Carotenoids, vitamin A, vitamin C, vitamin E, and folate and risk of self-reported hearing loss in women

L-Shaped Associations Between Composite Dietary Antioxidant Index and Hearing Loss: A Cross-Sectional Study From the National Health and Nutrition Examination Survey

BACKGROUND

Oxidative stress has been implicated in the pathogenesis of hearing loss (HL). Dietary intake is a modifiable factor that could influence the oxidant and antioxidant capacity. We hypothesized that a higher composite dietary antioxidant index (CDAI) is associated with a reduced odds for HL.

METHODS

Adult participants from the 2001-2012 & 2015-2018 National Health and Nutrition Examination Study were included in this cross-sectional study. The CDAI was calculated from vitamins A, C, E, selenium, zinc, and caretenoid through 24-h dietary recall. Outcomes were HL, speech frequency HL (SFHL), and high frequency HL (HFHL). The associations between CDAI and HL, SFHL, and HFHL were evaluated by weighted multivariable logistic regression.

RESULTS

CDAI was associated with lower odds of HL (OR = 0.98, 95%CI 0.95-1.00, p = .043) and SFHL (OR = 0.97, 95%CI 0.95-1.00, p = .041), but not HFHL (OR = 0.98, 95%CI 0.96-1.00, p = .118) after adjustment for confounders. The multivariable-adjusted model showed a significant trend toward decreased risk of HL, SFHL, and HFHL with increasing CDAI quartile (all p for trend < 0.05). Restricted cubic spline analysis suggested that the associations between CDAI and HL, SFHL, and HFHL were L-shaped, with inflection points of CDAI at -0.61, 2.33, and 4.32, respectively. Subgroup analysis showed that participants with exposure to loud noise benefited from a higher CDAI for SFHL (p for interaction = 0.039).

CONCLUSION

Higher CDAI is associated with reduced odds of HL and SFHL in the U.S. adult population and serves as a promising intervention target to be further explored in prospective longitudinal studies in the future.

Role of Oxidative Stress in Sensorineural Hearing Loss

Hearing is essential for communication, and its loss can cause a serious disruption to one's social life. Hearing loss is also recognized as a major risk factor for dementia; therefore, addressing hearing loss is a pressing global issue. Sensorineural hearing loss, the predominant type of hearing loss, is mainly due to damage to the inner ear along with a variety of pathologies including ischemia, noise, trauma, aging, and ototoxic drugs. In addition to genetic factors, oxidative stress has been identified as a common mechanism underlying several cochlear pathologies. The cochlea, which plays a major role in auditory function, requires high-energy metabolism and is, therefore, highly susceptible to oxidative stress, particularly in the mitochondria. Based on these pathological findings, the potential of antioxidants for the treatment of hearing loss has been demonstrated in several animal studies. However, results from human studies are insufficient, and future clinical trials are required. This review discusses the relationship between sensorineural hearing loss and reactive oxidative species (ROS), with particular emphasis on age-related hearing loss, noise-induced hearing loss, and ischemia-reperfusion injury. Based on these mechanisms, the current status and future perspectives of ROS-targeted therapy for sensorineural hearing loss are described.

The association between dietary total antioxidant capacity and hearing loss: results from the Tehran employees Cohort Study

BACKGROUND

Despite numerous studies that have explored the association between individual antioxidants or specific combinations and the risk of hearing loss, there is lack of information regarding the relationship between dietary total antioxidant capacity (dTAC) and hearing loss. The conflicting results on this association further highlight the need for more research in this area. This study aims to investigate the association between overall dietary antioxidant intake and the risk of hearing loss among Iranian adults.

METHODS

This cross-sectional study recruited 3443 adult participants aged between 19 and 67 years (with an average age of 41.4 years ± 8.8) who were employed at Tehran University of Medical Sciences in Iran. Participants underwent dietary assessment using a validated Food Frequency Questionnaire (FFQ). The hearing status of each participant was evaluated by a licensed audiologist in a soundproof room, using diagnostic audiometry that adhered to American National Standards specifications and followed standard audiometric clinical procedures. The dietary total antioxidant capacity (dTAC) was calculated using the Ferric Reducing-Antioxidant Power (FRAP) values.

RESULTS

43.6% of male participants had hearing loss, while 26.8% among female participants. After accounting for various confounding factors, no significant association was observed between higher levels of dTAC and reduced odds of hearing loss in the overall population. However, among men under the age of 40, higher levels of dTAC were associated with decreased odds of hearing loss, even after adjusting for several covariates (OR: 0.56, 95% CI: 0.31-1.02, Ptrend = 0.02). This relationship was not evident in men over 40 years of age or among women.

CONCLUSION

The study found an inverse relationship between higher antioxidant intake in the diet and lower odds of hearing loss, specifically among men who were 40 years old or younger. However, this relationship was not observed in the overall population or among women. Additional prospective studies are necessary to validate these results.

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.

Serum fat-soluble vitamin levels may be related to sudden sensorineural hearing loss

BACKGROUND

Few related studies reported yet the association between vitamins and the onset of sudden sensorineural hearing loss (SSNHL).

OBJECTIVE

To explore the relationship between the serum levels of fat-soluble vitamins A, D, and E and the risk of SSNHL.

METHODS

This retrospective analysis included 310 SSNHL patients and 154 people without risk of hearing loss. The demographic information of all participants like age, gender, body mass index, occupation, cigarette smoking or drinking status, etc. were recorded. The serum levels of vitamins A, D, and E were determined using the electrochemical method.

RESULTS

The results indicated that serum vitamin D levels in SSNHL patients were significantly lower. Vitamin D deficiency was only observed in SSNHL group. Similarly, serum vitamin A levels in female SSNHL patients were significantly lower than the control group. Meanwhile, serum vitamin E levels in male SSNHL patients were significantly lower than the control group.

CONCLUSION AND SIGNIFICANCE

Our results revealed that the serum levels of fat-soluble vitamins A, D, and E in SSNHL patients were lower than those in the control group with normal hearing, indicating that the decrease of serum fat-soluble vitamins may be related to SSNHL pathogenesis.

Sex differences in the polygenic architecture of hearing problems in adults

BACKGROUND

Hearing problems (HP) in adults are common and are associated with several comorbid conditions. Its prevalence increases with age, reflecting the cumulative effect of environmental factors and genetic predisposition. Although several risk loci have been already identified, HP biology and epidemiology are still insufficiently investigated by large-scale genetic studies.

METHODS

Leveraging the UK Biobank, the Nurses' Health Studies (I and II), the Health Professionals Follow-up Study, and the Million Veteran Program, we conducted a comprehensive genome-wide investigation of HP in 748,668 adult participants (discovery N = 501,825; replication N = 226,043; cross-ancestry replication N = 20,800). We leveraged the GWAS findings to characterize HP polygenic architecture, exploring sex differences, polygenic risk across ancestries, tissue-specific transcriptomic regulation, cause-effect relationships with genetically correlated traits, and gene interactions with HP environmental risk factors.

RESULTS

We identified 54 risk loci and demonstrated that HP polygenic risk is shared across ancestry groups. Our transcriptomic regulation analysis highlighted the potential role of the central nervous system in HP pathogenesis. The sex-stratified analyses showed several additional associations related to peripheral hormonally regulated tissues reflecting a potential role of estrogen in hearing function. This evidence was supported by the multivariate interaction analysis that showed how genes involved in brain development interact with sex, noise pollution, and tobacco smoking in relation to their HP associations. Additionally, the genetically informed causal inference analysis showed that HP is linked to many physical and mental health outcomes.

