Does COPD have a clinically relevant impact on hearing loss? A retrospective matched cohort study with selection of patients diagnosed with COPD

Auditory function assessment in patients with chronic obstructive pulmonary disease

Background

Chronic obstructive pulmonary disease is a multisystem disease with multiple comorbidities. Hearing is dependent on the cochlear functions that may be affected by oxygenation. Affection of hearing is problematic and represents a major concern that should be seriously investigated as an important comorbidity in chronic obstructive pulmonary disease patients.

Objective

To assess auditory status among chronic obstructive pulmonary disease patients.

Methodology

The current study was carried out at Al-Azhar University Hospitals, Cairo, from 1 August 2021 to 2022, including 120 participants. In addition to the control group (60 healthy participants), there were two study groups: chronic obstructive pulmonary disease patients with respiratory failure group (30 patients) and non-respiratory failure group (30 patients). Hearing functions were studied using pure tone audiometry, and auditory brain stem response.

Results

There was statistically significant hearing impairment in chronic obstructive pulmonary disease patients in comparison to control group. The hearing impairment was more significant in chronic obstructive pulmonary disease with respiratory failure group in comparison to chronic obstructive pulmonary disease without respiratory failure group. The auditory impairment shows a negative interrelationship with oxygen tension (PaO2) and a positive interrelationship with the smoking index.

Conclusion

Hearing affection was meaningfully higher among chronic obstructive pulmonary disease patients and more prominent in patients with respiratory failure. Hypoxia results in deterioration of pure tone audiometry and increased absolute and interpeak latencies in auditory brain stem response. At every frequency, the mean pure tone audiometry thresholds were higher for chronic obstructive pulmonary disease groups than control group albeit remaining in the mild to moderate area of hearing loss. Retro-cochlear affection was suggested among patients with chronic obstructive pulmonary disease as evidenced with the prolongation of auditory brain stem response waves latencies.

COPD and 20-year hearing decline: The HUNT cohort study

BACKGROUND

We aimed to assess the association between chronic obstructive pulmonary disease (COPD) and long-term hearing decline. A further aim was to study sex differences.

METHODS

Population-based cohort study in Norway (the HUNT study) with baseline measurements in 1996-1998 and follow-up in 2017-2019. The sample included 12,082 participants (43% men, mean age at follow-up 64 years). We used multiple linear regression to assess the association between COPD (minimum one registered ICD-10 code with emphysema or other COPDs during follow-up) and 20-year hearing decline in the low/mid/high frequency area (0.25-0.5/1-2/3-8 kHz). We adjusted for age, sex, education, smoking, noise exposure, ear infections, hypertension and diabetes.

RESULTS

Persons registered with COPD (N = 403) had larger 20-year hearing decline at low frequencies (1.5 dB, 95% confidence interval (CI) 0.6-2.3) and mid frequencies (1.2 dB, 95% CI 0.4-2.1), but not at high frequencies. At high frequencies, the association was stronger and statistically significant only among women (1.9 dB, 95% CI 0.6-3.2). Persons registered with both COPD and respiratory failure (N = 19) had larger 20-year hearing decline at low and mid frequencies: 7.4 dB (95% CI 3.6-11.2) and 4.5 dB (95% CI 0.7-8.4), respectively.

CONCLUSION

Our large cohort study shows an association between COPD and increased long-term hearing decline. Women seem to be more susceptible to COPD-related hearing loss at high frequencies. The findings support that COPD can affect the cochlear function.

Chronic Obstructive Pulmonary Disease is a Risk Factor for Sensorineural Hearing Loss: A US Population Study

OBJECTIVES

The goal of this study is to determine if chronic obstructive pulmonary disease (COPD) is associated with sensorineural hearing loss (SNHL) in a national database.

STUDY DESIGN

Cross-sectional study.

SETTING

National sample of the United States population.

