Association of hearing impairment with chronic kidney disease: a cross-sectional study of the Korean general population

A Systematic Review on Hearing and Balance in Patients with Chronic Kidney Disease with and Without Hemodialysis

Objective

Exploring the auditory and vestibular manifestations associated with chronic kidney disease (CKD) has been growing in recent years. Understanding these complaints in CKD patients is crucial for comprehensive patient care. This review aimed to investigate the audiological findings and profiles across various stages of CKD and guide for informed decision-making in their management.

Methods

Relevant articles from PubMed, ScienceDirect, EBSCO Medline, SCOPUS, Google Scholar, and Clinical Key were identified for review. The selected articles were published from 2008 to 2023 and written in English language. A total of 41 articles on auditory and vestibular assessments in CKD were eligible for review.

Results

Pure tone audiometry (PTA), immittance audiometry (IA) and otoacoustic emissions (OAEs) were the most commonly employed hearing tests respectively, with a higher frequency of utilization in hemodialysis cases compared to non-hemodialysis ones. Also, vestibular evoked myogenic potentials (VEMPs) emerged as the most popular vestibular test among hemodialysis patients while questionnaires were frequently employed in CKD patients. Moreover, our analysis suggests a potential association between the duration of hemodialysis and the development of tinnitus and vertigo. Abnormalities were also observed in auditory brainstem response (ABR), speech audiometry, central auditory processing tests and videonystagmography (VNG) assessment in hemodialysis and non-hemodialysis patients.

Conclusion

CKD patients, particularly those undergoing hemodialysis, face a higher risk of hearing loss, tinnitus, and vestibular complaints. Performing otoacoustic emissions and vestibular-evoked myogenic potentials along with PTA on CKD patients, regardless of the disease stage is recommended to more effective management of audiovestibular complaints in these population.

The effectiveness of curcumin as a safe agent on hearing threshold improvement in patients with chronic kidney disease: a double-blind, placebo-controlled trial

Hearing impairment in patients with chronic kidney disease (CKD), can affect the quality of life. At present, hearing dysfunction does not have an approved pharmacologic therapy. This study aimed to investigate the protective effects and possible mechanisms of curcumin as a therapeutic agent on hearing impairment in patients with chronic kidney disease. We conducted a randomized controlled trial of 40 chronic kidney disease patients not on dialysis with hearing impairment. Participants were randomly divided into two groups. One group received curcumin daily and the other received a placebo for 12 weeks. The interval between III and V waves, latency of wave V, auditory brain stem response (ABR) threshold, speech reception threshold (SRT), and speech discrimination score (SDS) were evaluated and analyzed before and after the intervention. After treatment, in the curcumin group, III-V waves interval and the latency of wave V were significantly reduced (P value < 0.0001), also ABR threshold was demonstrated a significant improvement (P value < 0.0001). In the trial group, the SDS was increased (P = 0.001) and the SRT was attenuated (P < 0.0001). We had either significant deterioration due to the course of the disease or insignificant changes in the placebo group. Daily administration of curcumin, can significantly improve hearing impairment in CKD patients. Accordingly, curcumin should be considered as a therapeutic option for treating hearing impairment in patients with chronic kidney disease.

Association between hearing loss, tinnitus, and chronic kidney disease: the NHANES 2015-2018

Background

Previous studies suggested that chronic kidney disease (CKD) might contribute to hearing loss and tinnitus. Patients with CKD are often at risk of sudden onset hearing loss and tinnitus; however, few epidemiological investigations have been conducted on this topic. The purpose of this investigation was to analyze the correlation between hearing loss, tinnitus, and CKD based on information obtained from the National Health and Nutrition Examination Survey (NHANES).

Methods

Using data from the NHANES 2015-2018, a cross-sectional analysis was conducted, which included 5,131 participants, and used multivariate logistic regression analyses and subgroup analysis to investigate the association between hearing loss, tinnitus, and CKD.

Results

CKD was associated independently with hearing loss, with the CKD group being more at risk of hearing loss than the non-CKD group [age-adjusted 95% confidence interval (CI): 1.54 (1.31-1.8), p < 0.001]; multivariable-adjusted 95% CI: 1.31 (1.1-1.55), p = 0.002. Multifactorial logistic regression analysis did not find an association between CKD and tinnitus, however, further subgroup analyses showed a relationship in some populations.

Conclusion

The results suggested that CKD is associated with hearing loss and tinnitus. The complexity of the relationship between CKD and hearing loss requires further research.

Predicting Sudden Sensorineural Hearing Loss Recovery with Patient-Personalized Seigel's Criteria Using Machine Learning

BACKGROUND

Accurate prognostic prediction is crucial for managing Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). Previous studies developing ISSHL prognosis models often overlooked individual variability in hearing damage by relying on fixed frequency domains. This study aims to develop models predicting ISSHL prognosis one month after treatment, focusing on patient-specific hearing impairments.

