Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999-2004

Association of herpes simplex virus infection with hearing loss: a cross-sectional study using NHANES data from 2011 to 2012 and 2015 to 2016

OBJECTIVES

To investigate the relationship between herpes simplex virus (HSV) and hearing loss using comprehensive population-based research.

DESIGN

This cross-sectional study utilised data from the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between HSV (types 1 and 2) and hearing loss. The final sample comprised 4608 participants aged 20-49 years. Weighted multivariate regression, subgroup and sensitivity analyses were employed for statistical evaluations.

SETTING

Utilising the NHANES data, this cross-sectional study provides insights into the American population aged 20-49 years.

PARTICIPANTS

The study includes 4608 participants from the NHANES 2011-2012 and 2015-2016 cycles, focusing on those with complete data on HSV infection and hearing assessment.

INTERVENTIONS EXPOSURE

The study analyses the association between HSV (types 1 and 2) infection and hearing loss, using weighted multivariate regression for statistical evaluations.

RESULTS

We observed an association between HSV-1 infection and an increased likelihood of hearing impairment (OR, 1.4 (95% CI 1.1 to 1.9)). A similar association was noted for those coinfected with HSV-1 and HSV-2 (OR, 1.6 (95% CI 1.1 to 2.3)). Similarly, higher grades of hearing loss and elevated pure-tone averages were more prevalent in these groups. Notably, the association between HSV-1 and hearing impairment was more pronounced in individuals aged 20-34 (OR, 2.1 (95% CI 1.4 to 3.3); P for interaction=0.020) and those with a body mass index (BMI) below 30 (OR, 1.8 (95% CI 1.1 to 2.8); P for interaction=0.028).

CONCLUSIONS

Our findings suggest an association between HSV-1 infection or coinfections with HSV-1 and HSV-2 and the presence of hearing impairment. The association appears particularly pronounced among younger individuals and those with a lower BMI. Further prospective research is needed to explore the causal impact of HSV on auditory function.

Association between blood volatile organic aromatic compound concentrations and hearing loss in US adults

OBJECTIVE

Benzene, ethylbenzene, meta/para-xylene, and ortho-xylene, collectively referred to as benzene, ethylbenzene, and xylene (BEX), constitute the main components of volatile organic aromatic compounds (VOACs) and can have adverse effects on human health. The relationship between exposure to BEX and hearing loss (HL) in the adult U.S. population was aimed to be assessed.

METHODS

Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) for the years 2003-2004, 2011-2012, and 2015-2016 were analyzed. This dataset included complete demographic characteristics, pure-tone audiometry measurements, and volatile organic compound detection data from the NHANES database. A weighted multivariate logistic regression model was employed to investigate the associations between blood BEX concentrations HL, low-frequency hearing loss (SFHL), and high-frequency hearing loss (HFHL).

RESULTS

2174 participants were included, with weighted prevalence rates of HL, SFHL, and HFHL being 46.81%, 25.23%, and 45.86%, respectively. Exposure to benzene, ethylbenzene, meta/para-xylene, and ortho-xylene, and cumulative BEX concentrations increased the risk of hearing loss (odds ratios [ORs] were 1.36, 1.22, 1.42, 1.23, and 1.31, respectively; all P < 0.05). In the analysis with SFHL as the outcome, ethylbenzene, m-/p-xylene, o-xylene, benzene, and overall BEX increased the risk (OR 1.26, 1.21, 1.28, 1.20, and 1.25, respectively; all P < 0.05). For HFHL, exposure to ethylbenzene, m-/p-xylene, o-xylene, benzene, and overall BEX increased the risk (OR 1.36, 1.22, 1.42, 1.22, and 1.31, respectively; all P < 0.05).

CONCLUSION

Our study indicated that a positive correlation between individual or cumulative exposure to benzene, ethylbenzene, meta/para-xylene, and ortho-xylene and the risk of HL, SFHL, and HFHL. Further research is imperative to acquire a more comprehensive understanding of the mechanisms by which organic compounds, notably BEX, in causing hearing loss and to validate these findings in longitudinal environmental studies.

Col1a1 mediates the focal adhesion pathway affecting hearing in miR-29a mouse model by RNA-seq analysis

Age-related hearing loss (ARHL) is a common neurodegenerative disease. Its molecular mechanisms have not been fully elucidated. In the present study, we obtained differential mRNA expression in the cochlea of 2-month-old miR-29a+/+ mice and miR-29a-/- mice by RNA-seq. Gene ontology (GO) analysis was used to identify molecular functions associated with hearing in miR-29a-/- mice, including being actin binding (GO: 0003779) and immune processes. We focused on the intersection of differential genes, miR-29a target genes and the sensory perception of sound (GO:0007605) genes, with six mRNA at this intersection, and we selected Col1a1 as our target gene. We validated Col1a1 as the direct target of miR-29a by molecular and cellular experiments. Total 6 pathways involved in Col1a1 were identified by through Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. We selected the focal adhesion pathway as our target pathway based. Their expression levels in miR-29a-/- mice were verified by qRT-PCR and Western blot. Compared with miR-29a+/+ mice, the expression levels of Col1a1, Itga4, Itga2, Itgb3, Itgb7, Pik3r3 and Ptk2 were different in miR-29a-/- mice. Immunofluorescence was used to locate genes in the cochlea. Col1a1, Itga4 and Itgb3 were differentially expressed in the basilar membranes and stria vascularis and spiral ganglion neurons compared to miR-29a+/+ mice. Pik3r3 and Ptk2 were differentially expressed in the basilar membranes and stria vascularis, but not at the s spiral ganglion neurons compared to miR-29a+/+ mice. Our results show that when miR-29a is knocked out, the Col1a1 mediates the focal adhesion pathway may affect the hearing of miR-29a-/- mice. These findings may provide a new direction for effective treatment of age-related hearing loss.

The Impact of Diabetes Mellitus on Sensorineural Hearing Loss: A Cross-Sectional Study in Eastern India

Objective Hearing loss as a comorbidity of type 2 diabetes mellitus (type 2 DM) is frequently overlooked by patients and healthcare professionals because of a lack of awareness. This cross-sectional study aims to investigate the impact of DM on sensorineural hearing loss (SNHL) in the population of Eastern India. The primary objectives are to assess the prevalence and severity of SNHL among individuals with DM, explore demographic and clinical factors associated with hearing impairment, and contribute valuable insights to the understanding of this relationship in a specific regional context. Methods An institutional-based cross-sectional study was conducted on 198 patients with type 2 DM. Of these, 46 patients were excluded based on exclusion criteria. All patients underwent detailed demographic and clinical assessments, including glycemic control, DM duration, and associated complications. Pure tone audiometry was used to evaluate hearing thresholds. Otoacoustic emission testing was performed to assess cochlear dysfunction. Results A high prevalence of SNHL (70.4%) was observed among the 152 participants meeting the inclusion criteria. Females exhibited a higher prevalence than males, and most participants experienced mild SNHL. Rural residence, lower socioeconomic status, and poor glycemic control were associated with increased SNHL. Significant associations were found between hearing loss severity and DM duration, glycosylated hemoglobin (HbA1c) levels, and complications. Among complications, a strong association was noted with diabetic neuropathy. No significant association was observed with the presence or absence of otoacoustic-emission. Conclusion This study reveals a substantial impact of DM on SNHL in Eastern India, emphasizing the importance of routine hearing assessments in diabetic populations. The findings contribute to regional understanding and have implications for targeted healthcare interventions and preventive strategies.

