Inner ear symptoms: can we use them to approach cardiovascular diseases?

Autonomic Nervous Function in Patients with Sudden Sensorineural Hearing Loss and Its Association with Prognosis and Disease Severity

INTRODUCTION

Vascular disorder is considered one of the main mechanisms of sudden sensorineural hearing loss (SSNHL) due to the anatomy of the inner ear. One factor that can contribute to vascular disorder is impairment in the autonomic nervous system. This study aims to investigate autonomic function in patients with SSNHL and its association with prognosis and disease severity from January 2018 to October 2019.

METHODS

We conducted a cross-sectional study involving 40 healthy controls and 55 subjects with SSNHL. We compared the autonomic function of controls and patients using heart rate variability (HRV). SSNHL patients were divided into improvement and no-improvement groups and into mild and severe groups according to pure-tone audiometry results.

RESULTS

The SSNHL group had significantly decreased total power (TP), low frequency (LF), and high frequency (HF) compared to the control group. However, there were no significant differences between the mild and severe groups. In the no-improvement group, LF was significantly higher and normalized HF was significantly lower than in the improvement group. According to a multiple logistic regression analysis, age and LF were significantly correlated with improvement.

CONCLUSION

This is the first study to evaluate the significance of HRV in patients with SSNHL, according to prognosis and disease severity. Further studies about the relationship between autonomic nervous system and SSNHL with larger sample size and prospective design are needed.

Vestibular Function After the 2016 Kumamoto Earthquakes: A Retrospective Chart Review

This retrospective chart review aimed to examine both the vestibular function and causes of dizziness experienced by individuals following a series of major earthquakes and repetitive aftershocks. All patients with balance disorders who experienced the 2016 Kumamoto earthquakes and their aftershocks completed questionnaires relevant to balance disorders and were enrolled in this study after providing informed consent. There were 2.8 times more patients with balance disorders post the earthquake. Anxiety (P = 0.02), orthostatic dysregulation (P = 0.005), and motion sickness scores (P = 0.03) were all significantly higher after the earthquakes. A subset of participants underwent clinical equilibrium testing, showing significant deteriorations in the equilibrium test results (stabilometry: P = 0.01), cervical vestibular-evoked myogenic potentials (P = 0.04), and head-up tilt (P = 0.03) after the earthquake. The findings of this study also suggest that earthquake-induced disequilibrium may be further influenced by physical stressors, including sensory disruptions induced by earthquake vibrations, changes in the living conditions, and autonomic stress. This study increases our understanding of human equilibrium in response to natural disasters. Moreover, these findings will facilitate the management of dizziness experienced during or after such disasters. Future studies should identify strategies for mitigating autonomic dysfunction to prevent post-earthquake dizziness.

Relationships Among Self-Reported Hearing Problems, Psychological Distress, and Cardiovascular Disease in U.S. Adults, National Health Interview Survey 1997-2017

Objective The purpose of this study was to explore the hypothesis that the relationship between hearing problems and cardiovascular disease (CVD) includes a connection to psychological distress. Design We used generalized structural equation modeling to assess relationships between self-reported measures of hearing problems, psychological distress, and CVD in a pooled sample of 623,416 adult respondents in the 1997-2017 National Health Interview Survey. Hearing status without hearing aids was self-reported on an ordinal scale and further grouped for this study into 3 categories (excellent or good hearing, little or moderate trouble hearing, and a lot of trouble or deaf). Six CVDs (stroke, angina pectoris, hypertension, heart attack, coronary heart disease, or other heart condition/disease) were incorporated as a latent variable. Psychological distress was evaluated by the Kessler 6 Scale (Kessler et al., 2010). All estimates were population weighted, and standard errors were adjusted for a complex survey design. Results Nearly 83% reported excellent or good hearing, 14% reported a little or moderate trouble hearing, and 3% reported a lot of trouble hearing or said they were deaf. Hearing problems were positively associated with CVD. Relative to those reporting excellent/good hearing, adults reporting trouble hearing had a higher probability of CVD. Hearing problems were also significantly associated with psychological distress. When psychological distress was applied to the model, positive associations between hearing problems and CVD were attenuated but still significant. Results are consistent with the hypothesis that the connection between self-reported hearing problems and CVD is mediated through psychological distress. Conclusions The relationship between self-reported hearing problems and CVD is mediated by psychological distress. Further research is needed to identify causal pathways and psychophysiological mechanisms involved in this relationship and to identify effective methods for addressing cardiovascular health-related psychosocial factors in the treatment of hearing impairment.

The cardiovascular aspects of a Ménière's disease population - A pilot study

INTRODUCTION

MD is considered a rare disease. An adequate model that explains MD's pathophysiology is not well established. Recently, the vascular theory of the disease has been revived.

OBJECTIVES

To characterize a MD population according to its cardiovascular risk and correlate it to the MD clinical course.