METHODS

Patient-Personalized Seigel's Criteria (PPSC) were developed considering patient-specific hearing impairment related to ISSHL criteria. We performed a statistical test to assess the shift in the recovery assessment when applying PPSC. The utilized dataset of 581 patients comprised demographic information, health records, laboratory testing, onset and treatment, and hearing levels. To reduce the model's reliance on hearing level features, we used only the averages of hearing levels of the impaired frequencies. Then, model development, evaluation, and interpretation proceeded.

RESULTS

The chi-square test (p-value: 0.106) indicated that the shift in recovery assessment is not statistically significant. The soft-voting ensemble model was most effective, achieving an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.864 (95% CI: 0.801-0.927), with model interpretation based on the SHapley Additive exPlanations value.

CONCLUSIONS

With PPSC, providing a hearing assessment comparable to traditional Seigel's criteria, the developed models successfully predicted ISSHL recovery one month post-treatment by considering patient-specific impairments.

The multifaceted links between hearing loss and chronic kidney disease

Hearing loss affects nearly 1.6 billion people and is the third-leading cause of disability worldwide. Chronic kidney disease (CKD) is also a common condition that is associated with adverse clinical outcomes and high health-care costs. From a developmental perspective, the structures responsible for hearing have a common morphogenetic origin with the kidney, and genetic abnormalities that cause familial forms of hearing loss can also lead to kidney disease. On a cellular level, normal kidney and cochlea function both depend on cilial activities at the apical surface, and kidney tubular cells and sensory epithelial cells of the inner ear use similar transport mechanisms to modify luminal fluid. The two organs also share the same collagen IV basement membrane network. Thus, strong developmental and physiological links exist between hearing and kidney function. These theoretical considerations are supported by epidemiological data demonstrating that CKD is associated with a graded and independent excess risk of sensorineural hearing loss. In addition to developmental and physiological links between kidney and cochlear function, hearing loss in patients with CKD may be driven by specific medications or treatments, including haemodialysis. The associations between these two common conditions are not commonly appreciated, yet have important implications for research and clinical practice.

Shared features in ear and kidney development - implications for oto-renal syndromes

The association between ear and kidney anomalies has long been recognized. However, little is known about the underlying mechanisms. In the last two decades, embryonic development of the inner ear and kidney has been studied extensively. Here, we describe the developmental pathways shared between both organs with particular emphasis on the genes that regulate signalling cross talk and the specification of progenitor cells and specialised cell types. We relate this to the clinical features of oto-renal syndromes and explore links to developmental mechanisms.

Prevelance of Hearing Loss and Factors Association in Chronic Kidney Disease Patients

Aim: Chronic kidney disease (CKD) is becoming a great concern, especially in developing countries and SNHL among patients with CKD is considerably higher than general population. So, current study aims evaluation and assessment of degree of hearing loss in chronic kidney disease patients using pure tone audiogram and correlation of hearing loss with its contributing factors. Materials and methods:70 patients with CKD were included in this prospective observational cross sectional study performed in tertiary care hospital. A detailed history; general physical, otological examination, blood investigation was done.CKD staging was done using KDIGO guidelines and hearing assessment using pure tone audiometry. Hearing loss association with CKD and contributing factors were studied. Result: Out of 70 participants, SNHL was seen in twenty one participants. Hearing loss was present in 3 out of 22 participants of CKD-3; 6 out of 12 participants of CKD-4 and 12 out of 15 participants of stage CKD-5. A statistically significant association of hearing loss was found with CKD stage, albuminuria, hemodialysis, hypertension and other factors. Discussion: Since hearing impairment may well have a negative impact on the social function of an affected individual, the use of pure tone audiogram to monitor CKD patients should be considered as a routine procedure. Patients with CKD would benefit from early detection of hearing loss which will allow for early rehabilitative measures to be taken.

Associations between medical conditions and auditory dysfunction in US Veterans

OBJECTIVE

To examine associations between non-otologic medical conditions and auditory dysfunction.

DESIGN

Cross-sectional analysis of baseline data from the Noise Outcomes in Service members Epidemiology (NOISE) study. Logistic regression was used to estimate the association between medical conditions (0, 1, and 2 or more conditions) and auditory dysfunction (hearing loss pure tone average ≥20 dB HL and tinnitus), adjusting for key confounders including noise exposure. Secondarily, the association between specific medical conditions and auditory dysfunction was examined. All variables were self-reported.

STUDY SAMPLE

United States military Veterans (n = 580) with mean age 34.1 years (standard deviation = 9.2), who were within approximately 2.5 years of separation from service.

RESULTS

Compared to Veterans reporting no medical conditions, Veterans reporting two or more had increased odds on low-frequency hearing loss and on tinnitus but not on high or extended-high frequency hearing loss. Furthermore, specific conditions sleep disorder and arthritis were associated with auditory dysfunction.

CONCLUSIONS

Non-otologic medical conditions were associated with low-frequency hearing loss and tinnitus in this sample of young Veterans. This suggests medical conditions may play a role in Veterans' hearing health. Whether management of medical conditions earlier in life reduces the risk of hearing loss and tinnitus requires further study.