4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Diabetes mellitus and hearing loss

Diabetes mellitus (DM) is a major disease threatening human health and its incidence is increasing year on year. As a chronic complication of DM, hearing loss mostly occurs undetectably. However, the mechanism of this diabetes-related hearing loss (DRHL) remains unclear and there is no effective clinical treatment. Studies of animal or human pathology show that DM causes damage to the blood vessels, spiral ganglion neurons, afferent nerve fibers, the organ of Corti, and the stria vascularis of the inner ear. In recent years, more advances in pathological research have revealed the possible mechanism of DRHL. In addition, a large number of clinical studies suggest that the duration and severity of DM are closely related to the incidence and severity of DRHL. This review focuses on the relationship between DM and hearing loss. The clinical audiological characteristics of diabetic patients, risk factors for DRHL, typical pathology, and potential interventions of DRHL are summarized. This will help reveal the pathogenesis and intervention approaches for DRHL.

MiR-29a-deficiency causes thickening of the basilar membrane and age-related hearing loss by upregulating collagen IV and laminin

Age-related hearing loss (ARHL) is the most common sensory degenerative disease and can significantly impact the quality of life in elderly people. A previous study using GeneChip miRNA microarray assays showed that the expression of miR-29a changes with age, however, its role in hearing loss is still unclear. In this study, we characterized the cochlear phenotype of miR-29a knockout (miR-29a^-/-) mice and found that miR-29a-deficient mice had a rapid progressive elevation of the hearing threshold from 2 to 5 months of age compared with littermate controls as measured by the auditory brainstem response. Stereocilia degeneration, hair cell loss and abnormal stria vascularis (SV) were observed in miR-29a^-/- mice at 4 months of age. Transcriptome sequencing results showed elevated extracellular matrix (ECM) gene expression in miR-29a^-/- mice. Both Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis revealed that the key differences were closely related to ECM. Further examination with a transmission electron microscope showed thickening of the basilar membrane in the cochlea of miR-29a^-/- mice. Five Col4a genes (Col4a1-a5) and two laminin genes (Lamb2 and Lamc1) were validated as miR-29a direct targets by dual luciferase assays and miR-29a inhibition assays with a miR-29a inhibitor. Consistent with the target gene validation results, the expression of these genes was significantly increased in the cochlea of miR-29a^-/- mice, as shown by RT-PCR and Western blot. These findings suggest that miR-29a plays an important role in maintaining cochlear structure and function by regulating the expression of collagen and laminin and that the disturbance of its expression could be a cause of progressive hearing loss.

Peripheral Neuropathy and Vision and Hearing Impairment in US Adults With and Without Diabetes

We aimed to assess the associations of peripheral neuropathy (PN) with vision and hearing impairment among adults aged ≥40 years who attended the lower-extremity disease exam for the National Health and Nutrition Examination Survey (United States, 1999-2004). Overall, 11.8% (standard error (SE), 0.5) of adults had diabetes, 13.2% (SE, 0.5) had PN (26.6% (SE, 1.4) with diabetes, 11.4% (SE, 0.5) without diabetes), 1.6% (SE, 0.1) had vision impairment, and 15.4% (SE, 1.1) had hearing impairment. The prevalence of vision impairment was 3.89% (95% CI: 2.99, 5.05) among adults with PN and 1.29% (95% CI: 1.04, 1.60) among adults without PN (P < 0.001). After adjustment, PN was associated with vision impairment overall (odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.03, 2.13) and among adults without diabetes (OR = 1.80, 95% CI: 1.17, 2.77) but not among adults with diabetes (P for interaction = 0.018). The prevalence of hearing impairment was 26.5% (95% CI: 20.4, 33.7) among adults with PN and 14.2% (95% CI: 12.4, 16.3) among adults without PN (P < 0.001). The association of PN with moderate/severe hearing impairment was significant overall (OR = 2.55, 95% CI: 1.40, 4.64) and among adults without diabetes (OR = 3.26, 95% CI: 1.80, 5.91). Overall, these findings suggest an association between peripheral and audiovisual sensory impairment that is unrelated to diabetes.

Modifiable Risk Factors for Dementia Among Migrants, Refugees and Asylum Seekers in Australia: A Systematic Review

While the prevalence of non-communicable disease risk factors is understood to be higher among migrants than for people born in host nations, little is known about the dementia risk profile of migrants, refugees and asylum seekers. This systematic review examines published literature to understand what is currently reported about 12 identified modifiable risk factors for dementia among migrants, refugees, and asylum seekers residing in Australia. Three literature databases (PubMed/CINAHL/MEDLINE) were systematically searched to find articles reporting excessive alcohol consumption, traumatic brain injury, air pollution, lack of education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and limited social contact in Australia's migrant, refugee and asylum seeker population samples. Papers were systematically reviewed following PRISMA guidelines. A total of 763 studies were found, of which 676 articles were excluded, and 79 articles remained. Despite wide variability in study design, size and purpose, the prevalence and correlates of modifiable risk factors of dementia appears markedly different among the studied samples. Compared with Australian-born participants, migrant samples had a higher prevalence of depression, social isolation, physical inactivity and diabetes mellitus. Insufficient information or conflicting evidence prevented inference about prevalence and correlates for the remaining dementia risk factors. A better understanding of the prevalence and correlates of modifiable dementia risk factors is needed in Australia's migrant, refugee and asylum seeker populations. This information, together with a deeper understanding of the contextual and cultural contributing factors affecting people who arrive in Australia through differing pathways is needed before preventive interventions can be realistically targeted and sensitively implemented.

Age-related hearing loss was accelerated by apoptosis of spiral ganglion and stria vascularis cells in ApoE KO mice with hyperglycemia and hyperlipidemia

Age-related hearing loss (ARHL) is associated with diabetes and/or dyslipidemia in humans. However, the detailed mechanism for the development of ARHL by diabetes and/or dyslipidemia has not been elucidated. In this study, we investigated the etiology of ARHL in apolipoprotein E (ApoE)-deficient mice with diabetes and dyslipidemia. The atherosclerotic CD-STZ (mice fed with a control diet and received an STZ injection), WD-con (mice fed with a western diet), and WD-STZ (mice fed with a western diet and received an STZ injection) mice showed a 2.4-, 4.9-, and 6.8-fold larger area, respectively, occupied by lesions throughout the aorta compared with the CD-con mice. A significantly larger area under the curve (AUC) was observed in the STZ-treated groups than in the non-treated groups based on the oral glucose tolerance test (OGTT). At 20 weeks of age, HbA_1c levels were significantly higher in the CD-STZ and WD-STZ mice than in the CD-con and WD-con mice. In all the groups, the auditory brainstem response (ABR) thresholds of the 16-week-old mice were significantly higher compared with those of the 8-week-old mice. In particular, in the WD-STZ mice, the ABR thresholds of the left and right ears reached the maximum decibel peak equivalent sound pressure levels (130 dBpeSPL), which is a sign of deafness. The apoptotic spiral ganglion neurons (SGNs) of the WD-STZ mice were significantly increased compared with those of the other three groups, indicating that SGN apoptosis resulted in hearing loss in STZ-induced diabetic ApoE KO mice fed with a WD. A significant loss of the stria vascularis cells was observed in the WD-STZ group compared with the CD-con mice. In the organ of Corti, few apoptotic hair cells were found in all the groups; however, no significant difference was observed. Therefore, we consider that the reduced hearing ability in the STZ-treated and WD-fed groups was attributed to the damage to the SGN and stria vascularis in the cochlea. Thus, our results indicated that ototoxicity by diabetes and/or dyslipidemia accelerated ARHL in ApoE KO mice, thereby suggesting the importance of appropriate treatment of patients with diabetes and/or dyslipidemia to prevent ARHL.

