions (DPOAEs) in 242 young adults with self-reported normal hearing. We hypothesized that young adults with genetic comorbidities associated with age-related hearing difficulty would exhibit subclinical decline in HTs and DPOAEs in both ears.

METHODS

A total of 111,243 participants reported age-related hearing difficulty in the UK Biobank sample (> 40 years). The PRS models were derived from the polygenic risk score catalog to obtain 2627 PRS predictors across the health spectrum. HTs (0.25-16 kHz) and DPOAEs (1-16 kHz, L1/L2 = 65/55 dB SPL, F2/F1 = 1.22) were measured on 242 young adults. Saliva-derived DNA samples were subjected to low-pass whole genome sequencing, followed by genome-wide imputation and PRS calculation. The logistic regression analyses were performed to identify PRS predictors of age-related hearing difficulty in the UK Biobank cohort. The linear mixed model analyses were performed to identify PRS predictors of HTs and DPOAEs.

RESULTS

The PRS-based association analysis identified 977 PRS predictors across the health spectrum associated with age-related hearing difficulty. Hearing difficulty and hearing aid use PRS predictors revealed the strongest association with the age-related hearing difficulty phenotype. Youth with a higher genetic predisposition to hearing difficulty revealed a subclinical elevation in HTs and a decline in DPOAEs in both ears. PRS predictors associated with age-related hearing difficulty were enriched for mental health, lifestyle, metabolic, sleep, reproductive, digestive, respiratory, hematopoietic, and immune traits. Fifty PRS predictors belonging to various trait categories were replicated for HTs and DPOAEs in both ears.

CONCLUSION

The study identified genetic comorbidities associated with age-related hearing loss across the health spectrum. Youth with a high genetic predisposition to age-related hearing difficulty and other related complex traits could exhibit sub-clinical decline in HTs and DPOAEs decades before clinically meaningful age-related hearing loss is observed. We posit that effective communication of genetic risk, promoting a healthy lifestyle, and reducing exposure to environmental risk factors at younger ages could help prevent or delay the onset of age-related hearing difficulty at older ages.

Environmental Risk Factors, Protective Factors, and Biomarkers for Hearing Loss: An Umbrella Review

OBJECTIVE

We aimed to investigate the potential environmental risk factors, protective factors, and biomarkers of hearing loss (HL), and establish a hierarchy of evidence.

DATA SOURCES

Embase, PubMed, Cochrane Library, and Web of Science electronic database from inception to June 1, 2023.

REVIEW METHODS

We included meta-analyses of observational studies of associations between HL and environmental risk factors, protective factors, or biomarkers. We calculated summary effect estimates, 95% confidence interval, heterogeneity I2 statistic, 95% prediction interval, small study effects, and excess significance biases.

RESULTS

Of the 9211 articles retrieved, 60 eligible articles were included. The 60 eligible articles identified 47 potential environmental risk and protective factors (N = 4,123,803) and 46 potential biomarkers (N = 173,701). Evidence of association was convincing (class I) for rheumatoid arthritis (RA) and every 1 cm increase in height. Evidence of association was highly suggestive (class II) for human immunodeficiency virus (HIV), diabetes, cumulative noise exposure (CNE), smoking, congenital cytomegalovirus (CMV) infection, combined exposure to organic solvents and noise, non-Gaussian noise exposure, each 1 kg increase in birth weight, noise exposure, and alopecia areata (AA).

CONCLUSION

In this umbrella review, RA, every 1 cm increase in height, HIV, diabetes, CNE, smoking, congenital CMV infection, combined exposure to organic solvents and noise, non-Gaussian noise exposure, each 1 kg increase in birth weight, noise exposure, and AA were strongly associated with HL.

Association of oxidative balance score with hearing loss and tinnitus: NHANES 1999-2018

Background

Oxidative stress is associated with the occurrence of hearing loss and tinnitus. The oxidative balance score (OBS), a composite indicator evaluating the balance between antioxidant and pro-oxidative components across various dietary and lifestyle factors, indicates the overall oxidative balance status. However, the association of OBS with hearing loss and tinnitus has not been reported previously.

Methods

Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 were analyzed. Weighted multivariable logistic regression, weighted multivariable linear regression, and restricted cubic spline curve (RCS) regression were employed to explore the relationship between OBS and hearing loss at speech, low, and high frequencies, along with tinnitus. Subgroup analysis and sensitivity analysis were used to ascertain the consistency across subgroups and stability of the results.

Results

We included 13,715 and 21,644 individuals to investigate the association between OBS and hearing loss, as well as between OBS and tinnitus, respectively. The second, third, and fourth quartiles of OBS were significantly associated with a lower risk of hearing loss at speech, low, and high frequencies, as well as tinnitus, compared to the lowest quartile. The RCS regression analysis indicated a negative linear association of OBS with hearing loss and tinnitus. Most associations were maintained in subgroup analysis and sensitivity analysis. Additionally, the dietary and lifestyle OBS independently contribute to the protection against hearing loss and tinnitus.