Association of Chronic Kidney Disease with Prior Tinnitus: A Case-Control Study

This population-based, case−control study aims to explore the relationship between prior tinnitus and the occurrence of chronic kidney disease (CKD) using a nationwide, population-based cohort study. We used data from the Taiwan National Health Insurance Research Database to explore the association of CKD with tinnitus. We identified 15,314 patients aged ≥40 years old with a first-time diagnosis of CKD as the cases. We used propensity-scored matching to select 45,942 controls (1:3 ratio). We performed multivariate logistic regression to estimate the odds ratio (OR) of a prior tinnitus diagnosis among the CKD group vs. the control group. Analysis showed that 770 (1.26%) out of the 61,256 sampled patients had previously diagnosed tinnitus. Chi-square testing revealed a significant difference in the rate of previously diagnosed tinnitus between cases and controls (3.86% vs. 0.93%, p < 0.001). Univariate logistic regression analysis showed an OR of prior tinnitus for cases of 10.249 (95% confidence interval (CI): (8.662~12.126)) relative to controls. In adjusted analysis, cases were more likely than controls to have a prior diagnosis of tinnitus (OR = 10.970, 95% CI = 9.255~13.004, p < 0.001) after adjusting for age, sex, monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and autoimmune disease. Our study shows that CKD patients have a higher likelihood of having suffered from tinnitus before CKD was diagnosed, but we have no data suggesting that tinnitus is a predictor of subsequent CKD. Patients diagnosed with tinnitus may benefit from proactive measures to prevent CKD and detect it early through lifestyle modifications and regular renal function examinations, regardless of CKD-related symptoms.

Estimated Glomerular Filtration Rate and Hearing Impairment in Japan: A Longitudinal Analysis Using Large-Scale Occupational Health Check-Up Data

Several longitudinal studies have examined associations between renal dysfunction and hearing impairment. Here, we explored the longitudinal association between estimated glomerular filtration rate (eGFR) and hearing impairment among the working-age population in Japan. Participants were 88,425 males and 38,722 females aged 20-59 years, without hearing impairment at baseline (2013), who attended Japanese occupational annual health check-ups from 2013 to 2020 fiscal year. eGFR was categorized into four groups (eGFR upper half of ≥90, lower half of ≥90 (reference), 60-89, and <60 mL/min/1.73 m²). Low- and high-frequency hearing impairment were assessed using data from pure-tone audiometric testing. A Cox proportional hazards model was applied to estimate hazard ratio (HR) values for hearing impairment. Low eGFR did not increase the risk of low- or high-frequency hearing impairment. For males, multivariable-adjusted HR of high-frequency hearing impairment was 1.16 (95% confidence interval, 1.01-1.34) for the upper half of the ≥90 mL/min/1.73 m²; however, this positive association between high eGFR and high-frequency hearing impairment did not appear to be robust in a number of sensitivity analyses. We conclude that, among the Japanese working-age population, eGFR was not generally associated with hearing impairment in people of either sex.

Relationship between Nutrient Intake and Hearing Loss According to the Income Level of Working-Aged Adults: A Korean National Health and Nutrition Survey

The relationship between hearing impairment and nutrition has been extensively investigated; however, few studies have focused on this topic in working-age adults by income level. Herein, we aimed to determine the differences in hearing impairment among working-age adults by income level and identify the nutritional factors that affect hearing loss in various socioeconomic groups. Seven-hundred-and-twenty participants had hearing impairment, while 10,130 had normal hearing. After adjustment for propensity score matching, income and smoking status were identified as significant variables. By assessing the relationship between hearing impairment and nutrient intake by income level using multiple regression analyses, significant nutrients differed for each income category. Carbohydrate and vitamin C levels were significant in the low-income group; protein, fat, and vitamin B1 levels were significant in the middle-income group; and carbohydrates were significant in the high-income group. Income was significantly associated with hearing impairment in working-age adults. The proportion of individuals with hearing impairment increased as income decreased. The association between hearing impairment and nutritional intake also differed by income level. Our findings may enable the establishment of health policies for preventing hearing impairment in working-age adults by income level.

Correlation between blood urea nitrogen level and cochlear outer hair cell function in non-dialysis chronic kidney disease patients

Background: Hearing loss due to impaired cochlear function, which results from increased blood urea nitrogen (BUN) level, is one of the important clinical problems in chronic kidney disease (CKD) patients with uremia. This study aims to determine correlation between blood urea nitrogen (BUN) levels and cochlear outer hair cell (OHC) dysfunction in non-dialysis stage 3-5 CKD patients so that the BUN levels may also be used to determine the presence of cochlear OHC dysfunction.

Design and methods: An observational analytic study with a cross sectional design and consecutive sampling. This study was conducted from November 2019 to February 2020 at the Department of Internal Medicine, Soetomo Hospital, Surabaya, Indonesia, and Otorhinolaryngology-Head and Neck Surgery Department, Soetomo Hospital, Surabaya, Indonesia. Non-dialysis CKD patients who met the inclusion and exclusion criteria were subjected to a Distortion Product Otoacoustic Emissions (DPOAE) test to assess cochlear OHC function at the Otorhinolaryngology- Head and Neck Surgery, Soetomo Hospital, Surabaya.