CONCLUSIONS

The results provide many novel insights into the biology and epidemiology of HP in adults. Our sex-specific analyses and transcriptomic associations highlighted molecular pathways that may be targeted for drug development or repurposing. Additionally, the potential causal relationships identified may support novel preventive screening programs to identify individuals at risk.

Association of vitamins with hearing loss, vision disorder and sleep problem in the US general population

Based on nationally representative samples from US, we aimed to assess the associations of vitamins with hearing loss, vision disorder and sleep problem. A total of 25,312, 8425 and 24,234 participants were included in this study to investigate the relationship of vitamins with hearing loss, vision disorder and sleep problem from National Health and Nutrition Examination Survey, respectively. Vitamins including niacin, folic acid, vitamin B6, A, C, E and carotenoids were considered in our study. Logistic regression models were used to assess the associations between all included dietary vitamin intake concentrations and the prevalence of specific outcomes. Increased lycopene (odds ratio [OR]: 0.904, 95% confidence interval [CI]: 0.829-0.985) intake was associated with a deceased prevalence of hearing loss. Higher dietary intake of folic acid (OR: 0.637, 95% CI: 0.443-0.904), vitamin B6 (0.667, 0.465-0.947), alpha-carotene (0.695, 0.494-0.968), beta-carotene (0.703, 0.505-0.969) and lutein + zeaxanthin (0.640, 0.455-0.892) were associated with a decreased prevalence of vision disorder. The inversely associations of sleeping problem with niacin (OR: 0.902, 95% CI: 0.826-0.985), folic acid (0.882, 0.811-0.959), vitamin B6 (0.892, 0.818-0.973), vitamin C (0.908, 0.835-0.987), vitamin E (0.885, 0.813-0.963) and lycopene (0.919, 0.845-0.998) were also observed. Our findings provide evidence that increased specific vitamin intake is associated with decreased prevalence of hearing loss, vision disorder and sleep problem.

Retinol and Pro-Vitamin A Carotenoid Nutritional Status during Pregnancy Is Associated with Newborn Hearing Screen Results

The prenatal period is critical for auditory development; thus, prenatal influences on auditory development may significantly impact long-term hearing ability. While previous studies identified a protective effect of carotenoids on adult hearing, the impact of these nutrients on hearing outcomes in neonates is not well understood. The purpose of this study is to investigate the relationship between maternal and umbilical cord plasma retinol and carotenoid concentrations and abnormal newborn hearing screen (NHS) results. Mother-infant dyads (n = 546) were enrolled at delivery. Plasma samples were analyzed using HPLC and LC-MS/MS. NHS results were obtained from medical records. Statistical analysis utilized Mann-Whitney U tests and logistic regression models, with p ≤ 0.05 considered statistically significant. Abnormal NHS results were observed in 8.5% of infants. Higher median cord retinol (187.4 vs. 162.2 μg/L, p = 0.01), maternal trans-β-carotene (206.1 vs. 149.4 μg/L, p = 0.02), maternal cis-β-carotene (15.9 vs. 11.2 μg/L, p = 0.02), and cord trans-β-carotene (15.5 vs. 8.0 μg/L, p = 0.04) were associated with abnormal NHS. Significant associations between natural log-transformed retinol and β-carotene concentrations and abnormal NHS results remained after adjustment for smoking status, maternal age, and corrected gestational age. Further studies should investigate if congenital metabolic deficiencies, pesticide contamination of carotenoid-rich foods, maternal hypothyroidism, or other variables mediate this relationship.

Biochemical Validation of a Self-Administered Carotenoid Intake Screener to Assess Carotenoid Intake in Nonobese Adults

Background

Epidemiological studies have demonstrated an association between carotenoid intake and health. However, an accurate measurement of carotenoid intake is challenging. FFQ is the most commonly used dietary assessment method and is typically composed of 100-200 items. However, the greater participant burden that accompanies a more detailed FFQ provides only a marginal gain in accuracy. Therefore, a brief validated carotenoid intake screener is needed.

Objectives

To conduct secondary analysis evaluating the validity of a newly developed 44-item carotenoid intake screener from The Juice Study: Sensitivity of Skin Carotenoid Status to Detect Change in Intake (NCT03202043) against corresponding plasma carotenoid concentrations (primary) and skin carotenoids (secondary) in nonobese Midwestern American adults.

Methods

Healthy adults (n = 83; 25 men and 58 women) aged 18-65 y (mean age, 32 ± 12 y) with a BMI (in kg/m2) of 18.5-29.9 (mean BMI, 25 ± 3) were recruited between 25 April 2018 and 28 March 2019. Participants completed the carotenoid intake screener weekly during the 8-wk parent study. Plasma carotenoid concentrations were assessed at weeks 0, 4, and 8 using HPLC. Skin carotenoids were assessed weekly using pressure-mediated reflection spectroscopy (RS). Correlation matrices from mixed models were used to determine the correlation between carotenoid intake and plasma and skin carotenoids over time.

Results

The total carotenoid intake, as determined by the carotenoid intake screener, correlated with both the plasma total carotenoid concentration (r = 0.52; P < 0.0001) and the RS-assessed skin carotenoid concentration (r = 0.43; P < 0.0001). Correlations between reported intake and plasma concentrations of α-carotene (r = 0.40; P = 0.0002), cryptoxanthin (r = 0.28; P = 0.0113), and lycopene (r = 0.33; P = 0.0022) were also observed.

Conclusions

The results of this study demonstrate an acceptable relative validity of the carotenoid intake screener to assess total carotenoid intake in adults classified as those having a healthy body or those with overweight.

Effects of Diet and Lifestyle on Audio-Vestibular Dysfunction in the Elderly: A Literature Review

BACKGROUND

The world's age-related health concerns continue to rise. Audio-vestibular disorders, such as hearing loss, tinnitus, and vertigo, are common complaints in the elderly and are associated with social and public health burdens. Various preventative measures can ease their impact, including healthy food consumption, nutritional supplementation, and lifestyle modification. We aim to provide a comprehensive summary of current possible strategies for preventing the age-related audio-vestibular dysfunction.

METHODS

A PubMed, Embase, and Cochrane review databases search was conducted to identify the relationship between diet, lifestyle, and audio-vestibular dysfunction. "Diet", "nutritional supplement", "lifestyle", "exercise", "physical activity", "tinnitus", "vertigo" and "age-related hearing loss" were used as keywords.

RESULTS

Audio-vestibular dysfunction develops and progresses as a result of age-related inflammation and oxidative stress. Diets with anti-inflammatory and antioxidant effects have been proposed to alleviate this illness. A high-fat diet may induce oxidative stress and low protein intake is associated with hearing discomfort in the elderly. Increased carbohydrate and sugar intake positively correlate with the incidence of audio-vestibular dysfunction, whereas a Mediterranean-style diet can protect against the disease. Antioxidants in the form of vitamins A, C, and E; physical activity; good sleep quality; smoking cessation; moderate alcohol consumption; and avoiding noise exposure are also beneficial.

CONCLUSIONS

Adequate diet or nutritional interventions with lifestyle modification may protect against developing audio-vestibular dysfunction in elderly individuals.

