Smoking, central adiposity, and poor glycemic control increase risk of hearing impairment

Social inequalities in pure-tone hearing assessed using occupational stratification schemes

OBJECTIVE

The objective of this study is to analyse the performance of two occupational stratification approaches and the impact of social position on adult hearing.

DESIGN

The prevalence of hearing impairment, pure-tone averages (PTA) and prevalence ratios (PR) for relative hearing loss, which focuses on the position of one's PTA in the age- and gender-specific distribution, were compared in groups defined by ISCO Skill Level and the International Socio-Economic Index (ISEI).

STUDY SAMPLE

About 1571 subjects aged 30-89, including 677 highly screened adults, from the cross-sectional study HÖRSTAT.

RESULTS

ISCO Skill Level and ISEI yielded qualitatively the same results. The prevalence difference between the socially least and most advantaged group ranges between 10 and 16%, varying with the scheme applied. Low- and high-frequency PTA and PR for relative hearing loss confirm the gradient. Screening reduced, but did not negate the social differences. The prevalence difference dropped to 6-7% in the otologically normal subsample.

CONCLUSIONS

Social groups defined by hierarchical, occupational measures differ in their pure-tone hearing, even if the main risk factors are controlled for. This underlines the need for population-based sampling, the relevance of reporting the study group's social composition and the importance of advancing the discussion on appropriate social measures in hearing research.

Association between metabolic syndrome and sensorineural hearing loss: a cross-sectional study of 11,114 participants

BACKGROUND/OBJECTIVES

Hearing loss (HL) is associated with certain diseases and affects health, resulting in a low quality of life. Some components of the metabolic syndrome (MetS) coincide with the risk factors for sensorineural hearing loss (SNHL). To date, very few studies have examined the link between MetS and HL. The aim of the current study was to try to understand the potential association between MetS and HL.

METHODS

Using Iranian health surveys of professional drivers, we enrolled 11,114 individuals aged 20-60 years, whose main job is to operate a motor vehicle. We examined participants for the presence and absence of SNHL and the components of the MetS. Additionally, we investigated the relationship between MetS and the pure tone air conduction hearing thresholds of participants with SNHL, including low-frequency and high-frequency thresholds.

RESULTS

This cross-sectional study consisted of 11,114 participants: 3202 (28.81%) diagnosed with MetS and 7911 (71.18%) without and 2772 (24.94%) with SNHL and 8432 (75.86%) without. Participants with SNHL had a higher number of components of MetS (P<0.001 for all components).

CONCLUSION

Our results demonstrated that an association possibly exists between different components of MetS (obesity, hypertension, hypertriglyceridemia, high fasting glucose levels, and waist circumference) and SNHL in a population of West Azerbaijan drivers. Therefore, it is important to schedule periodic checkups for drivers to detect and avoid the increase in MetS components at an early stage in this population.

Association Between Hearing Impairment and Albuminuria With or Without Diabetes Mellitus

Objectives

Few studies have evaluated the accurate association between hearing loss (HL) and albuminuria in patients with or without diabetes mellitus (DM). The aim of our study was to identify the clinical effects of albuminuria on HL with or without DM.

Methods

This study included 9,762 patients from the Korean National Health and Nutrition Examination Survey between 2011 and 2013. Participants were divided into 4 groups based on DM and urine albumin/creatinine ratio levels: group 1 included participants with neither DM nor albuminuria, group 2 included participants without DM and with albuminuria, group 3 included patients with DM and without albuminuria, and group 4 included patients with both DM and albuminuria. The low- or mid-frequency and high-frequency, and average hearing threshold values were obtained.

Results

There were 7,508, 545, 1,325, and 384 participants in groups 1, 2, 3, and 4, respectively. Univariate and multivariate analyses showed that the 3 hearing thresholds in group 1 were the lowest and those in group 4 were the highest among the 4 groups. No significant differences were observed in those thresholds between groups 2 and 3. Group 4 was associated with HL compared with the other groups, but moderate to severe HL was not associated with DM or albuminuria.

Conclusion

The presence of albuminuria was associated with a modest effect on hearing thresholds regardless of presence of DM.

Odor detection thresholds in a population of older adults

OBJECTIVES/HYPOTHESIS

To measure odor detection thresholds and associated nasal and behavioral factors in an older adult population.

STUDY DESIGN

Cross-sectional cohort study.

METHODS

Odor detection thresholds were obtained using an automated olfactometer on 832 participants, aged 68 to 99 (mean age = 77) years in the 21-year (2013-2016) follow-up visit of the Epidemiology of Hearing Loss Study.