Hearing Loss and Cardiovascular Disease Risk Profiles: Data from the Hispanic Community Health Study/Study of Latinos

BACKGROUND

 Individual cardiovascular disease (CVD) risk factors (RFs) have been associated with hearing loss (HL). The relationship to aggregate risk is poorly understood and has not been explored in the Hispanic/Latino population.

PURPOSE

 The aim of this study was to characterize the association between aggregate CVD RF burden and hearing among Hispanics/Latinos.

RESEARCH DESIGN

 Cross-sectional examination.

STUDY SAMPLE

 Participants (18-74 years; n = 12,766) in the Hispanic Community Health Study/Study of Latinos.

DATA COLLECTION AND ANALYSIS

 Thresholds (0.5-8 kHz) were obtained, and HL was defined dichotomously as pure-tone average (PTA0.5,1, 2,4) > 25 dB HL. Optimal CVD risk burden was defined as follows: systolic blood pressure (SBP) < 120 mm Hg and diastolic blood pressure (DBP) < 80 mm Hg; total cholesterol < 180 mg/dL; nonsmoking; and no diabetes. Major CVD RFs were diabetes, currently smoking, SBP >160 or DBP > 100 mm Hg (or antihypertensives), and total cholesterol > 240 mg/dL (or statins). Thresholds were estimated by age (18-44 and ≥45 years) and sex using linear regression. The association between CVD risk burden and HL was assessed using multivariable logistic regression. Models were adjusted for age, sex, Hispanic/Latino background, center, education, income, alcohol use, body mass index, and noise exposure.

RESULTS

 In the target population, 53.03% were female and 18.81% and 8.52% had all RFs optimal and ≥2 major RFs, respectively. Elevated BP (SBP 120-139 mm Hg or DBP 80-89 mm Hg) was associated with HL in females < 45 years (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.14-4.16). Diabetes (OR, 1.37; 95% CI, 1.01-1.84) and tobacco smoking (OR, 1.44; 95% CI, 1.03-2.01) were associated with HL in females ≥ 45 years. The odds of HL were higher for females ≥ 45 years with ≥2 RFs versus those with all RFs optimal (OR, 1.99; 95% CI, 1.12-3.53). Elevated BP (SBP 140-159 mm Hg or DBP 90-99 mm Hg), but not aggregate risk burden, was associated with HL in males ≥ 45 years (OR, 1.49; 95% CI, 1.02-2.19). No relationships with major CVD RFs were significant in males < 45 years.

CONCLUSIONS

 HL is associated with elevated BP in females < 45 years, with diabetes and hypertension in males ≥ 45 years, and with diabetes, smoking, and having ≥2 major CVD RFs in females ≥ 45 years. Future studies are needed to examine if these factors are associated with incident HL.

Hearing Screening Age Considerations for Adults: National Health and Nutrition Examination Survey

BACKGROUND

The United States Preventative Service Taskforce recently determined that there was insufficient evidence to recommend hearing screening in adults.

PURPOSE

To determine the age to screen adults in the U.S. for hearing loss and identify factors related to increased odds of hearing loss.

RESEARCH DESIGN

Epidemiological Cross-Sectional Study.

STUDY SAMPLE

Data from 3,409 individuals aged 20-69 years(y) were analyzed from the 1999-2000 and 2000-2002 cycles of the National Health and Nutrition Examination Survey (NHANES).

DATA COLLECTION AND ANALYSIS

Hearing sensitivity from 0.5-8 kHz was assessed and hearing loss was defined as pure tone average 0.5, 1, 2, 4 kHz (PTA4) > 15 dBHL for the worse ear. Thresholds were examined separately for men and women in 2-year intervals. A multivariate ordinal regression model adjusting for age, sex, race/ethnicity, and education was used to examine relationship to determinants.

RESULTS

Slight (>15 dBHL) hearing loss based on threshold at a single audiometric frequency was first evident in males aged 28-29y. For females, this occurred at age 34-35y. The age at which average PTA4 increased above 15 dBHL (slight hearing loss) was 46-47y for males and 56-57y for females. Multivariate ordinal regression revealed the following "high risk" factors: increased age, male sex, tinnitus, perceived hearing loss, and diabetes.

CONCLUSIONS

For the function of primary prevention, these data suggest screening should initiate at ∼30y for males and 35y for females, the ages when average hearing thresholds at a single frequency can be classified as slight hearing loss. For secondary prevention, the recommended screening ages are higher - 45y for males and 55y for females. Hearing screening is recommended for asymptomatic adults, especially those with high risk factors. Our results also highlight the limitations of PTA4 in identifying early indices of hearing loss.

4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2022

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Healthcare system performance and socioeconomic inequalities in hearing and visual impairments in 17 European countries

BACKGROUND

Socioeconomic status is associated with health status among older adults, including hearing and vision impairments, and healthcare system performance is an important consideration in examining that association. We explored the link between a country's healthcare system performance and the hearing and visual impairments of its people in Europe.

METHODS

This study enrolled 65 332 individuals aged 50+ from 17 countries participating in the Survey of Health, Ageing and Retirement in Europe Wave 6. We used latent class analysis to identify groups of countries based on six domains of healthcare system performance. We then performed multiple logistic regressions to quantify the association between socioeconomic status and hearing and visual impairments adjusted for demographic and other co-variates; finally, we compared the patterns of observed associations in each of the country groups.

RESULTS

The latent class analysis separated countries into three groups based on the performance of their healthcare systems: poor, moderate and high. Respondents in countries with moderate and poor healthcare performance were more likely to experience hearing and visual impairment than those in countries with high healthcare performance. With respect to hearing and visual impairments, wealth gradients at the individual level varied among countries in different healthcare performance groups, with less wealth associated with worse hearing and seeing only in the countries with moderate and poor healthcare performance.

CONCLUSION

The relationships between wealth and hearing and visual impairments differ among countries with different healthcare performance.

4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2021

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Classification of Tinnitus: Multiple Causes with the Same Name

Tinnitus is spoken of as if it were a single thing, but there are many different causes, likely many different mechanisms, and many different subtypes. This article reviews a broad range of approaches to understand and demarcate different tinnitus subtypes, which will be critical for exploring and finding cures for different subtypes.