Results: Female patients were in larger number than male patients in a ratio of 1 : 2. Most of the patients were between 51-60 years of age. DPOAE distribution was refer in 25 patients (83.3%) and pass in 5 patients (16.7%). The highest pass was at 2000 Hz in 24 patients (80.0%), while the refer results were mostly at 12,000 Hz in 29 patients (96.7%). The highest average signal to noise ratio (SNR) was at 2000 Hz and 4000 Hz (12.77 dB and 11.13 dB), while the lowest at 11,000 Hz and 12,000 Hz (1.60 dB and 1.03 dB). Pearson’s correlation test on DPOAE results did not show a significant correlation (p>0.05) between BUN levels and impaired cochlear OHC function.

Conclusions: There was no correlation between increased blood urea nitrogen levels and cochlear outer hair cell function disorders in non-dialysis patients with CKD stage 3-5.

The correlation between fibroblast growth factor-23 and ESRD patients with hearing impairment

Background

End-stage renal disease (ESRD) patients often experience hearing impairment, resulting in a high rate of disability and a decline in their quality of life. Fibroblast growth factor-23 (FGF23) is a diagnostic biomarker for chronic kidney disease (CKD) and a pathogenic contributor to CKD progression. However, the correlation between FGF23 level and CKD patients with hearing impairment remains elusive. This study aimed to investigate the relationship between the FGF23 and ESRD accompanied with hearing impairment.

Methods

A total of 144 ESRD patients, who were admitted to the First Affiliated Hospital of Kunming Medical University from November to December 2020, were enrolled in this study. Firstly, 144 ESRD patients underwent pure-tone audiometry (PTA). Secondly, it was attempted to randomly select 20 ESRD patients with normal hearing, and 20 ESRD patients with hearing impairment (match ratio, 1:1). Age- and gender-matched healthy people (n = 20) were also recruited as controls group. The expression levels of FGF23 was detected by enzyme-linked immunosorbent assay (ELISA).

Results

The results of pure-tone audiometry showed that the prevalence of hearing impairment in ESRD patients was 80.5%. Male ESRD patients were more likely to develop hearing impairment compared to female patients. The incidence rate of hearing impairment at a high frequency was significantly higher than that at a low frequency (P < 0.01). The serum levels of FGF23, phosphorus, and parathyroid hormone (PTH) in ESRD patients with hearing impairment significantly increased compared with those with normal hearing and healthy controls.

Conclusion

ESRD patients had a higher risk of hearing loss, especially high-frequency hearing impairment. As FGF23 level increased, the risk of hearing loss was also elevated. The hearing impairment in ESRD patients was associated with the degree of kidney injury, and serum FGF23 level.

Low vitamin D status is associated with hearing loss in the elderly: a cross-sectional study

BACKGROUND

The elderly are at increased risk of both hearing loss (HL) and osteoporosis. Bone mineral density (BMD) has been putatively linked to HL. However, the roles of serum calcium concentrations and vitamin D status have yet to be elucidated.

OBJECTIVES

The purpose of this study was to examine the relation between vitamin D status, parathyroid hormone (PTH), total calcium, BMD, and HL in a nationally representative sample of elderly adults.

METHODS

Using the NHANES (2005-2010), audiometry and BMD data of 1123 participants aged ≥70 y were analyzed in a cross-sectional manner. HL was defined as pure tone averages >25 dB HL at 500, 1000, and 2000 Hz (low frequency); 500, 1000, 2000, and 4000 Hz (speech frequency); and 3000, 4000, 6000, and 8000 Hz (high frequency) in either ear. Multivariable logistic regression was used to examine the relation between HL and total 25-hydroxyvitamin D [25(OH)D], PTH, total calcium, and BMD, adjusting for covariates.

RESULTS

In multivariable analyses, total 25(OH)D < 20 ng/mL was found to be associated with greater odds of low-frequency HL (OR: 2.02; 95% CI: 1.28, 3.19) and speech-frequency HL (OR: 1.96; 95% CI: 1.12, 3.44). A 1-unit decrease in femoral neck BMD (OR: 4.55; 95% CI: 1.28, 16.67) and a 1-unit decrease in total spine BMD (OR: 6.25; 95% CI: 1.33, 33.33) were found to be associated with greater odds of low-frequency HL. Serum PTH and total calcium were not found to be associated with HL.

CONCLUSIONS

In the elderly, low vitamin D status was associated with low-frequency and speech-frequency HL. Low vitamin D status may be a potential risk factor for age-related HL.

Chronic kidney disease in the context of multimorbidity patterns: the role of physical performance : The screening for CKD among older people across Europe (SCOPE) study

Background

Chronic kidney disease (CKD) is known to be associated with several co-occurring conditions. We aimed at exploring multimorbidity patterns associated with CKD, as well as the impact of physical performance and CKD severity on them in a population of older outpatients.