Role of Oxidative Stress and Antioxidants in Acquired Inner Ear Disorders

Oxygen metabolism in the mitochondria is essential for biological activity, and reactive oxygen species (ROS) are produced simultaneously in the cell. Once an imbalance between ROS production and degradation (oxidative stress) occurs, cells are damaged. Sensory organs, especially those for hearing, are constantly exposed during daily life. Therefore, almost all mammalian species are liable to hearing loss depending on their environment. In the auditory pathway, hair cells, spiral ganglion cells, and the stria vascularis, where mitochondria are abundant, are the main targets of ROS. Excessive generation of ROS in auditory sensory organs is widely known to cause sensorineural hearing loss, and mitochondria-targeted antioxidants are candidates for treatment. This review focuses on the relationship between acquired hearing loss and antioxidant use to provide an overview of novel antioxidants, namely medicines, supplemental nutrients, and natural foods, based on clinical, animal, and cultured-cell studies.

Long-term exposure to ambient air pollutants and hearing loss in Korean adults

BACKGROUND

Hearing loss is the most prevalent sensory deficit globally, and its prevalence has been growing at a rapid pace, mainly due to aging population. Although there is plentiful evidence that exposure to air pollutants contributes to oxidative stress and free radical formation in inner ear is linked to hearing impairment, there is little awareness of the contribution of air pollution to hearing loss.

OBJECTIVE

To evaluate the associations between long-term exposures to air pollution and hearing loss in Korean adults, while controlling for sociodemographic and clinical factors and occupational, recreational, and firearm noise exposures.

METHODS

We analyzed data from 15,051 adults in the Korean National Health and Nutrition Examination Survey V (2010-2012). Ambient air pollutant concentrations for participant residing in administrative division and local/town units were collected for current-to-3 years prior to the audiometric examination. Pure-tone average (PTA) of hearing thresholds at speech-frequency (0.5, 1, 2, 4kHz) and high-frequency (3, 4, 6kHz) were computed, and hearing loss was defined as PTA >25dB in either ear.

RESULTS

Ambient PM₁₀ was significantly associated with the increased risk of hearing loss at speech-frequency and high-frequency (current year and prior year 3), while CO was significantly associated with the increased risk of hearing loss at speech-frequency (prior year 2 and 3) and high-frequency (prior year 2), when air pollution was assessed at local/town (finer unit). After additional adjustment for regional socioeconomic status and population density (a proxy for traffic noise), NO₂ became significantly associated with hearing loss at speech-frequency. When air pollution was assessed at administrative division (larger unit), PM₁₀ and CO became stronger and SO₂ became significant in hearing loss at speech-frequency.

CONCLUSION

Our results suggest that long-term exposures to environmental PM₁₀, NO₂, CO, and SO₂ at the levels currently observed in the general population may be risk factors affecting hearing loss.

[Triggers and predictors of development and formation of sensorineural hearing loss]

The purpose of the study is to review the results of scientific researches in recent years in an expanded interdisciplinary view of the problem of etiopathogenesis of sensorineural hearing loss, as well as the role of comorbidities and triggers in the formation of persistent changes in the audio-receiving part of the auditory analyzer.

The Inverted-U Relationship Between Dietary Inflammatory Potential and Hearing Loss Among Adults Aged 20 Years and Over in the United States: A Cross-Sectional Study

Purpose

The purpose of this study was to examine the relationship between dietary inflammatory index and objective hearing loss (HL).

Materials and Methods

A cross-sectional analysis of a nationally representative sample of participants was performed based on data in National Health and Nutrition Examination Survey (NHANES) (2009-2016). HL was defined as pure tone averages >25 dB at 500, 1000, and 2000 Hz (low frequency); 3000, 4000, 6000, and 8000 Hz (high frequency) in either ear. The energy-adjusted dietary inflammatory index (E-DII) score was calculated for each participant based on two 24-h dietary recalls to assess diet-associated inflammation. Multivariable logistic regression was used to examine the linear relationship between HL and E-DII score or E-DII quartiles. Restricted cubic spline was applied to identify any non-linear associations of the E-DII score with hearing loss. Subgroup analyses were performed by age and gender to explore the moderating roles of these factors. Akaike's Information Criterion (AIC) values were used to select the better-fitted model among linear and non-linear models.

Results

An inverted-U shaped relationship with low-frequency hearing loss (LFHL) was identified for the E-DII score (P-nonlinear =0.023) after adjustment for potential confounders. But significant linear or nonlinear association between E-DII score and high-frequency hearing loss (HFHL) was not found.

Conclusion

E-DII score had inverted-U relationship with LFHL. Both pro-inflammatory diet and anti-inflammatory diet seemed to be associated with a decreased risk of LFHL compared to diet that was neither pro-inflammatory diet nor anti-inflammatory diet.

Relationship Between Diet, Tinnitus, and Hearing Difficulties

OBJECTIVES

Diet may affect susceptibility of the inner ear to noise and age-related effects that lead to tinnitus and hearing loss. This study used complementary single nutrient and dietary pattern analysis based on statistical grouping of usual dietary intake in a cross-sectional analysis of tinnitus and hearing difficulties in a large population study sample.

DESIGN

The research was conducted using the UK Biobank resource. Tinnitus was based on report of ringing or buzzing in one or both ears that lasts more than five minutes at a time and is currently experienced at least some of the time. Identification of a hearing problem was based on self-reported difficulties with hearing. Usual dietary intake and dietary patterns (involving statistical grouping of intake to account for how foods are combined in real-life diets) were estimated based on between two and five administrations of the Oxford Web-Q 24-hour dietary recall questionnaire over the course of a year for 34,576 UK adult participants aged 40 to 69.

RESULTS

In a multivariate model, higher intake of vitamin B12 was associated with reduced odds of tinnitus, while higher intakes of calcium, iron, and fat were associated with increased odds (B12, odds ratio [OR] 0.85, 95% confidence interval [CI] 0.75 to 0.97; Calcium, OR 1.20, 95% CI 1.08 to 1.34; Iron, OR 1.20, 95% CI 1.05 to 1.37; Fat, OR 1.33, 95% CI 1.09 to 1.62, respectively, for quintile 5 versus quintile 1). A dietary pattern characterised by high protein intake was associated with reduced odds of tinnitus (OR 0.90, 95% CI 0.82 to 0.99 for quintile 5 versus quintile 1). Higher vitamin D intake was associated with reduced odds of hearing difficulties (OR 0.90, 95% CI 0.81 to 1.00 for quintile 5 versus quintile 1), as were dietary patterns high in fruit and vegetables and meat and low in fat (Prudent diet: OR 0.89, 95% CI 0.83 to 0.96; High protein: OR 0.88, 95% CI 0.82 to 0.95; High fat: OR 1.16, 95% CI 1.08 to 1.24, respectively, for quintile 5 versus quintile 1).

CONCLUSIONS

There were associations between both single nutrients and dietary patterns with tinnitus and hearing difficulties. Although the size of the associations was small, universal exposure for dietary factors indicates that there may be a substantial impact of diet on levels of tinnitus and hearing difficulties in the population. This study showed that dietary factors might be important for hearing health.

Diet Quality and the Risk of Impaired Speech Reception Threshold in Noise: The UK Biobank cohort

OBJECTIVE

Previous studies have examined the association between several diet quality indexes and risk of hearing loss, based on self-reported information or on audiometry test, with inconsistent results. However, the impact of healthy diets on the capacity to listening in noise, a proxy of disability due to hearing loss, is unknown. This research assessed the prospective association between five diet quality indexes and the speech reception threshold in noise in the UK Biobank study.