Low-grade albuminuria is associated with hearing loss in non-diabetic US males: A cross-sectional analysis of 1999-2004 national health and nutrition examination survey

High levels of albuminuria have been demonstrated to associate with hearing loss in non-diabetic people, while the clinical impact of low-grade albuminuria has attracted less attention. This cross-sectional population-based study aimed to examine whether hearing loss in non-diabetic United States (US) adults is independently associated with low-grade albuminuria or reduced estimated glomeruli filtration rate (eGFR).A total of 2518 participants aged 20 to 69 years were selected from the US National Health and Nutritional Examination Survey database. Participants with diabetes or high-grade albuminuria were excluded. Hearing loss was assessed using low-frequency pure-tone average (LFPTA) thresholds (0.5, 1.0, 2.0 kHz) and high-frequency pure-tone average (HFPTA) thresholds (3.0, 4.0, 6.0, 8.0 kHz). Logistic and linear regression analyses were used to evaluate associations between renal function indicators and hearing loss.The median age of included participants was 37.4 years, and 55% of them were female. Multivariate analysis revealed that participants with urinary albumin-to-creatinine ratio (UACR) in the highest tertile had a significantly higher risk of hearing loss (OR, 1.79; 95% CI, 1.01-3.19) and higher HFPTA thresholds (β: 2.23; SE: 0.77). Participants with eGFR <60 mL/min/1.73 m had higher LFPTA thresholds (β: 4.31; SE: 1.79). After stratification by sex, a significant risk remained only for males in the highest UACR tertile, with 2.18 times the risk of hearing loss (95% CI, 1.06-4.48).Non-diabetic US males with low-grade albuminuria are at increased risk of hearing loss, independent of eGFR.

4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2020

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Epidemiology of Diabetes and Hearing Loss

Hearing loss is a highly prevalent chronic condition. In addition to age, sex, noise exposure, and genetic predisposition, cardiovascular disease and its antecedents may precipitate hearing loss. Of emerging interest is the connection between diabetes and auditory dysfunction. Cross-sectional studies consistently suggest that prevalence of hearing loss is higher in persons with diabetes compared with those without diabetes, especially among younger persons. Furthermore, longitudinal studies have demonstrated higher incidence of hearing loss in persons with diabetes compared to those without diabetes. These findings seem to hold for both type 1 and type 2 diabetes, although considerably more population-based evidence is available for type 2 diabetes. Data on gestational diabetes and hearing outcomes are limited, as are data relating diabetes to otologic sequelae such as fungal infection. Here, we examine evidence from epidemiologic studies of diabetes and hearing loss and consider clinical and laboratory data where population-based data are lacking.

Evaluation and Management of Patients with Diabetes and Hearing Loss

Diabetes mellitus is a significant risk factor for acquired hearing loss and tinnitus. Persons with diabetes (PWD) may present with hearing loss symptoms earlier in life than those without diabetes. Furthermore, diabetes may exacerbate risk for hearing loss related to noise exposure and ototoxic drugs. The purpose of this article is to provide recommendations for the prevention, screening, evaluation, and management of hearing loss in PWD.

RISK FACTORS FOR HEARING IMPAIRMENT IN TYPE 1 DIABETES

Objective: Studies have demonstrated that glycated hemoglobin (HbA1c) is a significant predictor of hearing impairment in type 1 diabetes. We identified additional factors associated with hearing impairment in participants with type 1 diabetes from the Diabetes Control and Complications Trial and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods: A total of 1,150 DCCT/EDIC participants were recruited for the Hearing Study. A medical history, physical measurements, and a self-administered hearing questionnaire were obtained. Audiometry was performed by study-certified personnel and assessed centrally. Logistic regression models assessed the association of risk factors and comorbidities with speech- and high-frequency hearing impairment. Results: Mean age was 55 ± 7 years, duration of diabetes 34 ± 5 years, and DCCT/EDIC HbA1c 7.9 ± 0.9% (63 mmol/mol). In multivariable models, higher odds of speech-frequency impairment were significantly associated with older age, higher HbA1c, history of noise exposure, male sex, and higher triglycerides. Higher odds of high-frequency impairment were associated with older age, male sex, history of noise exposure, higher skin intrinsic florescence (SIF) as a marker of tissue glycation, higher HbA1c, nonprofessional/nontechnical occupations, sedentary activity, and lower low-density-lipoprotein cholesterol. Among participants who previously completed computed tomography and carotid ultrasonography, coronary artery calcification (CAC) >0 and carotid intima-medial thickness were significantly associated with high-but not speech-frequency impairment. Conclusion: Consistent with previous reports, male sex, age, several metabolic factors, and noise exposure are independently associated with hearing impairment. The association with SIF further emphasizes the importance of glycemia-as a modifiable risk factor-over time. In addition, the macrovascular contribution of CAC is novel and important. Abbreviations: AER = albumin excretion rate; CAC = coronary artery calcification; CVD = cardiovascular disease; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; eGFR = estimated glomerular filtration rate; ETDRS = Early Treatment Diabetic Retinopathy Study; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; IMT = intima-media thickness; LDL = low-density lipoprotein; NHANES = National Health and Nutrition Examination Survey; OR = odds ratio; SIF = skin intrinsic fluorescence; T1D = type 1 diabetes.

Self-reported hearing loss in Russians: the population-based Ural Eye and Medical Study

OBJECTIVE

With data on frequency of hearing loss in Russia and Eastern Europe generally lacking, we assessed the prevalence of hearing loss in a Russian population.

SETTING

The population-based Ural Eye and Medical Study was conducted in the rural and urban regions of Bashkortostan, Russia.

PARTICIPANTS

With an inclusion criterion of age 40+ years, the study included 5899 (80.5%) out of 7328 eligible individuals (mean age: 59.0±10.7 years; range: 40-94 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

Hearing loss was examined in 5397 (91.5%) study participants, assessed using a standardised interview with questions from the 'Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S)'.

RESULTS

The prevalence of self-reported hearing loss (26.1%, 95% CI 24.2 to 27.2) increased from 10.9% (95% CI 8.0 to 13.7) in participants aged 40-45 years old to 59.0% (95% CI 51.6 to 66.4) in those aged 80+ years old. It was higher for men than for women in the 60-80 years age group (38.93%, 95% CI 35.8 to 42.1, vs 32.8%, 95% CI 30.2 to 35.3; p=0.003). On multivariable analysis, higher prevalence of hearing loss was associated with older age (p<0.001; OR [per year of age]: 1.06 [1.06 to 1.07]), male gender (p<0.001; OR: 1.26 [1.09 to 1.47]), higher depression score (p<0.001; OR: 1.06 [1.04 to 1.08]), higher prevalence of headache (p=0.001; OR: 1.27 [1.10 to 1.47]), history of cardiovascular diseases including stroke (p=0.001; OR: 1.32 [1.13 to 1.55]), and osteoarthritis (p<0.001; OR: 1.40 [1.18 to 1.67]), physically vigorous activity during work (p<0.001; OR: 1.40 [1.21 to 1.62]), alcohol consumption (p<0.001; OR: 1.51 [1.28 to 1.78]), and dry eye feeling (p<0.001; OR: 1.67 [1.30 to 2.16]). It was marginally correlated with a higher anxiety score (p=0.07; OR: 1.03 [0.998 to 1.06]). It was independent of diabetes (p=0.52), arterial hypertension (p=0.20), level of education (p=0.11), region of habitation (p=0.70), blood concentration of high-density lipoproteins (p=0.17) and low-density lipoproteins (p=0.52), current smoking (p=0.95) and smoking pack-years (p=0.37), and best corrected visual acuity (p=0.93).

CONCLUSIONS

As in other countries the prevalence of hearing loss is high in this elderly population in Russia. It is primarily or secondarily associated with older age, depression, male gender, cardiovascular disease and alcohol consumption.

