Factors associated with age related hearing loss

doi:10.21203/rs.3.rs-5278533/v1

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Factors associated with age related hearing loss

https://doi.org/10.21203/rs.3.rs-5278533/v1

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Background

Age-related hearing impairment (ARHI) is a multifaceted degenerative condition in older adults. Since various factors contribute to the development of ARHI, it is crucial to identify the key influencing elements to better understand and prevent its progression.

Methods

A cross-sectional study using a questionnaire was carried out with 100 patients. Demographic information was collected during the first visit. Additionally, personal medical history and lifestyle factors, such as smoking and alcohol consumption, were assessed through a structured questionnaire. The patients' histories of cardiovascular disease, diabetes mellitus, and cerebrovascular conditions were recorded, along with any medications they were taking. Furthermore, they were asked about related symptoms, including tinnitus and vertigo.

Results

The study sample consisted of 100 patients, with a mean age of 73.44 years and a standard deviation of 4.52 years. An analysis of the medical histories revealed that 25 patients had hypertension (25%), while 13 patients had diabetes (13%). Among the auricular symptoms reported, tinnitus emerged as the most common, affecting 45 patients (45%). When asked about previously diagnosed ear conditions, 15 patients reported a diagnosis of tympanic membrane perforation (15%). In terms of genetic background, 16 patients (16%) had a family history of hearing loss. Regarding medication usage, beta-blockers were the most frequently prescribed, with 38 patients currently taking this medication.

Conclusion

The occurrence of age-related hearing impairment (ARHI) is common among older adults, and various factors may interact throughout its progression. The results of this study can be instrumental in counseling high-risk individuals regarding the significance of regular audiological evaluations.

Otorhinolaryngology

hearing loss

hypertension

diabetes.

Age-related hearing impairment (ARHI), also known as presbycusis, is a multifaceted and progressively degenerative condition that impacts cognitive, emotional, and social functioning among older adults [1]. Research indicates that hearing sensitivity declines markedly with advancing age, with the prevalence of hearing loss approximately doubling every decade from the 20s to the 70s. According to a recent epidemiological study, utilizing a threshold of 25 dB HL to define hearing loss, the prevalence of ARHI in individuals over 70 years of age was found to be 68.1% [2]. Furthermore, as populations age, a growing proportion of individuals is expected to experience ARHI in the near future.

Age-related hearing impairment (ARHI) does not manifest uniformly across all individuals. Despite extensive research over the years, there remains a lack of reliable methods to predict who is at the greatest risk, as well as no definitive strategies for prevention and treatment. While the precise pathophysiological mechanisms underlying ARHI are not fully understood, numerous intrinsic (genetic) and extrinsic (environmental) factors have been suggested to contribute to its development over time [3]. Given that multiple factors interact to create cumulative effects, it is crucial to identify the key influencing factors associated with ARHI in order to better understand and mitigate its progression.

Several cross-sectional studies have identified potential risk factors related to age-related hearing impairment (ARHI), including male gender, advancing age, hypertension, cardiovascular disease, cerebrovascular disease, smoking, diabetes, and exposure to noise [4, 5]. However, the risk factors identified in these cross-sectional studies only provide a snapshot of the condition's causality, lacking definitive evidence of a temporal relationship between exposure and outcome. These limitations inherent in cross-sectional studies could be addressed through a longitudinal design. To date, few epidemiological studies have examined the risk factors associated with ARHI over time in adults [6]. Additionally, there is a lack of studies that have conducted comprehensive laboratory profiling and analysis of risk factors within a large population cohort.

The objective of this study was to identify the risk factors linked to the development of age-related hearing impairment (ARHI) in adults.

A cross-sectional study utilizing a questionnaire was conducted involving 100 patients. Demographic data were gathered during the initial visit. Furthermore, personal medical history and lifestyle factors, including cigarette smoking and alcohol consumption, were evaluated using a structured questionnaire. The patients' history of cardiovascular diseases, diabetes mellitus, and cerebrovascular diseases was documented, along with any medications they were taking. Additionally, patients were asked about associated symptoms such as tinnitus and vertigo.