Methods

Our series consisted of 2252 patients enrolled in the Screening of CKD among Older People across Europe multicenter observational study. Hypertension, stroke, transient ischemic attack, cancer, hip fracture, osteoporosis, Parkinson’s disease, asthma, chronic obstructive pulmonary disease, congestive heart failure, angina, myocardial infarction, atrial fibrillation, anemia, CKD (defined as GFR < 60, < 45 or < 30 ml/min/1.73 m²), cognitive impairment, depression, hearing impairment and vision impairment were included in the analyses. Physical performance was assessed by the Short Physical Performance Battery (SPPB) and used as stratification variable. Pairs of co-occurring diseases were analyzed by logistic regression. Patterns of multimorbidity were investigated by hierarchical cluster analysis.

Results

CKD was among the most frequently observed conditions and it was rarely observed without any other co-occurring disease. CKD was significantly associated with hypertension, anemia, heart failure, atrial fibrillation, myocardial infarction and hip fracture. When stratifying by SPPB, CKD was also significantly associated with vision impairment in SPPB = 5–8 group, and hearing impairment in SPPB = 0–4 group. Cluster analysis individuated two main clusters, one including CKD, hypertension and sensory impairments, and the second including all other conditions. Stratifying by SPPB, CKD contribute to a cluster including diabetes, anemia, osteoporosis, hypertension and sensory impairments in the SPPB = 0–4 group. When defining CKD as eGFR< 45 or 30 ml/min/1.73 m², the strength of the association of CKD with hypertension, sensory impairments, osteoporosis, anemia and CHF increased together with CKD severity in pairs analysis. Severe CKD (eGFR< 30 ml/min/1.73 m²) contributed to a wide cluster including cardiovascular, respiratory and neurologic diseases, as well as osteoporosis, hip fracture and cancer.

Conclusions

CKD and its severity may contribute significantly to specific multimorbidity patterns, at least based on the cluster analysis. Physical performance as assessed by SPPB may be associated with not negligible changes in both co-occurring pairs and multimorbidity clusters.

Trial registration

The SCOPE study is registered at clinicaltrials.gov (NCT02691546).

Nephrotoxic effects caused by co-exposure to noise and toluene in New Zealand white rabbits: A biochemical and histopathological study

The biological and renal effects made by simultaneous and non-simultaneous exposure to toluene and noise were investigated. Twenty-four New Zealand white rabbits were exposed to 100 dB of white noise and 1000 ppm of toluene vapor for two weeks. The examined biochemical factors were urea, uric acid, creatinine, glucose, triglyceride, cholesterol, and albumin serum levels, measured on different days after the end of the exposure. Moreover, glutathione peroxidase activity (GPX), malondialdehyde dismutase activity (MDA), and superoxide dismutase (SOD) parameters were measured in the kidney tissue. The hematoxylin and eosin staining method was used for histopathological experiments. Overall, the noise increased albumin, uric acid, creatinine, and glucose levels, but it decreased urea, cholesterol, and triglyceride levels. Toluene decreased albumin, uric acid, and urea levels, while it increased creatinine, triglyceride, cholesterol, and glucose levels. Simultaneous exposure to noise and toluene decreased albumin, uric acid, cholesterol, and urea levels, whereas it increased creatinine, glucose, and triglyceride levels. GPX, MDA, and SOD levels increased by simultaneous and non-simultaneous exposure to noise and toluene. Furthermore, massive tubular degeneration, tubular cell vacuolization, glomerular disorganization, congestion, glomerular cell shrinkage, and unclear brush border were detected in the kidney tissue.

The association between reduced kidney function and hearing loss: a cross-sectional study

Background

The relationship between kidney function and hearing loss has long been recognized, but evidence of this association mostly comes from small observational studies or other populations. The aim of this study is to explore the association between reduced kidney function and hearing loss in a large population-based study among the middle-aged and elderly Chinese.

Methods

Data collected from the Chinese Health and Retirement Longitudinal Study (CHARLS) in 2015 were used for analysis. A cross-sectional study was conducted among 12,508 participants aged 45 years and older. Hearing loss, the outcome of this study, was defined according to interviewees’ responses to three survey questions related to hearing in the CHARLS. Estimated glomerular filtration rate (eGFR) was employed to assess kidney function, and participants were classified into three categories based on eGFR: ≥90, 60–89 and < 60 mL/min/1.73 m². Multivariable logistic regression was employed to adjust for potential confounders, including demographics, health-related behaviors, and cardiovascular risk factors.

Results

The overall prevalence of self-reported hearing loss in the study population was 23.6%. Compared with participants with eGFR ≥90 mL/min/1.73 m², participants with eGFR of 60–89 mL/min/1.73 m² (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.00–1.23) and eGFR < 60 mL/min/1.73 m² (OR: 1.25, 95% CI: 1.04–1.49) showed increased risk of hearing loss after adjusting for potential confounders.

Conclusions

Reduced kidney function is independently associated with hearing loss. Testing for hearing should be included in the integrated management of patients with chronic kidney disease.

Epidemiology of Clinically Significant Tinnitus: A 10-Year Trend From Nationwide Health Claims Data in South Korea

OBJECTIVES

Prevalence of tinnitus has been reported to vary according to the target population and definition of tinnitus. To improve the understanding of tinnitus, authors used the nation-wide health claim data to study the tinnitus in the entire population of South Korea.