Diabetes in the practice of otolaryngology

Diabetes mellitus is the most common endocrine disease, characterized by chronic hyperglycemia. The hyperglycemic milieu leads to endothelial injury in blood vessels of variant size, which results in microangiopathy and macroangiopathy (atherosclerosis). Consequential ischemia of nerves and hyperglycemia by itself lead to nerve degeneration and generalized neuropathy, affecting most often the sensory peripheral nerves and the autonomic nervous system. Auditory, vestibular and olfactory sensorium may be compromised by DM. People with DM have an increased susceptibility to infection, as a result of neutrophil dysfunction and impaired humoral immunity. Therefore DM predisposes to certain infectious diseases, such as fungal sinusitis or malignant otitis externa, which are rare in general population. Recovery from infections or from injuries may be compromised by coexisting DM. In this review we discuss complications of DM in the head and neck region. Otolaryngologists and general practitioners should be alert to specific conditions related to DM and be minded of the relevant complications and consequences.

Evaluation of health utility values for diabetic complications, treatment regimens, glycemic control and other subjective symptoms in diabetic patients using the EQ-5D-5L

AIMS

This study aimed to reveal health utility values for diabetic complications and treatment regimens with adjustment for glycemic control and other clinical manifestations in a diabetic population.

METHODS

The EuroQol 5-Dimension 5-Level (EQ-5D-5L) health utility values for 4963 Japanese diabetic patients were analyzed using a multivariate regression model including major complications and treatment regiments (minimally adjusted model), and that additionally included glycemic control and other subjective symptoms (musculoskeletal, dental, respiratory, gastrointestinal, urinary, and cutaneous symptoms, and hearing impairment) (further adjusted model).

RESULTS

The mean utility value was 0.901 ± 0.137. In the minimally adjusted model, blindness, overt nephropathy, regular dialysis, cardiac symptom, sequelae of stroke, symptomatic peripheral neuropathy, decreased sensation, claudication, foot ulcer/gangrene, major amputation, and complex treatment regimens were significantly associated with lower utility values, whereas proliferative retinopathy without blindness, coronary artery disease without cardiac symptom, sequela-free cerebrovascular disease, asymptomatic peripheral artery disease, and minor amputation were not. Major complications and treatment regimens that showed significant association in the minimally adjusted model still presented significant impact on the utility decrement in the further adjusted model. However, most of their regression coefficients were lower in absolute value compared to those in the minimally adjusted model.

CONCLUSIONS

The utility decrement related to each diabetic complication varied with its severity and accompanying symptoms. Complex treatment regimens were independently associated with lower utility values. The utility decrement associated with diabetic complication and complex treatment regimens would be overestimated in the analysis without adjustment for glycemic control or other subjective symptoms.

Health related outcomes among people with type 2 diabetes by country of birth: Result from the 45 and Up Study

BACKGROUND

Ethnic variation in the occurrence of type 2 diabetes, complications, mortality, and health behaviours has been reported. The current research examined patterns of health-related outcomes by country of birth in people with diabetes aged 45years and over in New South Wales, Australia.

METHODS

This study was based on the baseline data of 266,848 participants aged 45years and over from "The Sax Institute's 45 and Up Study" (2006-2009), NSW; Australia's most populous state. Health-related factors including self-rated overall health, Quality of Life (QoL), eyesight, subjective memory complaint, hearing loss, psychological distress and functional limitation were examined according to country of birth among 23,112 people with type 2 diabetes. Logistic regression modelling was used to compare the odds of poor outcomes between Australian-born and overseas-born participants, adjusting for potential confounding and mediating variables. Both age-sex and fully adjusted odds ratios (aORs) are reported.

RESULTS

Nearly half of the people with diabetes in the sample reported hearing loss and high levels of functional limitations, a third reported poor overall health. Compared to people with diabetes born in Australia, people born in South East Europe, North Africa, the Middle East had significantly greater odds of poor outcomes across the majority of examined health-related factors, with the largest odds observed in the elevated level of psychological distress outcome (aOR=3.4 in North African and the Middle East group). Higher aORs of poor overall health, QoL, memory problems and poor eyesight, and lower aORs for hearing loss, were also found among those born in the Asian countries.

CONCLUSIONS

The results demonstrated significant ethnic disparity in the prevalence of health-related outcomes. These findings provide important context for the formulation of culturally sensitive secondary prevention strategies.

Auditory Late Latency Response in Individuals with Type 2 Diabetes Mellitus

OBJECTIVES

The study was done to compare Auditory late latency response (ALLR) in normal-hearing individuals without diabetes mellitus and normal-hearing individuals with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

A total of 50 participants within the age range of 40-60 years were enrolled in the study based on the inclusion and exclusion criteria. They were divided into two groups with one group consisting of 25 individuals with T2DM and the other group consisted of 25 individuals without diabetes as the control group.

RESULTS

The results revealed prolonged latencies and reduced amplitude of P1, N1 and P2 wave among individuals with T2DM compared to control group. There was a significant positive correlation observed for ALLR latency and duration of T2DM, and a negative correlation observed for ALLR amplitude and duration of T2DM.

CONCLUSION

The present study concluded that there is a problem in the encoding of speech at the cortical level despite normal hearing in individuals with type 2 diabetes mellitus.

Haemoglobin A1c and hearing impairment: longitudinal analysis using a large occupational health check-up data of Japan

OBJECTIVES

The aim of this study was to determine whether haemoglobin A1c (HbA1c) level is associated with the incidence of hearing impairment accounting for smoking status and diabetic condition at baseline.

METHODS

Participants were 131 689 men and 71 286 women aged 30-65 years and free of hearing impairment at baseline (2008) who attended Japanese occupational annual health check-ups from 2008 to 2015. We defined low-frequency hearing impairment at a hearing threshold >30 dB at 1 kHz and high frequency at >40 dB at 4 kHz in the better ear in pure-tone audiometric tests. HbA1c was categorised into seven categories. The association between HbA1c and hearing impairment was assessed using the Cox proportional hazards model.

RESULTS

On 5 years mean follow-up, high HbA1c was associated with high-frequency hearing impairment. In non-smokers, HbA1c≥8.0% was associated with high-frequency hearing impairment, with a multivariable HR (95% CI) compared with HbA1c 5.0%-5.4% of 1.46 (1.10 to 1.94) in men and 2.15 (1.13 to 4.10) in women. There was no significant association between HbA1c and hearing impairment in smokers. A J-shaped association between HbA1c and high-frequency hearing impairment was observed for participants with diabetes at baseline. HbA1c was not associated with low-frequency hearing impairment among any participants.

CONCLUSIONS

HbA1c ≥8.0% of non-smokers and ≥7.3% of participants with diabetes was associated with high-frequency hearing impairment. These findings indicate that appropriate glycaemic control may prevent diabetic-related hearing impairment.

Manganese in toenails is associated with hearing loss at high frequencies in humans

PURPOSE

Elevated hearing thresholds from high frequencies are known to be one of the hallmarks of age-related hearing loss. Our recent study showed accumulation of manganese (Mn) in inner ears resulting in acceleration of age-related hearing loss in mice orally exposed to Mn. However, there is no evidence showing an association between Mn in non-invasive biological samples and hearing loss in humans evaluated by pure tone audiometry (PTA). In this study, we evaluated Mn in non-invasive biological samples as a possible biomarker for hearing loss in humans.

MATERIALS AND METHODS

We determined hearing levels by PTA and Mn levels in toenails, hair and urine with an inductively coupled plasma mass spectrometer (ICP-MS) in 145 healthy subjects in Bangladesh.

RESULTS

Multivariable analyses showed that Mn levels in toenails, but not in hair and urine samples, were significantly associated with hearing loss at 8 kHz and 12 kHz. Moreover, our experimental study showed a significant correlation between Mn levels in inner ears and nails, but not hair, in mice orally exposed to Mn.