Conclusion

OBS is negatively correlated with the risk of hearing loss and tinnitus. The findings suggest that combined antioxidant diet and lifestyle hold promise as potential strategies for reducing the prevalence of hearing loss and tinnitus.

Association of conventional cigarette smoking, heated tobacco product use, and dual use with hearing loss: A working population-based study

INTRODUCTION

Although conventional cigarette smoking has been linked to an increased risk of hearing loss, the association between heated tobacco products (HTPs) and hearing loss is unknown. The objective of this study was to investigate the association between cigarette and HTP use and hearing loss.

METHODS

This cross-sectional study examined the data of 7769 employees from five companies (Study I) and 34404 employees from a large company (Study II), all participants in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were categorized into five groups based on their self-reported tobacco use: never smokers, former smokers, exclusive cigarette smokers, exclusive users of HTPs, and those who used both cigarettes and HTPs. Hearing levels were measured using pure-tone audiometry at 1 and 4 kHz frequencies. Separate analyses were carried out for each study, and the results were then combined using fixed-effect models to pool the estimates.

RESULTS

The analysis included 42173 participants, with a prevalence of 12.9% for exclusive cigarette smoking, 9.8% for exclusive HTP use, and 5.5% for dual use. The pooled adjusted odds ratios with 95% confidence intervals for unilateral hearing loss at 4 kHz were 1.21 (95% CI: 1.10-1.33) for former smokers, 1.83 (95% CI: 1.64-2.05) for exclusive cigarette smokers,1.46 (95% CI: 1.28-1.67) for exclusive HTP users, and 1.66 (95% CI: 1.41-1.96) for dual users, compared to never smokers. Additionally, the adjusted odds ratios for hearing loss at 4 kHz among exclusive cigarette smokers, exclusive HTP users, and dual users increased with the intensity of cigarette/HTP consumption (all p for trend <0.001). No significant associations were found between exclusive HTP use, dual use, and hearing loss at 1 kHz, apart from exclusive cigarette smoking.

CONCLUSIONS

In this cross-sectional study, associations were found between exclusive cigarette smoking, exclusive HTP use, dual use, and hearing loss, particularly at 4 kHz. Further research is needed to confirm these findings.

A machine learning screening model for identifying the risk of high-frequency hearing impairment in a general population

BACKGROUND

Hearing impairment (HI) has become a major public health issue in China. Currently, due to the limitations of primary health care, the gold standard for HI diagnosis (pure-tone hearing test) is not suitable for large-scale use in community settings. Therefore, the purpose of this study was to develop a cost-effective HI screening model for the general population using machine learning (ML) methods and data gathered from community-based scenarios, aiming to help improve the hearing-related health outcomes of community residents.

METHODS

This study recruited 3371 community residents from 7 health centres in Zhejiang, China. Sixty-eight indicators derived from questionnaire surveys and routine haematological tests were delivered and used for modelling. Seven commonly used ML models (the naive Bayes (NB), K-nearest neighbours (KNN), support vector machine (SVM), random forest (RF), eXtreme Gradient Boosting (XGBoost), boosting, and least absolute shrinkage and selection operator (LASSO regression)) were adopted and compared to develop the final high-frequency hearing impairment (HFHI) screening model for community residents. The model was constructed with a nomogram to obtain the risk score of the probability of individuals suffering from HFHI. According to the risk score, the population was divided into three risk stratifications (low, medium and high) and the risk factor characteristics of each dimension under different risk stratifications were identified.

RESULTS

Among all the algorithms used, the LASSO-based model achieved the best performance on the validation set by attaining an area under the curve (AUC) of 0.868 (95% confidence interval (CI): 0.847-0.889) and reaching precision, specificity and F-score values all greater than 80%. Five demographic indicators, 7 disease-related features, 5 behavioural factors, 2 environmental exposures, 2 hearing cognitive factors, and 13 blood test indicators were identified in the final screening model. A total of 91.42% (1235/1129) of the subjects in the high-risk group were confirmed to have HI by audiometry, which was 3.99 times greater than that in the low-risk group (22.91%, 301/1314). The high-risk population was mainly characterized as older, low-income and low-educated males, especially those with multiple chronic conditions, noise exposure, poor lifestyle, abnormal blood indices (e.g., red cell distribution width (RDW) and platelet distribution width (PDW)) and liver function indicators (e.g., triglyceride (TG), indirect bilirubin (IBIL), aspartate aminotransferase (AST) and low-density lipoprotein (LDL)). An HFHI nomogram was further generated to improve the operability of the screening model for community applications.