RESULTS

The mean odor detection threshold (ODT) score was 8.2 (range = 1-13; standard deviation = 2.54), corresponding to an n-butanol concentration of slightly less than 0.03%. Older participants were significantly more likely to have lower (worse) ODT scores than younger participants (P < .001). There were no significant differences in mean ODT scores between men and women. Older age was significantly associated with worse performance in multivariable regression models, and exercising at least once per week was associated with reduced odds of having a low (≤5) ODT score. Cognitive impairment was also associated with poor performance, whereas a history of allergies or a deviated septum was associated with better performance.

CONCLUSIONS

Odor detection threshold scores were worse in older age groups but similar between men and women in this large population of older adults. Regular exercise was associated with better odor detection thresholds, adding to the evidence that decline in olfactory function with age may be partly preventable.

LEVEL OF EVIDENCE

3b. Laryngoscope, 127:1257-1262, 2017.

Risk Factors for Hearing Impairment among Adults with Diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

AIM

The aim was to examine risk factors for hearing impairment among Hispanic/Latino adults with diabetes.

METHODS

Findings are based on 3384 participants aged 18-76 years with diagnosed or previously undetected diabetes who completed audiometric testing as part of the Hispanic Community Health Study/Study of Latinos. We defined hearing impairment as the pure-tone average (PTA) >25 decibels hearing level [dB HL] of pure-tone thresholds at high frequencies (3000, 4000, 6000, and 8000 Hz) in the worse ear and defined a second hearing impairment outcome with the additional requirement of PTA >25 dB HL of low/mid-frequency (500, 1000, and 2000 Hz) thresholds in the worse ear. We identified independent associations using logistic regression.

RESULTS

Controlling for age and Hispanic/Latino background, prevalence ratios for hearing impairment in the high plus low/mid frequencies were 1.35 (95% CI 1.07, 1.71) for current smoking, 1.64 (1.14, 2.38) for alcohol consumption (≥ 14 drinks/week for men or ≥ 7 drinks/week for women), and 1.29 (1.06, 1.56) for triglycerides ≥ 150 mg/dL. For high-frequency only hearing impairment, the prevalence ratio for estimated glomerular filtration rate 30-59 mL/min/1.73m2 was 1.23 (1.03, 1.47) adjusted for age and sex. People with family income less than $20,000 had almost twice the prevalence of hearing impairment (PR=1.93 (1.34, 2.78)) as people with income over $40,000.

CONCLUSIONS

Current smoking, alcohol consumption, high triglycerides, and chronic kidney disease are potentially preventable correlates of hearing impairment for persons with diabetes. Low income is a marker of increased likelihood of hearing impairment.

Hearing loss and use of health services: a population-based cross-sectional study among Finnish older adults

Background

Older adults with hearing difficulties face problems of communication which may lead to underuse of health services. This study investigated the association of hearing loss and self-reported hearing difficulty with the use of health services and unmet health care needs in older adults.

Methods

Data on persons aged 65 and older (n = 2144) drawn from a population-based study, Health 2000, were analyzed. Hearing loss was determined with screening audiometry (n = 1680). Structured face-to-face interviews were used to assess self-reported hearing difficulty (n = 1962), use of health services (physician and nurse visits, health examinations, mental health services, physical therapy, health promotion groups, vision test, hearing test, mammography, PSA test) and perceived unmet health care needs. Multivariable logistic regression analyses were used.

Results

After adjusting for socio-economic and health-related confounders, persons with hearing loss (hearing level of better ear 0.5–2 kHz > 40 dB) were more likely to have used mental health services than those with non-impaired hearing (OR = 3.2, 95 % CI 1.3–7.9). Self-reported hearing difficulty was also associated with higher odds for mental health service use (OR = 2.1 95 % CI 1.2–3.5). Hearing was not associated with use of the other health services studied, except presenting for a hearing test. Persons with self-reported hearing difficulty were more likely to perceive unmet health care needs than those without hearing difficulty (OR = 1.7, 95 % CI 1.4–2.1).

Conclusions

Older adults with hearing loss or self-reported hearing difficulty are as likely to use most health services as those without hearing loss. However, self-reported hearing difficulty is associated with experiencing unmet health care needs. Adequate health services should be ensured for older adults with hearing difficulties.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0356-5) contains supplementary material, which is available to authorized users.

Age-Related Sensory Impairments and Risk of Cognitive Impairment

OBJECTIVES

To evaluate the associations between sensory impairments and 10-year risk of cognitive impairment.

DESIGN

The Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study of aging in the Beaver Dam, Wisconsin community. Baseline examinations were conducted in 1993 and follow-up examinations have been conducted every 5 years.