CONCLUSIONS

The results provide novel evidence that Mn in toenails is a possible biomarker for hearing loss at high frequencies in humans.

Hearing Loss in Type 2 Diabetes in Association with Diabetic Neuropathy

BACKGROUND

Reports assessing hearing abnormalities in diabetes are debated. We aimed to evaluated auditory alterations and their possible associations with vascular and neurological dysfunction in 160 Type 2 diabetes mellitus individuals and 100 age and sex-matched healthy controls.

METHODS

Participants underwent pure tone audiometry (PTA). Associations with demographic, metabolic and neuropathic variables were assessed.

RESULTS

Compared with healthy controls, diabetic patients had higher mean hearing thresholds at each frequency, with statistical significance at 2-8 kHz (p <0.05). Prevalence of hearing loss in diabetics was 67.5% (108/160), including high-frequency (72.22%, 78/108), and low/mid- and high-frequency (27.78%, 30/108). The mild hearing loss was predominant in diabetics with high-frequency impairment (52.56%), while the moderate/severe hearing loss was high in individuals with both low-and high-frequency hearing loss (80.00%). Multiple logistic regression analysis of PTA parameters showed that higher Semmes Weinstein Monofilament (OR 1.24, 95% CI 1.02-1.52), Michigan Neuropathy Screening Instrument score (OR 1.38, 95% CI 1.14-1.68), and vibration perception threshold (OR 1.19, 95% CI 1.05-1.34) were independent risk factors for hearing impairment in diabetics after adjusting for potential covariates.

CONCLUSIONS

These findings suggest that hearing loss is common in T2DM subjects, with predominantly high frequency involved. Diabetic neuropathic factors may explain the underlying mechanism of the association between diabetes and hearing loss.

The Association Between Age-Related Hearing Impairment and Metabolic Syndrome in Korean Women: 5-Year Follow-Up Observational Study

BACKGROUND

Although several observational studies showed a relationship between various conditions of metabolic syndrome (MetS) and hearing threshold, there are no studies about longitudinal audiometric results related MetS. The aim of this study was to investigate the association between MetS and age-related hearing impairment (ARHI) through a large, average 5-year longitudinal follow-up, clinical comparative analysis.

MATERIALS AND METHODS

We recruited 1381 women older than 50 years who were enrolled in 2007 and reevaluated in 2012. They had normal or symmetrical sensorineural hearing loss. For the evaluation of the independent impact of MetS on hearing, multivariate analysis was used.

RESULTS

The average follow-up period was 5.0 ± 0.2 years. Subjects with MetS had higher hearing thresholds than subjects without MetS. The loss in high-frequency hearing (≥2000 Hz) progressed more rapidly in women with MetS over a 5-year period.

CONCLUSION

Our analysis using longitudinal and large data revealed that MetS is associated with ARHI in women 50 years and older. High-frequency hearing loss tended to be greater in women with MetS than in those without MetS at the 5-year follow-up. Therefore, older women with MetS should be followed up closely for hearing evaluation.

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.

Epidemiological analysis of the association between hearing and barium in humans

Our previous study experimentally showed barium (Ba)-mediated hearing loss in mice. To our knowledge, however, it remains unknown whether Ba affects hearing in humans. This epidemiological study aimed at investigating ototoxicity of Ba in humans. Associations of Ba levels in hair, toenails and urine with hearing levels (1, 4, 8 and 12 kHz) were analyzed in 145 Bangladeshi subjects. Binary logistic regression analysis with adjustment for age, sex, body mass index (BMI) and smoking showed that Ba levels in hair had significant associations with hearing loss at 8 kHz (OR=4.75; 95% CI: 1.44, 17.68) and 12 kHz (OR=15.48; 95% CI: 4.04, 79.45). Ba levels in toenails were also associated with hearing loss at 8 kHz (OR=3.20; 95% CI: 1.35, 7.85) and 12 kHz (OR=3.63; 95% CI: 1.58, 8.55), whereas there was no correlation between Ba level in urinary samples and hearing. There was a significant correlation between hearing loss and Ba levels in hair and toenails in the model adjusted with arsenic levels as the confounder. In conclusion, this study suggested that Ba levels could be a new risk factor for hearing loss, especially at high frequencies of 8 and 12 kHz, in humans.

Focal and entrapment neuropathies

Of the many patterns of peripheral nerve disorders in diabetes mellitus (DM), isolated clinical involvement of single nerves, though less common than distal symmetric polyneuropathy and perhaps polyradiculoneuropathy, constitute an important collection of characteristic syndromes. These fall into four anatomical regions of the body: cranial, upper limb, truncal, and lower limb territories. Each of these groups of mononeuropathies has its own ensemble of epidemiologic patterns, clinical presentations, laboratory and radiologic findings, differential diagnosis, management principles and prognosis.

Hepatocyte nuclear factor-4 alpha in noise-induced cochlear neuropathy

Noise-induced hearing loss (NIHL) is a problem of profound clinical significance and growing magnitude. Alarmingly, even moderate noise levels, previously assumed to cause only temporary shifts in auditory thresholds ("temporary" NIHL), are now known to cause cochlear synaptopathy and subsequent neuropathy. To uncover molecular mechanisms of this neuropathy, a network analysis of genes reported to have significantly altered expression after temporary threshold shift-inducing noise exposure was performed. The transcription factor Hepatocyte Nuclear Factor-4 alpha (HNF4α), which had not previously been studied in the context of cochlear response to noise, was identified as a hub of a top-ranking network. Hnf4α expression and localization using quantitative RT-PCR and in situ hybridization, respectively, were described in adolescent and adult mice exposed to neuropathic noise levels in adolescence. Isoforms α3 and α12 in the cochlea were also identified. At every age examined, Hnf4α mRNA expression in the cochlear apex was similar to expression in the base. Hnf4α expression was evident in select cochlear cells, including spiral ganglion neurons (SGNs) and hair cells, and was significantly upregulated from 6 to 70 weeks of age, especially in SGNs. This age-related Hnf4α upregulation was inhibited by neuropathic noise exposure in adolescence. Hnf4α silencing with shRNA transfection into auditory neuroblast cells (VOT-33) reduced cell viability, as measured with the MTT assay, suggesting that Hnf4α may be involved in SGN survival. Our results motivate future studies of HNF4α in cochlear pathophysiology, especially because HNF4α mutations and polymorphisms are associated with human diseases that may include hearing loss. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 76: 1374-1386, 2016.

Glomerular Filtration Rate and Urine Albumin to Creatinine Ratio Associated With Hearing Impairment Among Korean Adults With Diabetes: A Nationwide Population-Based Study

The objective of this study was to examine the association of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR) with hearing impairment among diabetic adults in Korea. The study was based on data from Korea National Health and Nutrition Examination Survey 2011 to 2012. Participants were 1206 diabetic adults, aged over 19 years, who completed audiometric testing supervised by nationally certified clinicians. Hearing impairment was defined in three grades: no hearing impairment (pure-tone average 0-25 dB), slight hearing impairment (26-40 dB), and disabling hearing impairment (>40 dB) in the better ear at frequencies 0.5, 1, 2, 3, 4 and 6 kHz. Using logistic regression, risk of hearing impairment was assessed after having controlled for confounding factors. Higher levels of ACR and lower levels of eGFR correlated with an increase in percentage of disabling hearing impairment both unilaterally and bilaterally (P < 0.001). Controlling for possible confounding covariates, odds ratios for hearing impairment showed tendency to increase in higher ACR groups (P for trend = 0.029). Similar pattern was examined between eGFR and hearing impairment (P for trend = 0.006). Odds ratios were 1.981 (1.146, 3.424) for ACR Q4 and 2.773 (1.286, 5.983) for eGFR < 60 mL/min. Fall in eGFR and rise in ACR correlated with severity of hearing impairment. The association existed independently of age, sex, body mass index (BMI), smoking, drinking, exercise, new onset of diabetes, education, income, mental stress, noise exposure, and metabolic syndrome.

