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Monzani D, Liberale C, Segato E, De Cecco F, Arietti V, Palma S, Sacchetto L, Nocini R. The Role of Fibrinogen, Homocysteine and Metabolic Syndrome's Alterations in Sudden Sensorineural Hearing Loss (SSHL): A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1977. [PMID: 38004026 PMCID: PMC10673203 DOI: 10.3390/medicina59111977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
Fibrinogen and homocysteine (HCY) are molecules known to play a role in vascular homeostasis, and their blood levels are often elevated in patients with metabolic syndrome. Recent evidence suggests that sudden sensorineural hearing loss (SSHL) may have a vascular origin. This has led many authors to advocate that fibrinogen, homocysteine, and metabolic syndrome (MetS) may play a direct role in SSHL. The aim of this brief review is to examine the role and influence of these molecules and MetS on the mechanisms of SSHL. Elevated fibrinogen levels have been associated with a worse prognosis in SSHL, possibly due to increased blood viscosity and decreased blood flow. Similarly, HCY has been associated with vascular damage, particularly in hyperhomocysteinemia, although the exact association with SSHL remains controversial. MetS has been demonstrated to function both as a causative factor and as a contributor to poorer recovery in cases of SSHL. However, although some studies suggest a possible role for these biomarkers and MetS in the prognosis and treatment of SSHL, specific therapeutic and preventive strategies based solely on these factors have yet to be developed. Given their potential role in prognosis and treatment and the global epidemic of metabolic syndrome, this issue needs to be analyzed comprehensively. Thus, further quality studies need to be conducted, even though it is difficult to determine the actual impact of MetS on the development of SSHL, as it is a multifactorial disease affecting multiple organs.
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Affiliation(s)
- Daniele Monzani
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
| | - Carlotta Liberale
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
| | - Erika Segato
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
| | - Francesca De Cecco
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
| | - Valerio Arietti
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
| | - Silvia Palma
- Otolaryngology and Audiology Unit, University of Modena and Reggio Emilia, 41100 Modena, Italy;
| | - Luca Sacchetto
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
| | - Riccardo Nocini
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (D.M.); (C.L.); (F.D.C.); (V.A.)
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Cavallaro G, Pantaleo A, Pontillo V, Barbara F, Murri A, Quaranta N. Endothelial Dysfunction and Metabolic Disorders in Patients with Sudden Sensorineural Hearing Loss. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1718. [PMID: 37893435 PMCID: PMC10608295 DOI: 10.3390/medicina59101718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023]
Abstract
Sudden sensorineural hearing loss (SSNHL) is defined as a sensorineural hearing loss of 30 dB or greater on at least three contiguous audiometric frequencies occurring within a 72 h period. Although SSNHL is commonly encountered in clinical audiology and otolaryngology practice, its etiopathogenesis continues to be poorly understood. Scientific investigations have highlighted the vulnerability of cochlear microcirculation to blood flow alterations. Even mild hypoperfusion can lead to immediate dysfunction in the organ of Corti, given the heightened susceptibility of cochlear hair cells to hypoxia and ischemic damage. The purpose of this review paper is to present evidence of endothelial and vascular involvement in SSNHL and the risk factors, such as metabolic syndrome, that may negatively impact the inner ear's vascular supply, influencing the onset pattern, incidence, and prognosis of SSNHL. By addressing these variables, we can deepen our comprehension of the mechanisms underlying SSNHL and potentially uncover strategies for prevention.
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Affiliation(s)
- Giada Cavallaro
- Otolaryngology Unit, Madonna delle Grazie Hospital of Matera, 75100 Matera, Italy;
| | - Alessandra Pantaleo
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy (N.Q.)
| | - Vito Pontillo
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy (N.Q.)
| | - Francesco Barbara
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy (N.Q.)
| | - Alessandra Murri
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy (N.Q.)
| | - Nicola Quaranta
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy (N.Q.)