STUDY DESIGN

Retrospective big data review.

SETTING

Analysis of big data from the National Health Information Database.

PATIENTS

Patients diagnosed with tinnitus according to International Classification of Diseases code 10th edition (ICD-10) and requested to receive National Health Insurance claim at least once from January 2006 to December 2015.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Epidemiologic data, association of tinnitus with the otologic and systemic diseases.

RESULTS

The number of patients who received medical care because of tinnitus was 1.44% (0.78 million per 51 million) in 2015. There was a higher prevalence of tinnitus in women, and the overall prevalence increased with increasing age of patients and peaked at patients in their 70s (4.43%). The prevalence of tinnitus among patients aged 10 to 30 years, showed a tendency to increase during study period. In the regional analysis, highest prevalence was observed in Gwangju (2.02%). In comparison with the control group, the patients with tinnitus showed a higher frequency in otologic and systemic disease. Especially, noise induced hearing loss (adjusted odds ratio [AOR] = 82.1, 95% confidence interval [95% CI] = 74.8-90.2) and sudden sensorineueal hearing loss (AOR = 49.7, 95% CI = 48.4-51.0) showed high frequency in tinnitus patient group.

CONCLUSIONS

The prevalence and incidence of tinnitus in this study for entire nation were lower than previously reported studies. These results have limitation because the study only covered patient using the medical service for tinnitus and missed tinnitus sufferers not seeking medical service. However, this study is meaningful in that it was targeting entire nation, reflected the characteristics of clinically significant tinnitus patient enough to visit medical service.

[An epidemiological investigation of chronic kidney disease in children with hearing disorder in Hunan province, China]

OBJECTIVE

To investigate the prevalence of chronic kidney disease (CKD) among the children with hearing disorder in Hunan province, China.

METHODS

In this cross-sectional study, the multi-stage cluster sampling method was used to select 1 500 children as subjects. Questionnaire surveys, physical examinations, and laboratory examinations were performed on the spot.

RESULTS

Among the 1 500 children, 1 459 with complete data were included in analysis. Among the 1 459 children, 43 had CKD, with a prevalence rate of 2.95%. The <7 years group had a significantly higher prevalence rate than the 7-14 years group [5.8% (35/604) vs 0.9% (8/855); P<0.05]. Among the 43 children with CKD, 31 (72%) had proteinuria, 27 (63%) had hematuria, and 11 (26%) had a decreased glomerular filtration rate. Among the 43 children with CKD, stage 1, 2, 3a, 3b, 4, and 5 CKD accounted for 30% (13 cases), 44% (19 cases), 12% (5 cases), 7% (3 cases), 7% (3 cases), and 0% (0 case) respectively. The prevalence rate of CKD increased with the severity of hearing disorder (P<0.01).

CONCLUSIONS

The prevalence rate of CKD is higher among the children with hearing disorder in Hunan province. Most children have early-stage CKD. CKD is commonly seen in preschool children. Severity of hearing disorder is associated with the prevalence of CKD.

[An epidemiological investigation of chronic kidney disease in children with hearing disorder in Hunan province, China]

OBJECTIVE

To investigate the prevalence of chronic kidney disease (CKD) among the children with hearing disorder in Hunan province, China.

METHODS

In this cross-sectional study, the multi-stage cluster sampling method was used to select 1 500 children as subjects. Questionnaire surveys, physical examinations, and laboratory examinations were performed on the spot.

RESULTS

Among the 1 500 children, 1 459 with complete data were included in analysis. Among the 1 459 children, 43 had CKD, with a prevalence rate of 2.95%. The <7 years group had a significantly higher prevalence rate than the 7-14 years group [5.8% (35/604) vs 0.9% (8/855); P<0.05]. Among the 43 children with CKD, 31 (72%) had proteinuria, 27 (63%) had hematuria, and 11 (26%) had a decreased glomerular filtration rate. Among the 43 children with CKD, stage 1, 2, 3a, 3b, 4, and 5 CKD accounted for 30% (13 cases), 44% (19 cases), 12% (5 cases), 7% (3 cases), 7% (3 cases), and 0% (0 case) respectively. The prevalence rate of CKD increased with the severity of hearing disorder (P<0.01).

CONCLUSIONS

The prevalence rate of CKD is higher among the children with hearing disorder in Hunan province. Most children have early-stage CKD. CKD is commonly seen in preschool children. Severity of hearing disorder is associated with the prevalence of CKD.

Discrepancies between self-reported hearing difficulty and hearing loss diagnosed by audiometry: prevalence and associated factors in a national survey

OBJECTIVE

To evaluate discrepancies prevalent between self-reported hearing difficulty (SHD) and audiometrically measured hearing loss (AHL) and factors associated with such discrepancies.

DESIGN

Nationwide cross-sectional survey.

SETTING

Data from 2010 to 2012 Korea National Health and Nutrition Examination Survey conducted by the Korea Centers for Disease Control and Prevention.