METHODS

In this retrospective chart study the data of 31 MD patients observed between January 2017 and April 2018 in a tertiary university hospital were reviewed. Patients included in the study were diagnosed according to the Bárány Society criteria. Lost follow-ups, patients with autoimmune disease, atopy or allergy, major psychiatric disease and migraine were excluded. Age, gender, cardiovascular risk factors, audiometric and vestibular parameters, occurrence of MD attacks in the previous 6 months, vestibular medication in course and time course of MD were recorded and compared between groups (with and without cardiovascular risk factors).

RESULTS

31 patients (61.3% females) mean aged 60.3 years (±9.7) were studied. 74% of the population had at least one risk factor and 51.6% of patients had attacks in the last 6 months. There was a statistically significant difference in the occurrence of MD attacks in the last 6 months (p = 0.014) between MD patients with and without risk factors. Mean PTA thresholds were higher and speech discrimination was lower in individuals with more cardiovascular risk factors.

CONCLUSIONS

Treatment of MD focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures in this disorder.

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

OBJECTIVES

To investigate the relationship between hearing loss and cardiovascular disease risk factors.

DESIGN

Cross-sectional study.

METHODS

Participants were recruited between May 2010 and December 2015 and answered a health and risk factor questionnaire. Physical and biochemical assessments were performed.

SETTING

A community-based population.

PARTICIPANTS

A total of 5107 participants born within the years 1946-1964 enrolled in the Busselton Healthy Ageing Study.

MAIN OUTCOME MEASURES

Hearing was assessed behaviourally through the best ear pure-tone average (500, 1000, 2000, 4000 Hz), low-frequency average (250, 500, 1000 Hz) and high-frequency average (4000, 8000 Hz). Self-reported hearing loss, tinnitus and hyperacusis were assessed via questionnaire. Cardiovascular risk factors were assessed via a patient-completed questionnaire and objective measurements including blood pressure, body mass index, waist circumference, lipid profile and glycated haemoglobin.

RESULTS

Of the participants, 54% were female, with the mean age of 58 years (range 45-69 years). Age, sex and family history of hearing loss were consistently strong determinants of hearing loss outcomes. After adjusting for these, obesity, current smoking, peripheral arterial disease and history of cardiovascular disease were significantly associated with pure-tone, low-frequency and high-frequency hearing loss. In addition, high blood pressure, triglyceride and glycated haemoglobin were significantly associated with low-frequency hearing loss. There was a graded association between hearing loss and Framingham Risk Score for cardiovascular risk (P<0.001).

CONCLUSIONS

Established cardiovascular disease and individual and combined cardiovascular disease risk factors were found to be associated with hearing loss. Future research should prospectively investigate whether targeting cardiovascular disease can prevent hearing loss.

Instrumento para la valoración de síntomas coronarios en la mujer

<p>Objetivo: Diseñar y validar un instrumento para la valoración de los síntomas en la mujer con enfermedad coronaria, enmarcada en la Teoría de los Síntomas Desagradables Metodología: Estudio metodológico, psicométrico, orientado por los Síntomas, concepto central de la Teoría de los Síntomas Desagradables de Lenz y colaboradores. Se realizó una crítica teórica del constructo elegido, demostrando su utilidad en la investigación y en la práctica disciplinar. Se ponderaron 260 evidencias por medio de una rigurosa crítica metodológica y empírica, aplicando el Sistema de Revisión Integrativa articulada al Modelo Conceptual Empírico de Fawcett y Garity. Se obtuvieron 30 piezas investigativas utilizadas para la construcción de los ítems. A los síntomas de Lenz se suman los síntomas psicosociales reportados en mujeres con enfermedad coronaria, generándose un primer instrumento compuesto por 87 ítems. Resultados: Se realizó una Validación de Contenido de expertos: Modelo Escobar y Cuervo 2008 (análisis estadístico SPSS 20) obteniéndose un Coeficiente de Correlación de Kendall de 0,682 (0,05), con buena concordancia entre jueces. El Modelo de Lawshe normalizado por Tristán 2008 reportó una Content Validity Ratio de 0,57 y un Index Validity Content de 0,797, demostrando que los ítems son unidades de análisis esenciales. Finalmente, la Validación Facial realizada mediante una prueba piloto a 21 mujeres que cumplieron los criterios de inclusión permitió la discriminación semiótica de los ítems, obteniéndose un instrumento compuesto por 67 ítems. Conclusiones: Éste es un remanente investigativo que requiere nuevas validaciones para elevar su capacidad psicométrica.</p>

Primary vascular dysregulation syndrome: Possible implications for inner ear acute diseases?

Primary vascular dysregulation syndrome has been reported as a possible cause for different eye diseases. Signs or symptoms of this syndrome not only may consist in a series of ocular disorders, as they possibly concern or are associated to various systemic conditions; even the damage of another terminal sensory organ as the inner ear is reported among the possible associations. Herein, the analogies between eye and inner ear are outlined, analyzing the PVD profile that well corresponds to our widely described model of subject without organic cardiovascular impairment but prone to inner ear acute disturbances. Actually, in absence of a recognized cause the latter can be due to a systemic dysregulation like the described one concerning ocular disorders.