Statistical analysis:

Our study's statistical analysis was completed using SPSS Version 27 for Windows (IBM Corp., Armonk, NY, USA). 5% was chosen as the degree of significance. For continuous variables, means and standard deviations (SDs) were used to describe the sample's characteristics, while for categorical variables, frequencies and percentages were used.

The study sample comprised 100 patients, with an average age of 73.44 years and a standard deviation of 4.52 years. The youngest participant was 62 years old, while the oldest was 86 years old. Among the patients, 42 were male (42%), and 58 were female (58%). Regarding smoking status, 24 patients identified as smokers (24%), whereas the remaining 76 patients were non-smokers (76%).

Examining the medical histories of the sample, we found that 25 patients had hypertension (25%), while 13 patients had diabetes (13%). Hypertension and diabetes co-occurred in 18 patients (18%), and only one patient had diabetes alongside asthma. Additionally, 43 patients reported no history of illness (43%). (Table 1).

Table 1

Clinical Characteristics.
Age
Mean (± SD)	73.44 (± 4.52)
Lowest value	62
Biggest value	86
Gender	N (%)
Male	42 (42)
Female	58 (58)
Smoking
Yes	24 (24)
No	76 (76)
Medical history
Hypertension	25 (25)
Diabetes	13 (13)
Hypertension + diabetes	18 (18)
Diabetes + Asthma	1 (1)
Nothing	43 (43)

Regarding the auricular symptoms reported by the patients, tinnitus was identified as the most prevalent symptom, affecting 45 patients (45%). Vertigo occurred concurrently with tinnitus in 25 patients (25%), while vertigo as an isolated symptom was observed in 14 patients (14%). The remaining 16 patients (16%) did not report any auricular symptoms.

When inquired about previously diagnosed ear conditions, 15 patients indicated a diagnosis of tympanic membrane perforation (15%), while 10 patients reported having vestibular vertigo (10%). The remaining 75 patients (75%) did not mention any prior diagnoses of ear diseases.

In terms of genetic history, 16 patients (16%) had a positive family history of hearing loss, while the other 84 patients (84%) did not report any such history.

Concerning the medications taken by the patients, beta-blockers were the most commonly used, with 38 patients on this medication. Additionally, 33 patients reported using angiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors. Antiplatelet agents and metformin were mentioned by 28 and 27 patients, respectively. (Table 2).

Table 2

Hearing loss related condition.
Auricular symptoms	N (%)
Vertigo	14 (14)
Tinnitus	45 (45)
Tinnitus + Vertigo	25 (25)
Nothing	16 (16)
Previously diagnosed ear conditions
Tympanic membrane perforation	15 (15)
Vestibular vertigo	10 (10)
Nothing	75 (75)
Genetic history to age related hearing loss
Yes	16 (16)
No	84 (84)
Taking any medication
Yes	66 (66)
No	34 (34)
Medication
Angiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors	33 (16)
Antiplatelet	28 (14)
Beta-blockers	38 (18)
Calcium Channel Blocker	5 (2)
Diuretics	11 (5)
Gliptin	13 (6)
Metformin	27 (13)
Statin	13 (6)

More than 5% of the global population experiences hearing loss, defined as a reduction in hearing ability of more than 40 decibels in the better hearing ear for adults, and over 30 decibels for children. According to the World Health Organization, it is projected that by 2050, over 900 million people—approximately one in ten—will have disabling hearing loss [7]. The most prevalent cause of hearing loss in older adults is age-related hearing decline. Other contributing factors to hearing impairment in adulthood include chronic otitis media and noise-induced trauma [8].

Hearing loss can have significant health implications, as it is linked to cognitive impairment [9], an elevated risk of falls [10], accelerated progression of dementia [11], social isolation, and mental health disorders such as depression, anxiety, and schizophrenia [12, 13]. As a result, hearing loss ranks as the fourth leading cause of years lived with disability for men and the seventh for women in the Global Burden of Disease study [14], surpassing several other conditions such as stroke, falls, and dementia.