PARTICIPANTS

We included 14 345 participants aged ≥19 years who had normal tympanic membranes (mean age of 49 years).

MEASURES

Self-reported hearing was assessed by asking participants whether they had difficulty in hearing. AHL was defined as >25 dB of mean hearing thresholds measured at 0.5, 1, 2 and 4 kHz in better ear. Underestimated hearing impairment (HI) was defined as having AHL without SHD. Likewise, overestimated HI was defined as having SHD without AHL. Prevalence of underestimated and overestimated HIs was determined. Univariable and multivariable analyses were performed to examine factors associated with such discrepancies compared with concordant HL.

RESULTS

Among 14 345 participants, 1876 (13.1%) had underestimated HI while 733 (5.1%) had overestimated HI. Multivariable models revealed that participants who had discrepancies between SHD and AHL were less likely to have older age (OR: 0.979, 95% CI: 0.967 to 0.991 for the underestimated HI, OR: 0.905, 95% CI: 0.890 to 0.921 for the overestimated HI) and tinnitus (OR: 0.425, 95% CI: 0.344 to 0.525 for the underestimated HI and OR 0.523, 95% CI: 0.391 to 0.699 for the overestimated HI) compared with those who had concordant HI. Exposure to occupational noise (OR: 0.566, 95% CI: 0.423 to 0.758) was associated with underestimated HI, and medical history of hypertension (OR: 1.501, 95% CI: 1.061 to 2.123) and depression (OR: 1.771, 95% CI: 1.041 to 3.016) was associated with overestimated HI.

CONCLUSION

Age, tinnitus, occupational noise exposure, hypertension and depression should be incorporated into evaluation of hearing loss in clinical practice.

Association between hearing organ and renal function in young adult type 1 diabetic patients: A cross-sectional study

Type 1 diabetes can lead to impaired function of many organs and tissues. The aim of this study was to evaluate associations between hearing and kidney function in young adult type 1 diabetic patients. 31 patients (9 women) with type 1 diabetes, aged <45, with disease duration <10 years were included. Blood and urine samples for laboratory tests and urinary albumin excretion (UAE) assessment were obtained. eGFR was calculated with CKD-EPI formula. In all patients pure-tone audiometry, transient evoked otoacoustic emissions and auditory brainstem responses were evaluated, also eye fundus was examined. Mean patients' age was 29.5 ± 7.0 years and disease duration 4.6 ± 2.6 years. All patients had eGFR > 60.0 ml/min/1.73 m². In one case microalbuminuria and in 3 patients early retinopathy were revealed. Linear correlation between eGFR and hearing threshold at 4, 6, 8 and 12 kHz was found. Patients with hearing impairment (n = 7) had lower eGFR 108.8 vs. 121.7 ml/min/1.73 m², p = 0.047 compared to normal-hearing subjects. Also patients with absence of otoacoustic emissions in at least one ear had lower eGFR, 103.1 vs. 123.3 ml/min/1.73 m², p < 0.001, compared to the remaining group. In auditory brainstem responses we found significant linear correlation between eGFR and wave III and interval I-III latencies, and between UAE and waves III, V and interval I-III latencies. This study suggests existence of relationship between hearing and kidney function in type 1 diabetic patients. Pathways directly linking hearing and renal function are unknown. Larger studies are necessary to further analyze these relationships.

Exocyst Complex Member EXOC5 Is Required for Survival of Hair Cells and Spiral Ganglion Neurons and Maintenance of Hearing

The exocyst, an octameric protein complex consisting of Exoc1 through Exoc8, was first determined to regulate exocytosis by targeting vesicles to the plasma membrane in yeast to mice. In addition to this fundamental role, the exocyst complex has been implicated in other cellular processes. In this study, we investigated the role of the exocyst in cochlear development and hearing by targeting EXOC5, a central exocyst component. Deleting Exoc5 in the otic epithelium with widely used Cre lines resulted in early lethality. Thus, we generated two different inner ear-specific Exoc5 knockout models by crossing Gfi1^Cre mice with Exoc5^f/f mice for hair cell-specific deletion (Gfi1^Cre/+;Exoc5^f/f) and by in utero delivery of rAAV-iCre into the otocyst of embryonic day 12.5 for deletion throughout the otic epithelium (rAAV2/1-iCre;Exoc5^f/f). Gfi1^Cre/+;Exoc5^f/f mice showed relatively normal hair cell morphology until postnatal day 20, after which hair cells underwent apoptosis accompanied by disorganization of stereociliary bundles, resulting in progressive hearing loss. rAAV2/1-iCre;Exoc5^f/f mice exhibited abnormal neurite morphology, followed by apoptotic degeneration of spiral ganglion neurons (SGNs) and hair cells, which led to profound and early-onset hearing loss. These results demonstrate that Exoc5 is essential for the normal development and survival of cochlear hair cells and SGNs, as well as the functional maintenance of hearing.