PATIENTS

Adults with audiometric and spirometry data from the National Health and Nutrition Examination Study (NHANES) database.

INTERVENTIONS

None.

METHODS

A total of 2,464 adults with spirometry and audiometry data from the NHANES database (2009-2012) were studied. Outcome measures included hearing, measured by high-frequency pure tone average (HFPTA; 3, 4, 6, 8 kHz) and low-frequency pure tone average (LFPTA; .5, 1, 2 kHz) frequencies. SNHL was defined as a HFPTA or LFPTA threshold more than 25 decibels (dB) in the better ear. Multivariable regression analyses explored the association between hearing loss and COPD.

RESULTS

The prevalence of COPD was 19.8% in individuals with SNHL in the better ear and 4.7% in individuals with normal hearing (p < 0.001). Presence of COPD was associated with elevated hearing thresholds (worse hearing) at each individual frequency. The presence of COPD was independently associated with a 3.29 dB (95% CI: 1.48, 5.09) increase in HFPTA (p < 0.001), and 2.32 dB (1.13, 3.50) increase in LFPTA (p < 0.001) after controlling for medical, social, and environmental covariates. The presence of COPD was independently associated with a 1.85-fold (1.12, 3.06) increased odds of isolated low-frequency SNHL (p = 0.017).

CONCLUSIONS

COPD was independently associated with sensorineural hearing loss after controlling for multiple confounding factors. These results contribute to the evidence that COPD and pulmonary dysfunction can be comorbid with hearing decline.

Investigation of the relationship between sensorineural hearing loss and associated comorbidities in patients with chronic kidney disease: A nationwide, population-based cohort study

Hearing impairment was observed in patients with chronic kidney disease (CKD). Our purpose was to investigate the relationship between sensorineural hearing loss (SNHL) and associated comorbidities in the CKD population. We conducted a retrospective, population-based study to examine the risk of developing SNHL in patients with CKD. Population-based data from 2000–2010 from the Longitudinal Health Insurance Database of the Taiwan National Health Insurance Research Database was used in this study. The population sample comprised 185,430 patients who were diagnosed with CKD, and 556,290 without CKD to determine SNHL risk factors. Cox proportional hazard regression analysis demonstrated the CKD group had a significantly increased risk of SNHL compared with the non-CKD group [adjusted hazard ratio (HR), 3.42; 95% confidence interval (CI), 3.01–3.90, p < 0.001]. In the CKD group, the risk of SNHL (adjusted HR, 5.92) was higher among patients undergoing hemodialysis than among those not undergoing hemodialysis (adjusted HR, 1.40). Furthermore, subgroup analysis revealed an increased risk of SNHL in patients with CKD and comorbidities, including heart failure (adjusted HR, 7.48), liver cirrhosis (adjusted HR, 4.12), type 2 diabetes mellitus (adjusted HR, 3.98), hypertension (adjusted HR, 3.67), and chronic obstructive pulmonary disease (adjusted HR, 3.45). CKD is an independent risk of developing SNHL. Additionally, hemodialysis for uremia can increase the risk of SNHL. Cardiovascular, lung, liver, and metabolic comorbidities in CKD patients may further aggravate the risk of SNHL by inter-organ crosstalk. We should pay attention to SNHL in this high-risk population.

Increased Risk of Sensorineural Hearing Loss as a Result of Exposure to Air Pollution