DESIGN

Prospective cohort with 105,592 participants aged ≥40 years. At baseline, adherence to the Mediterranean Diet Adherence Screener, the alternate Mediterranean Diet score, the Dietary Approaches to Stop Hypertension, the Alternate Healthy Eating Index-2010, and the healthful Plant-Based Diet Index were assessed. Functional auditory capacity was measured with a digit triplet test, and impairment was defined as a speech reception threshold in noise >-3.5 dB in any physical exam during the follow-up.

RESULTS

Over a median follow-up of 3.2 (SD: 2.1) years, 1704 participants showed impaired speech reception threshold in noise. After adjusting for potential confounders, the hazard ratios (95% confidence interval) of impairment per 1-SD increase in the Mediterranean Diet Adherence Screener, alternate Mediterranean Diet score, Dietary Approaches to Stop Hypertension, Alternate Healthy Eating Index-2010 and healthful Plant-Based Diet Index scores were, respectively, 0.98 (0.94 to 1.03), 1.01 (0.96 to 1.06), 1.02 (0.97 to 1.07), 1.01 (0.96 to 1.06), and 1.00 (0.96 to 1.05). Results were similar when analyses were restricted to those >60 years, with British ethnicity, without chronic disease, without tinnitus or with optimal cognitive function.

CONCLUSIONS

Adherence to a healthy diet did not show an association with the speech reception threshold in noise. More research is needed to identify the impact of individual foods or nutrients on this outcome.

Dietary fat intake and risk of disabling hearing impairment: a prospective population-based cohort study

Purpose

To examine the associations of specific dietary fats with the risk of disabling hearing impairment in the UK Biobank study.

Methods

This cohort study investigated 105,592 participants (47,308 men and 58,284 women) aged ≥ 40 years. Participants completed a minimum of one valid 24-h recall (Oxford Web-Q). Dietary intake of total fatty acids, polyunsaturated fatty acids (PUFA), saturated fatty acids (SFA), and monounsaturated fatty acids (MUFA) was assessed at baseline. Functional auditory capacity was measured with a digit triplet test (DTT), and disabling hearing impairment was defined as a speech reception threshold in noise > − 3.5 dB in any physical exam performed during the follow-up.

Results

Over a median follow-up of 3.2 (SD: 2.1) years, 832 men and 872 women developed disabling hearing impairment. After adjustment for potential confounders, including lifestyles, exposure to high-intensity sounds, ototoxic medication and comorbidity, the hazard ratios (HRs), and 95% confidence interval (CI) of disabling hearing function, comparing extreme quintiles of intakes were 0.91 (0.71–1.17) for total fat, 1.09 (0.83–1.44) for PUFA, 0.85 (0.64–1.13) for SFA and 1.01 (0.74–1.36) for MUFA among men. Among women, HRs comparing extreme intakes were 0.98 (0.78–1.24) for total fat, 0.69 (0.53–0.91) for PUFA, 1.26 (0.96–1.65) for SFA, and 0.91 (0.68–1.23) for MUFA. Replacing 5% of energy intake from SFA with an equivalent energy from PUFA was associated with 25% risk reduction (HR: 0.75; 95% CI: 0.74–0.77) among women.

Conclusions

PUFA intake was associated with decreased risk of disabling hearing function in women, but not in men.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02644-7.

Birth Weight and Adult-Onset Hearing Loss

OBJECTIVES

Among low-birth-weight infants, exposure to stress or undernutrition in utero may adversely affect cochlear development. As cochlear reserve declines, the risk of hearing loss may increase with age. While low birth weight is associated with a higher risk of neonatal hearing loss, our objective was to examine whether birth weight was associated with adult-onset, self-reported hearing loss in the Nurses' Health Studies (NHS) I and II (n = 113,130).

DESIGN

We used Cox proportional hazards regression to prospectively examine whether birth weight, as well as gestational age at birth, is associated with adult-onset hearing loss. Participants reported their birth weight in 1992 in NHS I and 1991 in NHS II. Mothers of NHS II participants reported gestational age at birth in a substudy (n = 28,590). The primary outcome was adult-onset, self-reported moderate or greater hearing loss, based on questionnaires administered in 2012/2016 in NHS I and 2009/2013 in NHS II.

RESULTS

Our results suggested a higher risk of hearing loss among those with birth weight <5.5 lbs compared with birth weight 7 to <8.5 lbs (pooled multivariable-adjusted hazard ratio 1.14, 95% confidence interval = 1.04-1.23; p trend = 0.01). Additionally, participants with gestational age at birth ≥42 weeks had a higher risk of hearing loss, compared with gestational age 38 to <42 weeks (multivariable-adjusted hazard ratio 1.33, 95% confidence interval = 1.06-1.65).

CONCLUSIONS

Birth weight <5.5 lbs was independently associated with higher risk of self-reported, adult-onset hearing loss. In addition, gestational age at birth ≥42 weeks was also associated with higher risk.

Incidence of Hearing Impairment and Changes in Pure-Tone Average Across Generations

Importance

Age-adjusted prevalence of hearing impairment (HI) decreased across generations in the 20th century, suggesting that HI is partially preventable. It is not known whether HI incidence differs by generation.

Objectives

To examine whether HI incidence and change in pure-tone average (PTA) differ by generation and identify factors underlying these differences.

Design, Setting, and Participants

This cohort study used data from the Epidemiology of Hearing Loss Study (EHLS) and Beaver Dam Offspring Study (BOSS), a pair of studies of adults in Beaver Dam, Wisconsin. Baseline examinations occurred from 1993 to 1995 in the EHLS and 2005 to 2008 in BOSS, with two 5-year follow-up examinations in each cohort. This longitudinal cohort study assessed 3651 participants without HI at baseline who had follow-up data.

Main Outcomes and Measures

The primary outcome was incident HI measured by pure-tone audiometry, defined as PTA greater than 25-dB hearing level (dB HL) in either ear. Associations of 5-year incidence were estimated by relative risks (RRs) and 10-year cumulative incidence with generation, as categorized by commonly used sociodemographic descriptors of year of birth, by hazard ratios (HRs). The 10-year change in PTA was investigated using a generation × time interaction term in generalized estimating equation models.

Results

Among the 3651 participants (mean [SD] age at baseline 53.1 [10.6] years; 2255 [61.8%] female; and 3567 [97.7%] non-Hispanic White), the 5-year HI incidence was 14.1% (95% CI, 13.0%-15.3%) and the 10-year cumulative incidence was 26.0% (95% CI, 24.6%-27.6%). The incidence increased with age. The risk of 5-year incident HI decreased by generation (RR, 0.80; 95% CI, 0.66-0.97) when adjusting for multiple covariates. The decreased risk was similar in the 10-year period (HR, 0.86; 95% CI, 0.73-1.01). The PTA change rate (per 5 years of follow-up) decreased by generation, with the Greatest Generation (born 1901-1924) experiencing the highest rate (7.03 dB HL). The rates were all significantly lower for the other generations (Silent Generation [born 1925-1945], 3.30 dB HL; Baby Boom Generation [born 1946-1964], 3.36 dB HL; and Generation X [born 1965-1984], 2.33 dB HL).