Is there a direct correlation between the duration and the treatment of type 2 diabetes mellitus and hearing loss?

AIM

The aim of the study was to determine the impact of the duration of diabetes and the control of glycemia on the auditory function of patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

This prospective study included 80 patients with T2DM (divided depending on when T2DM was diagnosed, and also according to the control of glycemia), and 50 healthy subjects.

RESULTS

The hearing threshold in T2DM patients was statistically significantly higher for 1,000 Hz, 2,000 Hz, 4,000 Hz and 8,000 Hz. Absolute latencies of brainstem auditory evoked potentials (BAEP) revealed significant differences between average absolute latencies for waves I, III and V, as well as inter-wave latencies I‒V and I‒III (p <0.001). A statistically significant difference was noted in the presence of transitory otoacoustic emissions (TEOAE) (p <0.001). In T2DM patients with poor glycemic control, where the glycated hemoglobin (HbA1c) is above 7%, the hearing threshold levels were statistically significantly higher in both ears at 8,000 Hz and at 2,000 Hz in the right ear, and the absolute latency of wave V was prolonged in the right ear. There was no evidence that the duration of diabetes significantly affected the auditory threshold, absolute and inter-wave BAEP latencies.

CONCLUSION

The patients with T2DM displayed an increased hearing threshold, qualitative changes in BAEP and the absence of TEOAE. The duration of poorly-controlled glycemia had a greater effect on the patients' auditory function than the duration of T2DM. Hippokratia 2016, 20(1): 32-37.

Metabolic Syndrome Is not an Independent Risk Factor for Hearing Impairment

OBJECTIVE

We aimed to investigate the association between metabolic syndrome (MS) and hearing impairment (HI) using nationally representative data from Korean adults.

DESIGN, SETTING AND PARTICIPANTS

A total of 16,799 subjects (≥19 years old; 7,170 men and 9,629 women) who underwent pure tone audiometry testing were included in the analysis. Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2010-2012). Subjects were divided into two groups according to the presence of MS.

RESULTS

Among the subjects with MS, 47% had HI. Logistic regression analysis revealed that MS was not an independent risk factor for HI, although increased fasting plasma glucose (OR 1·4, 95% CI: 1·1-1·8) was independently associated with HI. In addition, older age, male sex, very low body mass index (≤17·5 kg/m2), lower education level, smoking history, and occupational noise exposure were independently associated with HI. For low-frequency HI, independent risk factors included older age, lower educational level, lower economic status, and very low BMI (≤17·5 kg/m2). For high-frequency HI, independent risk factors included older age, male sex, lower educational level, lower economic status, increased blood pressure, lower high-density lipoprotein cholesterol, and smoking history.

CONCLUSIONS

MS itself was not an independent risk factor for HI, and, among the individual metabolic components, only increased fasting plasma glucose was independently associated with HI.

Diabetes-Associated Changes in Cortical Auditory-Evoked Potentials in Relation to Normal Aging

OBJECTIVES

(1) To characterize the influence of type 2 diabetes mellitus (DM) on cortical auditory-evoked potentials (CAEPs) separate from the effects of normal aging, and (2) to determine whether the disease-related effects are modified by insulin dependence.

DESIGN

A cross-sectional study was conducted in a large cohort of Veterans to investigate the relationships among type 2 DM, age, and CAEPs in randomly selected participants with (N = 108) and without (N = 114) the disease and who had no more than a moderate hearing loss. Participants with DM were classified as insulin-dependent (IDDM, N = 47) or noninsulin-dependent (NIDDM, N = 61). Other DM measures included concurrent serum glucose, HbA1c, and duration of disease. CAEPs were evoked using a passive homogeneous paradigm (single repeating stimulus) by suprathreshold tones presented to the right ear, left ear, or both ears. Outcome measures were adjusted for the pure-tone threshold average for frequencies of 0.5, 1, and 2 kHz and analyzed for differences in age effects between participant groups using multiple regression.

RESULTS

There is little variation across test ear conditions (left, right, binaural) on any CAEP peak in any of the groups. Among no-DM controls, P2 latency increases about 9 msec per decade of life. DM is associated with an additional delay in the P2 latency of 7 and 9 msec for the IDDM and NIDDM groups, respectively. Moreover, the slope of the function relating P2 latency with age is similar across participant groups and thus the DM effect appears constant across age. Effects on N1 latency are considerably weaker, with age effects of less than 4 msec per decade across all groups, and DM effects of only 2 (IDDM) or 3 msec (NIDDM). In the NIDDM group, the slope relating N1 latency to age is steeper relative to that observed for the no-DM group, providing some evidence of accelerated "aging" for this CAEP peak. DM does not substantially reduce N1-P2 amplitude and age relationships with N1-P2 amplitude are effectively absent. There is no association between pure-tone average at 0.5, 1, and 2 kHz and any aspect of CAEPs in this cohort.

CONCLUSIONS

In a large cohort of Veterans, we found that type 2 DM is associated with prolonged N1 and P2 latencies regardless of whether insulin is required to manage the disease and independent of peripheral hearing thresholds. The DM-related effects on CAEP latencies are threefold greater for P2 compared with N1, and there is little support that at the cortical level, IDDM participants had poorer responses compared with NIDDM participants, although their responses were more variable. Overall, these results indicate that DM is associated with slowed preattentive neural conduction. Moreover, the observed 7 to 9 msec P2 latency delay due to DM is substantial compared with normal age changes in P2, which are 9 msec per decade of life in this cohort. Results also suggest that whereas N1 latency changes with age are more pronounced among individuals with DM versus without DM, there was no evidence for more rapid aging of P2 among patients with DM. Thus, the damage responsible for the major DM-related differences may occur early in the DM disease process. These cross-sectional results should be verified using a longitudinal study design.

Auditory Impairment in Young Type 1 Diabetics

BACKGROUND AND AIMS

More attention has recently been focused on auditory impairment of young type 1 diabetics. This study aimed to evaluate auditory function of young type 1 diabetics and the correlation between clinical indexes and hearing impairment.

METHODS

We evaluated the auditory function of 50 type 1 diabetics and 50 healthy subjects. Clinical indexes were measured along with analyzing their relation of auditory function.

RESULTS

Type 1 diabetic patients demonstrated a deficit with elevated thresholds at right ear and left ear when compared to healthy controls (p <0.01). The elevated auditory threshold was significantly related with HDL-cholesterol, diabetes duration, and systemic blood pressure (p <0.05). Moreover, latencies of right ear (wave III, V and interwave I-V) and left ear (wave III, V and interwave I-III, I-V) in diabetic group significantly increased compared to those in control subjects (p <0.01). Auditory brainstem response was significantly related with GHbA1C and microalbuminuria (p <0.01). Furthermore, distortion product evoked otoacoustic emissions (DPOAE) of diabetes group were statistically significant in right ears at 4.0, 6.0 kHz and in left ears at 4.0, 6.0, 8.0 kHz (p <0.01) compared with those of controls. Diabetic patients demonstrated lower amplitude responses of the right ear than the left ear at 8.0 kHz. Only triglyceride was positively correlated to the hearing impairment defined by DPOAE (p <0.01). There was no significance of transient evoked otoacoustic emissions (TEOAE) between groups. TEOAE was associated with age and GHbA1C (p <0.01).