CONCLUSIONS

The HFHI risk screening model developed based on ML algorithms can more accurately identify residents with HFHI by categorizing them into the high-risk groups, which can further help to identify modifiable and immutable risk factors for residents at high risk of HI and promote their personalized HI prevention or intervention.

Variations in the Cadherin 23 Gene Associated With Noise-Induced Hearing Loss

Background

The relationship between CDH23 gene variants and NIHL is unclear. This study investigates the association between cadherin 23 (CDH23) gene variants and noise-induced hearing loss (NIHL).

Methods

This is a case-control study. Workers who were exposed to noise from a steel factory in North China were recruited and divided into two groups: the case group (both ears' high-frequency threshold average [BHFTA] ≥40dB) and the control group (BHFTA ≤25 dB). This study used the generalised multifactor dimensionality reduction method to analyse the association among 18 single-nucleotide polymorphisms (SNPs) in CDH23 and NIHL. Logistic regression was performed to investigate the main effects of SNPs and the interactions between cumulative noise exposure (CNE) and SNPs. Furthermore, CNE was adjusted for age, gender, smoking, drinking, physical exercise and hypertension.

Results

This study recruited 1,117 participants. The results showed that for rs11592462, participants who carried the GG genotype showed an association with NIHL greater than that of those who carried the CC genotype. Accordingly, genetic variation in the CDH23 gene could play an essential role in determining individual susceptibility to NIHL.

Conclusion

Genetic variations in the CDH23 gene may play an important role in determining individual susceptibility to NIHL. These results provide new insight into the pathogenesis and early prevention of NIHL.

Sex differences in associated factors for age-related hearing loss

The prevalence and age of onset of hearing loss differ according to sex. This study aimed to identify associated factors for age-related hearing loss (ARHL) and determine whether there are differences between males and females regarding associated factors for ARHL. This cross-sectional study used data from adults who underwent medical examinations including hearing tests from 2011 to 2021. A total of 2,349 individuals were included. The study conducted sex-specific analyses using both univariate and multiple regression. Univariate analysis employed logistic regression, while multiple regression involved variable selection through the augmented backward elimination method. Separate multiple logistic regression analyses were conducted for each sex. In the univariate analysis, among males, age, underweight, alcohol consumption, weight, and height exhibited statistical significance. Among females, age, hypertension, diabetes, dyslipidemia, obesity, sarcopenia, weight, height, age at menarche, and duration of hormone exposure were found to be significant factors. However, in the multiple logistic regression model for males, underweight, and smoking emerged as significant, while in females, age, weight, obesity, and age at menarche retained their significance. We found that there are different associated factors for ARHL in each sex. Assessment and counseling for smoking, obstetric history, underweight, and obesity may be beneficial in managing patients with ARHL.

Bidirectional associations between hearing difficulty and cognitive function in Chinese adults: a longitudinal study

Background

Middle-aged and older adults frequently experience hearing loss and a decline in cognitive function. Although an association between hearing difficulty and cognitive function has been demonstrated, its temporal sequence remains unclear. Therefore, we investigated whether there are bidirectional relationships between hearing difficulty and cognitive function and explored the mediating role of depressive symptoms in this relationship.

Method

We used the cross-lagged panel model and the random-intercept cross-lagged panel model to look for any possible two-way link between self-reported hearing difficulty and cognitive function. To investigate depressive symptoms' role in this association, a mediation analysis was conducted. The sample was made up of 4,363 adults aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018; 44.83% were women; mean age was 56.16 years). One question was used to determine whether someone had a hearing impairment. The tests of cognitive function included episodic memory and intelligence. The Center for Epidemiologic Studies Depression Scale, which consists of 10 items, was used to measure depressive symptoms.

Results

A bidirectional association between hearing and cognition was observed, with cognition predominating (Wald χ2 (1) = 7.241, p < 0.01). At the between-person level, after controlling for potential confounders, worse hearing in 2011 predicted worse cognitive function in 2013 (β = -0.039, p < 0.01) and vice versa (β = -0.041, p < 0.01) at the between-person level. Additionally, there was no corresponding cross-lagged effect of cognitive function on hearing difficulty; rather, the more hearing difficulty, the greater the cognitive decline at the within-person level. According to the cross-lagged mediation model, depressive symptoms partially mediates the impact of cognitive function on subsequent hearing difficulty (indirect effect: -0.003, bootstrap 95% confidence interval: -0.005, -0.001, p < 0.05), but not the other way around.

Conclusion

These results showed that within-person relationships between hearing impairment and cognitive function were unidirectional, while between-person relationships were reciprocal. Setting mental health first may be able to break the vicious cycle that relates hearing loss to cognitive decline. Comprehensive long-term care requires services that address depressive symptoms and cognitive decline to be integrated with the hearing management.