Conclusions and Relevance

This study suggests that the risk of HI and rate of PTA change is lower for the Silent Generation and Baby Boom Generation compared with the Greatest Generation. Part of this lower risk is likely associated with changes in modifiable factors. A potential continued benefit may exist for Generation X. Combined with the reduced risk of HI for the Silent Generation and Baby Boom Generation, this finding implies that the future HI burden may be lower than current estimates suggest.

Protective effects of vitamins/antioxidants on occupational noise-induced hearing loss: A systematic review

OBJECTIVES

Occupational noise-induced hearing loss (NIHL) due to industrial, military, and other job -related noise exposure can cause harmful health issues to occupied workers, but may also be potentially preventable. Vitamins/antioxidant have been studied as therapeutic strategies to prevent and/or delay the risks of human diseases as well as NIHL .So, this study was conducted to systematically review the protective effects of vitamins/antioxidants on occupational NIHL.

METHODS

Online databases including PubMed/Medline, Scopus, Web of Science, EMBASE, Science Direct, and Google Scholar were systematically searched up to 12 January 2021. Based on 6336 potentially relevant records identified through the initial search in the databases, 12 full-text publications were retrieved, one of which can be viewed as two separate trials, because it has studied the effects of two different antioxidants (ginseng and NAC) on NIHL, separately.

RESULTS

A review of the studies shows that vitamin B12, folic acid, and N-acetylcysteine (NAC) have a considerable protective effect on NIHL. However, these protective effects are not yet specified in different frequencies. The findings regarding the protective effects of other antioxidants are inconsistent in this field.

CONCLUSION

Vitamin B12, folic acid, and NAC may have a protective effect as an antioxidant on reducing occupational hearing loss. For a conclusive evidence of vitamin/antioxidant protective therapies, future studies with precise criteria for noise exposure and similar outcome parameters are required.

Cigarette Smoking, Smoking Cessation, and Risk of Hearing Loss in Women

BACKGROUND

Previous studies demonstrated higher risk of hearing loss among cigarette smokers, but longitudinal data on whether the risk is influenced by smoking cessation are limited. We prospectively investigated relations between smoking, smoking cessation, and risk of self-reported moderate or worse hearing loss among 81,505 women in the Nurses' Health Study II (1991-2013).

METHODS

Information on smoking and hearing status was obtained from validated biennial questionnaires. Cox proportional hazards regression was used to estimate multivariable-adjusted relative risks (MVRR, 95% confidence interval).

RESULTS

During 1,533,214 person-years of follow-up, 2760 cases of hearing loss were reported. Smoking was associated with higher risk of hearing loss and the risk tended to be higher with greater number of pack-years smoked. Compared with never smokers, the MVRR (95% confidence interval) among past smokers with 20+ pack-years of smoking was 1.30 (1.09-1.55) and 1.21 (1.02-1.43) for current smokers. The magnitude of elevated risk diminished with greater time since smoking cessation. Compared with never smokers, the MVRR among smokers who quit <5 years prior was 1.43 (1.17-1.75); 5-9 years prior was 1.27 (1.03-1.56); 10-14 years prior was 1.17 (0.96-1.41); and plateaued thereafter. Additional adjustment for pack-years smoking attenuated the results.

CONCLUSIONS

The higher risk of hearing loss associated with smoking may diminish over time after quitting.

Intake of antioxidant vitamins in women with different physical activity levels

Study aim: The purpose of this study was to compare intake of antioxidant vitamins (A, C, E) in young women with various levels of physical activity.

Material and methods: The study included 3 groups of females: 40 women with no extra physical activity (Sedentary), 40 women involved in regular, moderate sports activities (Recreationally Active) and 40 female athletes competing at an international level (Athletes). Participants’ diet was assessed on the basis of 3-day diet records which were analysed using the computer program ‘Dieta 5.0’. Body composition was evaluated by the bioelectrical impedance analysis (BIA) method.

Results: Athletes were characterized by the lowest body fat and highest lean body mass in comparison with the other groups. They also showed the highest intake of energy, proteins and carbohydrates compared to Active and Sedentary women. The consumption of vitamin A amounted to 180.0% of RDA in Athletes, 98.8% in Recreationally Active and 97.8% in Sedentary women. Vitamin C intake in Athletes equalled 275.0% of RDA, whereas the deficiency of this vitamin was observed in Recreationally Active and Sedentary women (62.3% and 46.1% of RDA, respectively). The study groups showed consumption of vitamin E at the level of 146.7% of AI in Athletes, 115.0% in Recreationally Active and 111.3% in Sedentary women.

Conclusion: Athletes consumed excessive amounts of antioxidant vitamins. Recreationally Active and Sedentary women met the demand for vitamin A and E, but the intake of vitamin C was not sufficient, which could lead to health problems. The current findings also indicate that energy intake was at a low level regardless of the study group.

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.

Prospective Study of Dietary Patterns and Hearing Threshold Elevation

We conducted a prospective study of dietary patterns and longitudinal change in audiometric hearing thresholds among 3,135 women (mean age = 59 years) in the Nurses' Health Study II (2012-2018). Diet adherence scores for the Dietary Approaches to Stop Hypertension (DASH) and Alternate Mediterranean (AMED) diets and the Alternate Healthy Eating Index 2010 (AHEI-2010) were calculated using validated food-frequency questionnaires. Baseline and 3-year follow-up hearing sensitivities were assessed by pure-tone audiometry at 19 US sites. We used multivariable-adjusted logistic regression models to examine independent associations between diet adherence scores and risk of ≥5 dB elevation in the pure-tone average (PTA) of low-frequency (LPTA0.5,1,2 kHz), mid-frequency (MPTA3,4 kHz), and high-frequency (HPTA6,8 kHz) hearing thresholds. Higher adherence scores were associated with lower risk of hearing loss. Compared with the lowest quintile of DASH score, the multivariable-adjusted odds ratios for mid-frequency and high-frequency threshold elevation in the highest quintile were 0.71 (95% confidence interval (CI): 0.55, 0.92; P for trend = 0.003) and 0.75 (95% CI: 0.59, 0.96; P for trend = 0.02); for AMED and AHEI scores, for mid-frequency threshold elevation, they were 0.77 (95% CI: 0.60, 0.99; P for trend = 0.02) and 0.72 (95% CI: 0.57, 0.92; P for trend = 0.002). Nonsignificant inverse associations were observed for high-frequency threshold elevation. There were no significant associations between adherence scores and low-frequency threshold elevation. Our findings indicate that eating a healthy diet might reduce the risk of acquired hearing loss.

Biomarkers of Systemic Inflammation and Risk of Incident Hearing Loss

BACKGROUND

Chronic inflammation may lead to cochlear damage, and the only longitudinal study that examined biomarkers of systemic inflammation and risk of hearing loss found an association with a single biomarker in individuals <60 years of age. The purpose of our study was to determine whether plasma inflammatory markers are associated with incident hearing loss in two large prospective cohorts, Nurses' Health Studies (NHS) I and II.