Whether exposure to air pollution is associated with developing sensorineural hearing loss (SHL) remains controversial. Using data from the National Health Insurance Research Database, we recruited a total of 75,767 subjects aged older than 20 years with no history of SHL from 1998 to 2010, and they were followed up until SHL was observed, they withdrew from the National Health Insurance program, or the study ended. The subjects were evenly exposed to low-level, mid-level, and high-level carbon monoxide (CO) and nitrogen dioxide (NO₂). The incidence rate ratio of SHL for patients exposed to high-level CO was 1.24 (95% confidence interval (CI) = 1.14–1.36). The NO₂ pollutants increased the incidence rate ratios of SHL in mid-level NO₂ and high-level NO₂ exposures by 1.10 (95% CI = 1.10–1.32) and 1.36 (95% CI = 1.24–1.49) times, respectively. The adjusted hazard ratio (adj. HR) of SHL in patients exposed to high-level CO was 1.45 (95% CI = 1.31–1.59), relative to that of patients exposed to low-level CO. Compared to patients exposed to low-level NO₂, patients exposed to mid-level NO₂ (adj. HR = 1.40, 95% CI = 1.27–1.54) and high-level NO₂ (adj. HR = 1.63, 95% CI = 1.48–1.81) had a higher risk of developing SHL. The increased risk of SHL following the increased concentrations of air pollutants (CO and NO₂) was statistically significant in this study. In conclusion, the subjects’ exposure to air pollution exhibited a significantly higher risk of developing SHL in Taiwan.

Is COPD associated with alterations in hearing? A systematic review and meta-analysis

Background and aims

COPD is an irreversible or persistent airflow obstruction, which affects up to 600 million people globally. The primary purpose of this systematic review was to explore the COPD-based alteration in the auditory system function by conducting a quantitative analysis of presently published data.

Materials and methods

We systematically searched seven diverse electronic databases and manual searching of references to identify relevant studies. Data from the selected studies were rated by two investigators independently in a blinded fashion. Meta-analysis was done on pooled data using Cochrane’s Review Manager 5.3.

Results

Sixteen articles received suitable scores and were thus included for further processes. Hearing loss (HL) was defined as a change in pure tone audiometry (PTA) thresholds, auditory brainstem response (ABR), and auditory P300 parameters. ABR wave was significantly elongated in patients with COPD than in controls (standardized mean difference [SMD]=0.27, 95% CI: 0.05–0.48, P=0.02). PTA was significantly higher in patients with COPD when compared with controls (SMD=1.76, 95% CI: 0.43–3.08, P=0.0004). We found that patients with COPD had a significantly higher latency than controls (SMD=1.30, 95% CI: 0.79–1.80, P=0.0001).

Conclusion

COPD patients had considerably greater incidence of HL when compared with controls. Interestingly, although the mean PTA thresholds at every frequency for COPD patients were higher than those for controls, these values were still in the slight to mild HL ranges. Prolonged ABR wave latencies in the COPD patients suggest retro-cochlear involvement. Thus, COPD most frequently clusters with HL, but it is worth noting that alteration in hearing is not always recognized by medical experts as a frequent comorbidity associated with COPD.

Experiences of a Slovak PhD pioneer

It has all started 10 years ago, at my first WON CA Europe conference in Istanbul in 2008, where I became amazed by so many general practitioners, who performed and presented their scientific work there. However it took me 7 years since the idea to start my PhD studies until it´s final completion in 2017. My PhD journey wasn´t straight, but rather twisty, with 2 interruptions. In 2011 I started to earn my basic research skills at 2 courses. The first one was the European General Practice Research Network (EG PRN) course in Nice and the second University of Crete´s research workshop in Slovakia lead by Professor Christos Lionis. The easiest part of my PhD studies was the clinical one – administering questionnaire and performing spirometry with my patients at my rural general practice. I also enjoyed teaching medical students at undergraduate as well as postgraduate level. I gave lectures at national conferences and published articles about general medicine in Slovak scientific journals, focusing on prevention, patient safety and respiratory diseases, especially COPD. I also contributed to two medical text books. My research was presented as posters or oral presentations at 3 WON CA Europe conferences, where I found a great space for sharing research ideas and results. Final results of my PhD thesis are going to be presented at Krakow conference. Even though I was a fruitful author of publications, reaching the goal of an international publication was the most difficult part for me, not achievable without a help of experienced colleague, Austrian general practitioner, Professor Gustav Kamenski.