SETTING

General community.

PARTICIPANTS

EHLS members without cognitive impairment at EHLS-2 (1998-2000). There were 1,884 participants (mean age 66.7) with complete EHLS-2 sensory data and follow-up information.

MEASUREMENTS

Cognitive impairment was defined as a Mini-Mental State Examination score of <24 or history of dementia or Alzheimer's disease. Hearing impairment was a pure-tone average of hearing thresholds (0.5, 1, 2, 4 kHz) of >25 dB hearing level in either ear, visual impairment was a Pelli-Robson contrast sensitivity of <1.55 log units in the better eye, and olfactory impairment was a San Diego Odor Identification Test score of <6.

RESULTS

Hearing, visual, and olfactory impairment were independently associated with cognitive impairment risk (hearing: hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.11-3.26; vision: HR = 2.05, 95% CI = 1.24-3.38; olfaction: HR = 3.92, 95% CI = 2.45-6.26)). Nevertheless, 85% of participants with hearing impairment, 81% with visual impairment, and 76% with olfactory impairment did not develop cognitive impairment during follow-up.

CONCLUSION

The relationship between sensory impairment and cognitive impairment was not unique to one sensory system, suggesting that sensorineural health may be a marker of brain aging. The development of a combined sensorineurocognitive measure may be useful in uncovering mechanisms of healthy brain aging.

Secondhand Smoke is Associated with Hearing Threshold Shifts in Obese Adults

Hearing loss resulted from multiple intrinsic and extrinsic factors. Secondhand smoke (SHS) and obesity had been reported to be related to hearing loss. This study explored the possible associations of SHS and obesity with the hearing threshold. The relations between SHS and the hearing threshold in subjects from three different body mass index classes were analyzed. Our study included data from 1,961 subjects aged 20–69 years that were obtained from the National Health and Nutrition Examination Survey for the years 1999–2004. After adjusting for potential confounding factors, the subjects with the higher tertiles of serum cotinine levels tended to have higher hearing thresholds than those with the lowest tertile of serum cotinine levels (for both trends, p < 0.05). Notably, the obese subjects with the higher tertiles of serum cotinine levels had significantly higher hearing thresholds for high frequencies and low frequencies than those with the lowest tertile of serum cotinine levels (for both trends, p < 0.05). Our study showed a significant positive association between SHS exposure and hearing thresholds in the adult population, especially in obese individuals. Based on our findings, avoiding exposure to SHS, especially in obese adults, may decrease the risk of hearing loss.

Markers of Overall Nutritional Status and Incident Hearing Impairment in Community-Dwelling Older Japanese: The Kurabuchi Study

OBJECTIVES

To examine the association between four markers of overall nutritional status (a serum biomarker (albumin) and three anthropometric indices (body mass index (BMI), midarm circumference (MAC), calf circumference (CC))) and incident hearing impairment in older Japanese adults.

DESIGN

Community-based prospective cohort study.

SETTING

Kurabuchi Town, Gunma Prefecture, Japan.

PARTICIPANTS

Individuals aged 65 and older (143 men, 195 women) without hearing impairment at baseline examination (2005-06) who participated in repeated examinations 4 years later (2009-10) (N = 338).

MEASUREMENTS

The three anthropometric indices were measured at baseline, and nephelometry was used to assess serum albumin levels. Hearing impairment was defined as failure to hear a 30-dB hearing level signal at 1 kHz and a 40-dB signal at 4 kHz in the better ear on pure-tone audiometry.

RESULTS

Over the 4-year period, 16.3% of participants developed hearing impairment. Those with lower marker values had greater risk of hearing impairment than those with higher marker values (multivariable adjusted odds ratio (aOR) = 2.18, 95% confidence interval (CI) = 1.05-4.57 for albumin ≤4.0 g/dL; aOR = 2.72, 95% CI = 1.10-6.71 for BMI <19.0 kg/m(2) ). The pattern of association showed a similar tendency for MAC and CC. Excluding obese participants did not changed the results substantially.

CONCLUSION

Further research is needed to determine whether interventions that improve markers of nutritional status may help prevent age-related hearing loss in older adults.

Is Body Mass Index Associated With the Development of Age-Related Hearing Impairment in Koreans? The Korean National Health and Nutrition Examination Survey 2009-2012

Objectives

The aim of this study was to evaluate whether body mass index (BMI) is associated with age-related hearing loss (ARHL) in the Asian elderly population.