METHODS

We examined the independent associations between plasma levels of markers of systemic inflammation (C-reactive protein [CRP], interleukin-6 [IL-6], and soluble tumor necrosis factor receptor 2 [TNFR-2]) and self-reported hearing loss. The participants in NHS I (n = 6194 women) were 42 to 69 years of age at the start of the analysis in 1990, while the participants in NHS II (n = 2885 women) were 32 to 53 years in 1995. After excluding women with self-reported hearing loss before the time of blood-draw, incident cases of hearing loss were defined as those women who reported hearing loss on questionnaires administered in 2012 in NHS I and 2009 or 2013 in NHS II. The primary outcome was hearing loss that was reported as moderate or worse in severity, pooled across the NHS I and NHS II cohorts. We also examined the pooled multivariable-adjusted hazard ratios for mild or worse hearing loss. Cox proportional hazards regression was used to adjust for potential confounders.

RESULTS

At baseline, women ranged from 42 to 69 years of age in NHS I and 32 to 53 years of age in NHS II. Among the NHS I and II women with measured plasma CRP, there were 628 incident cases of moderate or worse hearing loss during 100,277 person-years of follow-up. There was no significant association between the plasma levels of any of the three inflammatory markers and incident moderate or worse hearing loss (multivariable-adjusted pooled p trend for CRP = 0.33; p trend IL-6 = 0.54; p trend TNFR-2 = 0.70). There was also no significant relation between inflammatory marker levels and mild or worse hearing loss. While there was no significant effect modification by age for CRP or IL-6 in NHS I, there was a statistically significant higher risk of moderate or worse hearing loss (p interaction = 0.02) as well as mild or worse hearing loss (p interaction = 0.004) in women ≥60 years of age who had higher plasma TNFR-2 levels.

CONCLUSIONS

Overall, there was no significant association between plasma markers of inflammation and risk of hearing loss.

Increased oxidative stress, inflammation, and glutamate: Potential preventive and therapeutic targets for hearing disorders

Hearing disorders constitute one of the major health concerns in the USA. Decades of basic and clinical studies have identified numerous ototoxic agents and investigated their modes of action on the inner ear, utilizing tissue culture as well as animal and human models. Current preventive and therapeutic approaches are considered unsatisfactory. Therefore, additional modalities should be developed. Many studies suggest that increased levels of oxidative stress, chronic inflammation, and glutamate play an important role in the initiation and progression of damage to the inner ear leading to hearing impairments. To prevent these cellular deficits, antioxidants, anti-inflammatory agents, and antagonists of glutamate receptor have been used individually or in combination with limited success. It is essential, therefore, to simultaneously enhance the levels of antioxidant enzymes by activating the Nrf2 (a nuclear transcriptional factor) pathway, dietary and endogenous antioxidant compounds, and B12-vitamins in order to reduce the levels of oxidative stress, chronic inflammation, and glutamate at the same time. This review presents evidence to show that increased levels of these cellular metabolites, biochemical or factors are involved in the pathogenesis of cochlea leading to hearing impairments. It presents scientific rationale for the use of a mixture of micronutrients that may decrease the levels of oxidative damage, chronic inflammation, and glutamate at the same time. The benefits for using oral administration of proposed micronutrient mixture in humans are presented. Animal and limited human studies indirectly suggest that orally administered micronutrients can accumulate in the inner ear. Therefore, this route of administration may be useful in prevention, and in combination with standard care, in improved management of hearing problems following exposure to well-recognized and studied ototoxic agents, such as noise, cisplatin, aminoglycoside antibiotics, and advanced age.

The role of diet in vulnerability to noise-induced cochlear injury and hearing loss

The influence of dietary nutrient intake on the onset and trajectory of hearing loss during aging and in mediating protection from challenges such as noise is an important relationship yet to be fully appreciated. Dietary intake provides essential nutrients that support basic cellular processes related to influencing cellular stress response, immune response, cardiometabolic status, neural status, and psychological well-being. Dietary quality has been shown to alter risk for essentially all chronic health conditions including hearing loss and tinnitus. Evidence of nutrients with antioxidant, anti-inflammatory, and anti-ischemic properties, and overall healthy diet quality as otoprotective strategies are slowly accumulating, but many questions remain unanswered. In this article, the authors will discuss (1) animal models in nutritional research, (2) evidence of dietary nutrient-based otoprotection, and (3) consideration of confounds and limitations to nutrient and dietary study in hearing sciences. Given that there are some 60 physiologically essential nutrients, unraveling the intricate biochemistry and multitude of interactions among nutrients may ultimately prove infeasible; however, the wealth of available data suggesting healthy nutrient intake to be associated with improved hearing outcomes suggests the development of evidence-based guidance regarding diets that support healthy hearing may not require precise understanding of all possible interactions among variables. Clinical trials evaluating otoprotective benefits of nutrients should account for dietary quality, noise exposure history, and exercise habits as potential covariates that may influence the efficacy and effectiveness of test agents; pharmacokinetic measures are also encouraged.

Diet quality and hearing loss among middle-older aged adults in the USA: findings from National Health and Nutrition Examination Survey

OBJECTIVE

To examine the associations between overall diet quality and hearing function among middle-older aged adults in the USA.

DESIGN

Cross-sectional analysis. Diet quality was examined using the Mediterranean Diet Score (MDS), using data from a single 24 h dietary recall. Hearing function was objectively measured by audiometry assessments and hearing loss, including high- and low-frequency hearing loss, was defined as pure-tone averages at specific ranges of hearing frequencies >25 dB. Weighted logistic regression analyses were performed to examine the associations of MDS (scored 0-9, categorized at the median as ≤3 or >3) with hearing loss and high- and low-frequency hearing loss.

SETTING

National Health and Nutrition Examination Surveys 2000-2006 and 2009-2012.

PARTICIPANTS

Adults aged ≥50 years (n 1639) with valid dietary and audiometry assessments.

RESULTS

After adjusting for potential confounders, a non-significant trend for a protective association of higher MDS was observed for hearing loss (OR = 0·78; 95 % CI 0·49, 1·23). A significant inverse association was observed for high-frequency hearing loss (OR = 0·64; 95 % CI 0·43, 0·95). No association was found for low-frequency hearing loss among women; however, higher MDS was significantly associated with higher odds of low-frequency hearing loss among men (OR = 2·63; 95 % CI 1·39, 4·95).

CONCLUSIONS

Among middle-older aged adults, adherence to a Mediterranean-style diet was inversely associated with hearing loss, including those at high hearing frequencies, among older adults. However, a detrimental association was observed at low hearing frequencies among men. Future investigations with a longitudinal design are needed to clarify the associations between diet quality and hearing loss.

Otoprotectants: From Research to Clinical Application

There is an urgent need for otoprotective drug agents. Prevention of noise-induced hearing loss continues to be a major challenge for military personnel and workers in a variety of industries despite the requirements that at-risk individuals use hearing protection devices such as ear plugs or ear muffs. Drug-induced hearing loss is also a major quality-of-life issue with many patients experiencing clinically significant hearing loss as a side effect of treatment with life-saving drug agents such as cisplatin and aminoglycoside antibiotics. There are no pharmaceutical agents approved by the United States Food and Drug Administration for the purpose of protecting the inner ear against damage, and preventing associated hearing loss (otoprotection). However, a variety of preclinical studies have suggested promise, with some supporting data from clinical trials now being available as well. Additional research within this promising area is urgently needed.