Ototoxicity: The Radical Drum Beat and Rhythm of Cochlear Hair Cell Life and Death

The function and structure of the auditory information processing system establishes a unique sensory environment for the "perfect storm." The battle between life and death pits the cascade of an apoptotic storm, programmed cell death cascades, against simple cell death (necrosis) pathways. Live or die, the free radical biology of oxygen and hydroxylation, and the destruction of transition metal migration through the mechanical gate sensory processes of the hair cell lead to direct access to the cytoplasm, cytoplasmic reticulum, and mitochondria of the inner workings of the hair cells. These lead to subsequent interactions with nuclear DNA resulting in permanent hearing loss. The yin and yang of pharmaceutical product development is to document what kills, why it kills, and how do we mitigate it. This review highlights the processes of cell death within the cochlea.

Aminoglycoside-Induced Cochleotoxicity: A Review

Aminoglycoside antibiotics are used as prophylaxis, or urgent treatment, for many life-threatening bacterial infections, including tuberculosis, sepsis, respiratory infections in cystic fibrosis, complex urinary tract infections and endocarditis. Although aminoglycosides are clinically-essential antibiotics, the mechanisms underlying their selective toxicity to the kidney and inner ear continue to be unraveled despite more than 70 years of investigation. The following mechanisms each contribute to aminoglycoside-induced toxicity after systemic administration: (1) drug trafficking across endothelial and epithelial barrier layers; (2) sensory cell uptake of these drugs; and (3) disruption of intracellular physiological pathways. Specific factors can increase the risk of drug-induced toxicity, including sustained exposure to higher levels of ambient sound, and selected therapeutic agents such as loop diuretics and glycopeptides. Serious bacterial infections (requiring life-saving aminoglycoside treatment) induce systemic inflammatory responses that also potentiate the degree of ototoxicity and permanent hearing loss. We discuss prospective clinical strategies to protect auditory and vestibular function from aminoglycoside ototoxicity, including reduced cochlear or sensory cell uptake of aminoglycosides, and otoprotection by ameliorating intracellular cytotoxicity.

Increased risk of tinnitus in patients with chronic kidney disease: A nationwide, population-based cohort study

Tinnitus mostly results from central and peripheral auditory pathology. Chronic kidney disease (CKD) is a major risk factor for cerebrovascular disease. However, no studies have evaluated the association between tinnitus and CKD. The aim of this study is to investigate the risk of tinnitus in patients with CKD. This retrospective cohort study was conducted using Taiwan National Health Insurance Research Database from 2000 to 2010. We established a CKD group (n = 185,430) and a non-CKD comparison group (n = 556,290) to investigate the incidence of tinnitus. Cox proportional hazard regression analysis was used to evaluate the effects of CKD on tinnitus risk. The results showed CKD significantly increased the risk of tinnitus (adjusted hazard ratio, 3.02; 95% CI, 2.655-3.456, P<0.001). A subgroup analysis revealed the increase in risk of tinnitus is more in CKD patients with heart failure (adjusted hazard ratio, 9.975; 95% CI, 5.001-18.752) and diabetes mellitus (adjusted hazard ratio, 3.712; 95% CI, 2.856-5.007). Furthermore, compared to non-CKD patients, the risk of tinnitus was increased 4.586-fold (95% CI, 2.399-6.7) in CKD patients with dialysis and 2.461-fold (95% CI, 1.033-3.454) in CKD patients without dialysis. This study is the first to report that CKD is associated with an increased risk of tinnitus. Among CKD cohort, patients with dialysis are at a higher risk of tinnitus than those without dialysis.

Biochemical alteration in children with idiopathic nephrotic syndrome associated with an increased risk of sensorineural hearing loss; additional insights in cochlear renal relationship

OBJECTIVES

Children with Idiopathic Nephrotic Syndrome (INS) are at risk of hearing loss due to the adverse impact of medications and related immunological and genetic factors on both cochlea and kidney. So this work was planned to evaluate hearing status in children with INS and to clarify the possible associated risk factors by interpreting the clinical and laboratory profiles of those children.

METHODS

Ninety children with INS aged 5-14 years [30 patients with steroid-sensitive nephrotic syndrome (SSNS), 30 patients with steroid dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS), and 30 patients with steroid-resistant nephrotic syndrome (SRNS)], and 90 age and sex matched normal controls were enrolled into this study. Laboratory measurements of serum calcium, creatinine, cholesterol, blood urea and other relevant investigations were done. Pure tone audiometry was done with the sensory-neural hearing loss (SNHL) diagnosed when the level bone conduction was >20 dB and the difference in air to the bone gap was <15 dB.

RESULTS

40% children with INS had SNHL, mostly of mild degree HL and primarily occurred at the lower frequencies. A highly significant statistical difference between controls and various types of nephrotic syndrome regarding pure tone audiometry measurements at frequencies 250, 500, 1000 Hz, whereas insignificant difference interpreting pure tone audiometry measurements in 2000, 4000 and 8000 Hz.

CONCLUSIONS

Children with different phenotypes of nephrotic syndrome are at risk of sensorineural hearing impairment. The hazards associated with this impairment were higher blood pressure, hypercholesterolemia, hypoalbuminemia, and hypocalcemia.