CONCLUSIONS

Type 1 diabetics exerted higher auditory threshold, slower auditory conduction time and cochlear impairment. HDL-cholesterol, diabetes duration, systemic blood pressure, microalbuminuria, GHbA1C, triglyceride, and age may affect the auditory function of type 1 diabetics.

Analysis of Predisposing Factors for Hearing Loss in Adults

We aimed to estimate the effects of various risk factors on hearing level in Korean adults, using data from the Korea National Health and Nutrition Examination Survey. We examined data from 13,369 participants collected between 2009 and 2011. Average hearing thresholds at low (0.5, 1, and 2 kHz) and high frequencies (3, 4, and 6 kHz), were investigated in accordance with various known risk factors via multiple regression analysis featuring complex sampling. We additionally evaluated data from 4,810 participants who completed a questionnaire concerned with different types of noise exposure. Low body mass index, absence of hyperlipidemia, history of diabetes mellitus, low incomes, low educational status, and smoking were associated with elevated low frequency hearing thresholds. In addition, male sex, low body mass index, absence of hyperlipidemia, low income, low educational status, smoking, and heavy alcohol consumption were associated with elevated high frequency hearing thresholds. Participants with a history of earphone use in noisy circumstances demonstrated hearing thresholds which were 1.024 dB (95% CI: 0.176 to 1.871; P = 0.018) higher, at low-frequencies, compared to participants without a history of earphone use. Our study suggests that low BMI, absence of hyperlipidemia, low household income, and low educational status are related with hearing loss in Korean adults. Male sex, smoking, and heavy alcohol use are related with high frequency hearing loss. A history of earphone use in noisy circumstances is also related with hearing loss.

Diabetes and Hearing Loss Among Underserved Populations

Type 2 diabetes (T2DM) disproportionately affects the underserved population, and has been identified as the major risk factor for many microvascular diseases. T2DM also affects the vasculature and neural system of the inner ear, often leading to hearing loss, a major risk factor for falls, depression, and other health problems. This article aims to: increase awareness of the association between T2DM and hearing loss; promote screening for hearing loss; discuss available resources and assistive devices for those with hearing loss; and encourage nurses to take an active role in advocating for assessment and treatment of hearing loss in T2DM patients.

Hearing Impairment in Relation to Severity of Diabetes in a Veteran Cohort

OBJECTIVE

Type 2 diabetes is epidemic among veterans, approaching three times the prevalence of the general population. Diabetes leads to devastating complications of vascular and neurologic malfunction and appears to impair auditory function. Hearing loss prevention is a major health-related initiative in the Veterans Health Administration. Thus, this research sought to identify, and quantify with effect sizes, differences in hearing, speech recognition, and hearing-related quality of life (QOL) measures associated with diabetes and to determine whether well-controlled diabetes diminishes the differences.

DESIGN

The authors examined selected cross-sectional data from the baseline (initial) visit of a longitudinal study of Veterans with and without type 2 diabetes designed to assess the possible differences in age-related trajectories of peripheral and central auditory function between the two groups. In addition, the diabetes group was divided into subgroups on the basis of medical diagnosis of diabetes and current glycated hemoglobin (HbA1c) as a metric of disease severity and control. Outcome measures were pure-tone thresholds, word recognition using sentences presented in noise or time-compressed, and an inventory assessing the self-perceived impact of hearing loss on QOL. Data were analyzed from 130 Veterans ages 24 to 73 (mean 48) years with well-controlled (controlled) diabetes, poorly controlled (uncontrolled) diabetes, prediabetes, and no diabetes. Regression was used to identify any group differences in age, noise exposure history, and other sociodemographic factors, and multiple regression was used to model each outcome variable, adjusting for potential confounders. Results were evaluated in relation to diabetes duration, use of insulin (yes, no), and presence of selected diabetes complications (neuropathy and retinopathy).

RESULTS

Compared with nondiabetics, Veterans with uncontrolled diabetes had significant differences in hearing at speech frequencies, including poorer hearing by 3 to 3.5 dB for thresholds at 250 Hz and in a clinical pure-tone average, respectively. Compared with nondiabetic controls, individuals with uncontrolled diabetes also significantly more frequently reported that their hearing adversely impacted QOL on one of the three subscales (ability to adapt). Despite this, although they also had slightly poorer mean scores on both word recognition tasks performed, these differences did not reach statistical significance and all subjects performed well on these tasks. Compared with Veterans with controlled diabetes, those with uncontrolled disease tended to have had diabetes longer, be insulin-dependent, and have a greater prevalence of diabetic retinopathy. Results are generally comparable with the literature with regard to the magnitude of threshold differences and the prevalence of hearing impairment but extend prior work by providing threshold difference and hearing loss prevalence effect sizes by category of diabetes control and by including additional functional measures.

CONCLUSIONS

In a cohort of Veterans with type 2 diabetes and relatively good hearing, significant effects of disease severity were found for hearing thresholds at a subset of frequencies and for one of the three QOL subscales. Significant differences were concentrated among those with poorly controlled diabetes based on current HbA1c. Results provide evidence that the observed hearing dysfunction in type 2 diabetes might be prevented or delayed through tight metabolic control. Findings need to be corroborated using longitudinal assessments.

The association between metabolic syndrome or chronic kidney disease and hearing thresholds in Koreans: the Korean National Health and Nutrition Examination Survey 2009-2012

BACKGROUND

The aim of this study was to determine whether metabolic syndrome (MetS) or chronic kidney disease (CKD) is associated with hearing thresholds in the general Korean population.

PATIENTS AND METHODS

A total of 16,554 participants were included in this study. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III guidelines, and CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or a dipstick proteinuria result of ≥1+. The hearing thresholds were measured at 0.5, 1, 2, 3, 4, and 6 kHz. Low-frequency (Freq) was defined as pure-tone averages at 0.5 and 1 kHz, while Mid-Freq and High-Freq were defined as the average thresholds at mid-frequency (2 and 3 kHz) and high frequency (4 and 6 kHz), respectively.

RESULTS

In men, the hearing thresholds were 15.1 ± 14.5 dB, 22.2 ± 21.3 dB, and 37.3 ± 26.5 dB for Low-, Mid-, and High-Freq, respectively. In women, the hearing thresholds were 14.9 ± 15.3 dB, 16.6 ± 18.0 dB, and 26.1 ± 21.5 dB for Low-, Mid-, and High-Freq, respectively. The hearing thresholds for men were significantly higher than the hearing thresholds for women in all 3 threshold categories. Male and female subjects with MetS or CKD had higher hearing thresholds than the subjects that did not have these disorders. In the multivariate analysis, MetS was associated with increased hearing thresholds in women, and CKD was associated with increased hearing thresholds in men and women.

CONCLUSION

MetS is associated with hearing thresholds in women, and CKD is associated with hearing thresholds in men and women. Therefore, patients with MetS or CKD should be closely monitored for hearing impairment.