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Oussoren FK, Schermer TR, van Leeuwen RB, Bruintjes TD. Cardiovascular Risk Factors, Cerebral Small Vessel Disease, and Subsequent Risk of Stroke in Patients with Idiopathic Sudden Sensorineural Hearing Loss: Systematic Review and Meta-Analyses of the Current Literature. Audiol Neurootol 2023; 29:1-29. [PMID: 37557093 PMCID: PMC10836643 DOI: 10.1159/000530686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/04/2023] [Indexed: 08/11/2023] Open
Abstract
Vascular involvement in the pathophysiology of idiopathic sudden sensorineural hearing loss (iSSNHL) has been previously proposed. The objective of this study was to perform a systematic review of the current literature and conduct meta-analyses to evaluate associations between cardiovascular risk factors, cerebral small vessel disease, and subsequent stroke after presentation with iSSNHL. Three systematic literature reviews and meta-analyses were conducted using PubMed, Embase, and CINAHL. All studies investigating associations between iSSNHL and the cardiovascular risk factors: body mass index (BMI), diabetes mellitus, hyperlipidemia, hypertension, medical history of myocardial infarction (MI), smoking, the degree of white matter hyperintensities, and incidence of stroke were included. Adhering to the PRISMA guidelines, two independent reviewers reviewed the articles and assessed risk of bias. The cardiovascular risk factors of abnormal BMI, diabetes, hypertension, total cholesterol, low-density lipoprotein cholesterol, and a medical history of MI were significantly associated with iSSNHL. The adjusted hazard ratio of a higher degree of white matter hyperintensities was 0.70 (95% CI 0.44, 1.12). Patients with iSSNHL showed a higher risk of stroke compared to controls, with hazard ratios ranging from 1.22 up to 4.08. Several cardiovascular risk factors are more frequently present in patients with iSSNHL than in the general population. The degree of white matter hyperintensities does not appear to be increased in patients with iSSNHL, while the risk of stroke following ISSNHL is increased. Prospective studies with larger study populations are needed to confirm the associations between generalized cardiovascular disease and iSSNHL and to assess whether these patients benefit from cardiovascular risk management to prevent future cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Fieke K. Oussoren
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
- Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands
| | - Tjard R. Schermer
- Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tjasse D. Bruintjes
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
- Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands
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Gioacchini FM, Pisani D, Viola P, Astorina A, Scarpa A, Libonati FA, Tulli M, Re M, Chiarella G. Diabetes Mellitus and Hearing Loss: A Complex Relationship. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020269. [PMID: 36837470 PMCID: PMC9959034 DOI: 10.3390/medicina59020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023]
Abstract
Background and Objectives: Discussion is open about the relationship between diabetes (DM) and hearing loss (HL). There is a lot of evidence in the literature suggesting a causal link between these conditions, beyond being considered simple comorbidities. The difficulty in identifying populations free from confounding factors makes it difficult to reach definitive conclusions on the pathophysiological mechanisms at play. Nonetheless, there is numerous evidence that demonstrates how the population affected by DM is more affected by sensorineural HL (SNHL) and exhibit a higher prevalence of idiopathic sudden sensorineural HL (ISSNHL). Materials and Methods: Articles reporting potentially relevant information were reviewed, and the most significant results are discussed in this article. Starting from the possible mechanisms relating to auditory impairment in the diabetic condition, this article summarizes the studies on auditory evaluation in subjects with DM1 and DM2 and addresses the relationship between DM and ISSNHL. Results: DM is considered a risk factor for SNHL, although some studies have reported no relationship when the associations were adjusted for age, gender, and hypertension. Macro and microvascular insults that cause decreased blood flow, oxygen exchange, and ion transport are major complications of hypertension and DM and can have a direct effect on the sensory and support cells of the cochlea. Conclusions: Given the difficulty of carrying out studies on populations without confounding factors, new laboratory studies are strongly required to clarify which specific physiopathological mechanisms underlie the diabetic damage caused to the hearing organs and how pharmacological management may contribute to counteracting the pathophysiological effects of the diabetic condition on the auditory system.
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Affiliation(s)
- Federico Maria Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-096-1364-7124
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
| | | | - Michele Tulli
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Massimo Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
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Wang X, Gao Y, Jiang R. Diagnostic and predictive values of serum metabolic profiles in sudden sensorineural hearing loss patients. Front Mol Biosci 2022; 9:982561. [PMID: 36148011 PMCID: PMC9486159 DOI: 10.3389/fmolb.2022.982561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is an otologic emergency, and metabolic disturbance is involved in its pathogenesis. This study recruited 20 SSNHL patients and 20 healthy controls (HCs) and collected their serum samples. Serum metabolites were detected by liquid chromatography-mass spectrometry, and metabolic profiles were analyzed. All patients were followed up for 3 months and categorized into recovery and non-recovery groups. The distinctive metabolites were assessed between two groups, and their predictive values for hearing recovery were evaluated. Analysis results revealed that SSNHL patients exhibited significantly characteristic metabolite signatures compared to HCs. The top 10 differential metabolites were further analyzed, and most of them showed potential diagnostic values based on receiver operator characteristic (ROC) curves. Finally, 14 SSNHL patients were divided into the recovery group, and six patients were included in the non-recovery group. Twelve distinctive metabolites were observed between the two groups, and ROC curves demonstrated that N4-acetylcytidine, p-phenylenediamine, sphingosine, glycero-3-phosphocholine, and nonadecanoic acid presented good predictabilities in the hearing recovery. Multivariate analysis results demonstrated that serum N4-Acetylcytidine, sphingosine and nonadecanoic acid levels were associated with hearing recovery in SSNHL patients. Our results identified that SSNHL patients exhibited distinctive serum metabolomics signatures, and several serum biomarkers were proved to be potential in predicting hearing recovery. The discriminative metabolites might contribute to illustrating the mechanisms of SSNHL and provide possible clues for its treatments.
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Affiliation(s)
- Xiangsheng Wang
- Department of Otolaryngology-Head and Neck Surgery, Urumqi Maternal and Child Health Care Hospital, Urumqi, China
| | - Yan Gao
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xin Jiang Medical University, Urumqi, China
| | - Ruirui Jiang
- Department of Pharmacy, The First People’s Hospital of Urumqi (Children’s Hospital), Urumqi, China
- *Correspondence: Ruirui Jiang,
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