Dietary patterns and hearing loss in older men enrolled in the Caerphilly Study

The association between dietary patterns (DP) and prevalence of hearing loss in men enrolled in the Caerphilly Prospective Study was investigated. During 1979-1983, the study recruited 2512 men aged 45-59 years. At baseline, dietary data were collected using a semi-quantitative FFQ, and a 7-d weighed food intake (WI) in a 30 % subsample. Five years later, pure-tone unaided audiometric threshold was assessed at 0·5, 1, 2 and 4 kHz. Principal component analysis (PCA) identified three DP and multiple logistic and ordinal logistic regression models examined the association with hearing loss (defined as pure-tone average of frequencies 0·5, 1, 2 and 4 kHz &gt;25 dB). Traditional, healthy and high-sugar/low-alcohol DP were found with both FFQ and WI data. With the FFQ data, fully adjusted models demonstrated significant inverse association between the healthy DP and hearing loss both as a dichotomous variable (OR=0·83; 95 % CI 0·77, 0·90; P&lt;0·001) and as an ordinal variable (OR=0·87; 95 % CI 0·81, 0·94; P&lt;0·001). With the WI data, fully adjusted models showed a significant and inverse association between the healthy DP and hearing loss (OR=0·85; 95 % CI 0·73, 0·99; P&lt;0·03), and a significant association between the traditional DP (per fifth increase) and hearing loss both as a dichotomous variable (OR=1·18; 95 % CI 1·02, 1·35; P=0·02) and as an ordinal variable (OR=1·17; 95 % CI 1·03, 1·33; P=0·02). A healthy DP was significantly and inversely associated with hearing loss in older men. The role of diet in age-related hearing loss warrants further investigation.

Interplay between Nutrition and Hearing Loss: State of Art

Hearing loss has been recently ranked as the fifth leading cause of years lived with disability, ahead of many other chronic diseases such as diabetes, dementia, or chronic obstructive pulmonary disease. Moreover, according to the World Health Organization, moderate-to-profound hearing loss affects about 466 million people worldwide. Its incidence varies in each population segment, affecting approximately 10% of children and increasing to 30% of the population over 65 years. However, hearing loss receives still very limited research funding and public awareness. This sensory impairment is caused by genetic and environmental factors, and among the latter, the nutritional status has acquired relevance due its association to hearing loss detected in recent epidemiological studies. Several experimental models have proved that the onset and progression of hearing loss are closely linked to the availability of nutrients and their metabolism. Here, we have reviewed studies focused on nutrient effects on auditory function. These studies support the potential of nutritional therapy for the protection against hearing loss progression, which is especially relevant to the aging process and related quality of life.

Associations of food insecurity and psychosocial measures with diet quality in adults aging with HIV

People aging with HIV face social stressors which may negatively affect their overall nutrition. Here, we assess relationships between self-reported measures of depression, perceived stress, social support, and food insecurity with diet quality in older adults with HIV. A retrospective analysis of self-reported data from parent study at The University of Alabama at Birmingham 1917 HIV Clinic was performed. The study sample consisted of sixty people living with HIV (PLWH) with controlled HIV infection (<50 copies/mL), aged 50 years or older who participated in a cross-sectional microbiome study. Dietary intake was measured using the NHANES 12-month Food Frequency Questionnaire (FFQ) and three Automated Self-Administered (ASA) 24-hr diet recalls to calculate diet quality scores using the Mediterranean Diet Score (MDS); alternative Healthy Eating Index (aHEI); and the Recommended Food Score (RFS) indices. Food insecurity was measured with the Food Security Questionnaire (FSQ). Participants completed the following psychosocial scales: (1) depression - Patient Health Questionnaire-8 (PHQ8); (2) perceived stress - Perceived Stress Scale (PSS-10); (3) social support - Multidimensional Scale of Perceived Social Support (MSPSS). Linear regression models were used to investigate relationships among variables controlling for gender and income. The cohort was characterized as follows: Mean age 56 ± 4.6 years, 80% African-American, and 32% women. Mean body mass index (BMI) was 28.4 ± 7.2 with 55% reporting food insecurity. Most participants reported having post-secondary education (53%), although 77% reported annual incomes <$20,000. Food insecurity was independently associated with measures of poor dietary intake: aHEI (β = -0.08, p = .02) and MDS (β = -0.23, p < 0.01) and with low dietary intake of fibre (β = -0.27, p = .04), vitamin E (β = -0.35, p = .01), folate (β = -0.31, p = .02), magnesium (β = -0.34, p = .01) and copper (β = -0.36, p = .01). These data indicate food insecurity is associated with poor diet quality among PLWH. Clinical interventions are needed to improve food access for PLWH of low SES.

Adherence to Healthful Dietary Patterns Is Associated with Lower Risk of Hearing Loss in Women

Background

Specific nutrients have been associated with hearing status, but associations between healthful dietary patterns and risk of hearing loss have not been prospectively evaluated.

Objective

We sought to prospectively examine the relations between adherence to the Alternate Mediterranean diet (AMED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010), and risk of hearing loss.

Methods

We conducted a longitudinal cohort study (1991-2013) of 81,818 women in the Nurses' Health Study II, aged 27-44 y at baseline. We assessed diet every 4 y with the use of food frequency questionnaires and calculated AMED, DASH, and AHEI-2010 adherence scores. Baseline and updated information from validated biennial questionnaires was used in Cox proportional hazards regression models to examine independent associations between adherence scores and risk of self-reported moderate or worse hearing loss.

Results

During >1 million person-years of follow-up, 2306 cases of moderate or worse hearing loss were reported. Higher cumulative average AMED and DASH scores were significantly inversely associated with risk of hearing loss. For women with scores in the highest compared with the lowest quintile, the multivariable-adjusted relative risks (MVRRs) of hearing loss were 0.70 (95% CI: 0.60, 0.82) (P-trend <0.001) for AMED and 0.71 (95% CI: 0.61, 0.83) (P-trend <0.001) for DASH. Higher recent AHEI-2010 score was also associated with lower risk [MVRR = 0.79 (95% CI: 0.69, 0.91); P-trend <0.001]. Among participants with additional hearing-related information (n = 33,102), higher cumulative average adherence scores for all 3 dietary patterns were associated with lower risk; the MVRR was 0.63 (95% CI: 0.49, 0.81) for AMED, 0.64 (95% CI: 0.50, 0.83) for DASH, and 0.71 (95% CI: 0.56, 0.89) for AHEI-2010.

Conclusion

Adherence to healthful dietary patterns is associated with lower risk of hearing loss in women. Consuming a healthy diet may be helpful in reducing the risk of acquired hearing loss.

Menopause and postmenopausal hormone therapy and risk of hearing loss

OBJECTIVE

Menopause may be a risk factor for hearing loss, and postmenopausal hormone therapy (HT) has been proposed to slow hearing decline; however, there are no large prospective studies. We prospectively examined the independent relations between menopause and postmenopausal HT and risk of self-reported hearing loss.

METHODS

Prospective cohort study among 80,972 women in the Nurses' Health Study II, baseline age 27 to 44 years, followed from 1991 to 2013. Baseline and updated information was obtained from detailed validated biennial questionnaires. Cox proportional-hazards regression models were used to examine independent associations between menopausal status and postmenopausal HT and risk of hearing loss.

RESULTS

After 1,410,928 person-years of follow-up, 18,558 cases of hearing loss were reported. There was no significant overall association between menopausal status, natural or surgical, and risk of hearing loss. Older age at natural menopause was associated with higher risk. The multivariable-adjusted relative risk of hearing loss among women who underwent natural menopause at age 50+ years compared with those aged less than 50 years was 1.10 (95% confidence interval [CI] 1.03, 1.17). Among postmenopausal women, oral HT (estrogen therapy or estrogen plus progestogen therapy) was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk (P trend < 0.001). Compared with women who never used HT, the multivariable-adjusted relative risk of hearing loss among women who used oral HT for 5 to 9.9 years was 1.15 (95% CI 1.06, 1.24) and for 10+ years was 1.21 (95% CI 1.07, 1.37).