Methods

Data from the Korean National Health and Nutrition Examination Survey 2009–2012 were used for the analyses. The pure tones at 0.5 and 1 kHz of both ears of each subject were averaged to obtain the low-frequency, those at 2 and 3 kHz were averaged to obtain the mid-frequency, and those at 4 and 6 kHz were averaged to obtain the high-frequency. The average hearing threshold (AHT) was calculated as pure tone average at 4 frequencies in the better ear. ARHL was defined as the AHT >25 dB.

Results

Univariate analyses revealed an increase in the BMI tertile in men was associated with a decreased low-frequency threshold, while an increase in the BMI tertile in women was associated with decreased mid- and high-frequency thresholds. Multivariate analyses adjusted for confounders show no significant differences in low-, mid-, or high-frequency. There was no significant difference in the prevalence of ARHL by BMI tertiles. Linear regression analyses show no association between BMI and low-, mid-, and high-frequency or AHTs. The area under the receiver operating characteristic curve values for AHT was 0.515 in men and 0.522 in women. The logistic regression analyses showed no association between BMI and ARHL in either sex.

Conclusion

BMI is not advantageous for the prediction of ARHL. In future epidemiological studies, BMI as a covariate of obesity may be replaced by other active metabolic parameters that have better predictive ability of ARHL than BMI.

Relationships among measures of physical activity and hearing in African Americans: The Jackson Heart Study

OBJECTIVES/HYPOTHESIS

To evaluate the relationships among measures of physical activity and hearing in the Jackson Heart Study.

STUDY DESIGN

Prospective cohort study.

METHODS

We assessed hearing on 1,221 Jackson Heart Study participants who also had validated physical activity questionnaire data on file. Hearing thresholds were measured across frequency octaves from 250 to 8,000 Hz, and various frequency pure-tone averages (PTAs) were constructed, including PTA4 (average of 500, 1,000, 2,000, and 4,000 Hz), PTA-high (average of 4,000 and 8,000 Hz), PTA-mid (average of 1,000 and 2,000 Hz), and PTA-low (average of 250 and 500 Hz). Hearing loss was defined for pure tones and pure-tone averages as >25 dB HL in either ear and averaged between the ears. Associations between physical activity and hearing were estimated using linear regression, reporting changes in decibel hearing level, and logistic regression, reporting odds ratios (OR) of hearing loss.

RESULTS

Physical activity exhibited a statistically significant but small inverse relationship with PTA4, -0.20 dB HL per doubling of activity (95% confidence interval [CI]: -0.35, -0.04; P = .016), as well as with PTA-low and pure tones at 250, 2,000, and 4,000 Hz in adjusted models. Multivariable logistic regression modeling supported a decrease in the odds of high-frequency hearing loss among participants who reported at least some moderate weekly physical activity (PTA-high, OR: 0.69 [95% CI: 0.52, 0.92]; P = .011 and 4000 Hz, OR: 0.75 [95% CI: 0.57, 0.99]; P = .044).

CONCLUSIONS

Our study provides further evidence that physical activity is related to better hearing; however, the clinical significance of this relationship cannot be estimated given the nature of the cross-sectional study design.

LEVEL OF EVIDENCE

2b Laryngoscope, 126:2376-2381, 2016.

Comparison of Various Anthropometric Indices as Risk Factors for Hearing Impairment in Asian Women

Background

The objective of the present study was to examine the associations between various anthropometric measures and metabolic syndrome and hearing impairment in Asian women.

Methods

We identified 11,755 women who underwent voluntary routine health checkups at Yeungnam University Hospital between June 2008 and April 2014. Among these patients, 2,485 participants were <40 years old, and 1,072 participants lacked information regarding their laboratory findings or hearing and were therefore excluded. In total 8,198 participants were recruited into our study.

Results

The AUROC value for metabolic syndrome was 0.790 for the waist to hip ratio (WHR). The cutoff value was 0.939. The sensitivity and specificity for predicting metabolic syndrome were 72.7% and 71.7%, respectively. The AUROC value for hearing loss was 0.758 for WHR. The cutoff value was 0.932. The sensitivity and specificity for predicting hearing loss were 65.8% and 73.4%, respectively. The WHR had the highest AUC and was the best predictor of metabolic syndrome and hearing loss. Univariate and multivariate linear regression analyses showed that WHR levels were positively associated with four hearing thresholds including averaged hearing threshold and low, middle, and high frequency thresholds. In addition, multivariate logistic analysis revealed that those with a high WHR had a 1.347–fold increased risk of hearing loss compared with the participants with a low WHR.

Conclusion

Our results demonstrated that WHR may be a surrogate marker for predicting the risk of hearing loss resulting from metabolic syndrome.