CONCLUSIONS

Older age at menopause and longer duration of postmenopausal HT are associated with higher risk of hearing loss.

Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003-2004 National Health And Nutrition Examination Survey (NHANES)

BACKGROUND/OBJECTIVES

Studies based on food frequency questionnaires suggest that folate and vitamin B12 intake could protect against hearing loss. We investigated whether erythrocyte folate and serum vitamin B12 levels are independently associated with hearing loss in humans.

SUBJECTS/METHODS

Participants in the 2003-2004 US National Health and Nutrition Examination Survey who had data on hearing, folate, and vitamin B12 levels were included. Pure-tone average (PTA) at 0.5, 1.0, 2.0, and 4.0 kHz was computed for each ear. We used weighted logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the relation between quartiles of folate and vitamin B12, and hearing loss (present if PTA > 25 dB in either ear and absent if PTA ≤ 25 dB in both ears).

RESULTS

Participants (n = 1149) were 20-69 (mean 42) years old and 16.4% had hearing loss in at least one ear. Our data suggest a U-shaped relationship between folate and hearing loss. Compared to the 1st quartile, the ORs (95% CIs) for hearing loss were 0.87 (0.49-1.53), 0.70 (0.49-1.00), and 1.08 (0.61-1.94) for the 2nd, 3rd, and 4th quartile of erythrocyte folate in analyses adjusted for age, sex, vitamin B12, smoking, alcohol use, body mass index, race/ethnicity, exposure to noise, income, and education. Although we observed inverse associations between vitamin B12 and hearing loss, the associations were not statistically significant (P > 0.05).

CONCLUSIONS

Our data show a U-shaped relationship between erythrocyte folate levels and hearing loss, suggesting a need to evaluate whether optimizing blood folate levels could prevent hearing loss.

Skin Pigmentation and Risk of Hearing Loss in Women

Black individuals have a lower risk of hearing loss than do whites, possibly because of differences in cochlear melanocytes. Previous studies have suggested that darker-skinned individuals tend to have more inner ear melanin, and cochlear melanocytes are important in generating the endocochlear potential. We investigated the relationship between self-reported hearing loss and skin pigmentation by using hair color, skin tanning ability, and skin reaction to prolonged sun exposure as surrogate measures of pigmentation among 49,323 white women in the Nurses' Health Study. Cox proportional hazards regression models were used to adjust for potential confounders. During 1,190,170 person-years of follow-up (1982-2012), there was no association between risk of hearing loss and hair color (for black hair vs. red or blonde hair, multivariable-adjusted relative risk (RR) = 0.99, 95% confidence interval (CI): 0.90, 1.09), skin tanning ability (for dark tan vs. no tan, multivariable-adjusted RR = 0.98, 95% CI: 0.92, 1.05), skin reaction to prolonged sun exposure (for painful burn with blisters vs. practically no reaction, multivariable-adjusted RR = 1.01, 95% CI: 0.93, 1.08), or Fitzpatrick skin phototype (for type IV vs. type I, multivariable-adjusted RR = 0.99, 95% CI: 0.92, 1.05). In our cohort of white women, surrogates for skin pigmentation were not associated with risk of hearing loss.

Duration of Analgesic Use and Risk of Hearing Loss in Women

Aspirin, nonsteroidal antiinflammatory drugs (NSAID), and acetaminophen are commonly used. Frequent use of analgesics has been associated with a higher risk of hearing loss. However, the association between duration of analgesic use and the risk of hearing loss is unclear. We investigated the relationship between duration of analgesic use and self-reported hearing loss among 55,850 women in the Nurses' Health Study. Cox proportional hazards regression was used to adjust for potential confounders. During 873,376 person-years of follow-up (1990-2012), longer durations of NSAID use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.10, 95% confidence interval: 1.06, 1.15; P for trend < 0.001) and acetaminophen use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.09, 95% confidence interval: 1.04, 1.14; P for trend < 0.001) were associated with higher risks of hearing loss. Duration of aspirin use was not associated with hearing loss (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.01, 95% confidence interval: 0.97, 1.05; P for trend = 0.35). In this cohort of women, longer durations of NSAID and acetaminophen use were associated with slightly higher risks of hearing loss, but duration of aspirin use was not. Considering the high prevalence of analgesic use, this may be an important modifiable contributor to hearing loss.

Dietary supplement comprised of β-carotene, vitamin C, vitamin E, and magnesium: failure to prevent music-induced temporary threshold shift

This study examined potential prevention of music-induced temporary threshold shift (TTS) in normal-hearing participants. A dietary supplement composed of β-carotene, vitamins C and E, and magnesium was assessed using a randomized, placebo-controlled, double-blind study design. Dosing began 3 days prior to the music exposure with the final dose consumed approximately 30-min pre-exposure. There were no group differences in post-exposure TTS or music-induced decreases in distortion product otoacoustic emission (DPOAE) amplitude. Transient tinnitus was more likely to be reported by the treatment group, but there were no group differences in perceived loudness or bothersomeness. All subjects were monitored until auditory function returned to pre-exposure levels. Taken together, this supplement had no effect on noise-induced changes in hearing. Recommendations for future clinical trials are discussed.

Hypertension, Diuretic Use, and Risk of Hearing Loss

BACKGROUND

Hearing loss is highly prevalent among adults in the United States. Hypertension also is common and often treated with diuretics. Hypertension may increase the risk of hearing loss by decreasing vascular supply to the stria vascularis. Use of thiazides has been anecdotally associated with hearing loss. In small studies, furosemide use has been associated with hearing loss that is usually reversible, but can be permanent. We investigated the relation among hypertension, diuretic use, and hearing loss in a prospective cohort of 54,721 women in the Nurses' Health Study I, 1994 to 2012.

METHODS

Eligible participants included 54,721 female nurses aged 48 to 73 years in 1994 who provided information on thiazide diuretic and furosemide use in 1994, answered the question on hearing loss over their lifetime in 2012, and did not report hearing loss with date of onset before date of onset of hypertension diagnosis or medication use. The outcome was self-reported hearing loss. Cox proportional hazards regression was used to adjust for potential confounders.

RESULTS

During 774,096 person-years of follow-up, 19,296 cases of hearing loss were reported (incidence rate, 25 cases per 1000 person-years). At baseline in 1994, the mean age was 57.9 years and mean body mass index was 26.3 kg/m(2). Some 30.8% of participants had a history of hypertension. History of hypertension was independently associated with a modestly higher risk of hearing loss (multivariable adjusted relative risk, 1.04 [1.01-1.07]). Among women with a history of hypertension, neither thiazide diuretic (multivariable adjusted relative risk, 1.07 [0.99-1.16]) nor furosemide use (multivariable adjusted relative risk, 0.91 [0.75-1.09]) was significantly associated with risk of hearing loss when compared with women not taking antihypertensive medications. There was no significant effect modification by age.

CONCLUSIONS

History of hypertension was associated with a small increased risk of hearing loss. Thiazide diuretic use and furosemide use were not associated with risk of hearing loss among women with a history of hypertension.