Presbycusis, or age-related hearing loss (ARHL), is a gradual loss of hearing that affects most individuals as they age. According to the World Health Organization [15], nearly one-third of people over 65 experience disruptive hearing loss. By 2025, the global population of individuals aged 60 and above is expected to reach 1.2 billion, with over 500 million suffering from significant age-related deafness [15].

Epidemiological studies of large cohorts of older adults indicate that hearing sensitivity declines more rapidly in men after the age of 20 to 30, while in women, this acceleration begins after the age of 50 [5, 16]. Hearing thresholds for men show a steep increase in high-frequency hearing loss, whereas women’s hearing loss tends to follow a more gradual decline. Presbycusis is the leading cause of hearing loss worldwide, affecting nearly two-thirds of Americans aged 70 and older [17]. These findings align closely with the results of our study, where the average age of patients with age-related hearing loss was 73.44 years.

There is evidence in the literature suggesting that sex may play a role in the development of sensorineural hearing loss (SNHL). Hearing loss is more prevalent in older men compared to older women [18]. In Europe, the estimated prevalence of presbycusis, the most common sensory disorder in the elderly, is approximately 20% in females and 30% in males over the age of 70 [18]. Clinical data reveal a distinct sex-related pattern in presbycusis, with men experiencing an earlier decline in hearing thresholds than women [18]. However, understanding the influence of sex and gender-related factors in the onset of presbycusis is challenging due to the multifactorial nature of age-related hearing loss. Interestingly, the results from our study showed a higher proportion of females affected by presbycusis compared to males (58% versus 42%). Recent research indicates that the sex-related differences in audiometric patterns among older adults have diminished significantly, potentially due to changes in lifestyle and environmental factors between the sexes over the past two decades [18].

Cigarette smoking may impact hearing by disrupting antioxidant mechanisms or affecting the blood vessels that supply the auditory system [19, 20]. Several clinical studies have identified a correlation between smoking and hearing loss in adults. Weiss found that men who smoked more than one pack per day exhibited poorer hearing thresholds at frequencies between 250 and 1,000 Hz compared to non-smokers or "light" smokers, though no differences were observed at higher frequencies [21]. Siegelaub et al., in a large study involving 33,146 men and women, reported that among men with no history of noise exposure, current smokers were more likely than non-smokers to experience hearing loss at 4,000 Hz, although the effect size was minimal [22]. No such association was observed among women. Conversely, the Baltimore Longitudinal Study of Aging found no link between smoking and hearing loss in a sample of 531 upper-middle-class white men [23]. The findings of our study align with previous global research, as only 24% of patients with age-related hearing loss were smokers.

Hearing loss, tinnitus, and dizziness are linked to factors such as smoking, hypertension, diabetes, lifestyle choices, age, medical history, and occupational noise exposure, with auditory symptoms often correlating with cumulative lifetime noise exposure [24–26]. Our study produced results consistent with these findings, as 25% of patients with age-related hearing loss had hypertension, 13% had diabetes, and 18% had both conditions. Global studies have similarly found an association between diabetes, hypertension, and auditory symptoms such as dizziness, tinnitus, and hearing loss, identifying diabetes and hypertension as the most common conditions related to hearing disorders [27, 28].

The most common causes of tinnitus associated with hearing loss are noise-induced hearing loss and age-related hearing loss [29]. In our study, the largest proportion of patients with presbycusis (45%) experienced tinnitus, which aligns with global findings. A study conducted in Korea examined 1,868 tinnitus patients who visited the hospital during the study period, including 137 patients with presbycusis and 111 with noise-induced hearing loss. There were no statistically significant differences between these two groups in terms of age, sex, diabetes, or hypertension rates (p > 0.05 for each). Additionally, associated symptoms such as dizziness and ear fullness were more common in patients with presbycusis, but the differences were not statistically significant (p > 0.05 for each).

Many individuals with age-related hearing loss (presbycusis) report a family history of the condition in their parents, siblings, or other close relatives. However, it is often challenging to document the nature and extent of familial hearing loss, and this information is rarely recorded [30]. Our study yielded similar results, with only 18% of patients reporting a family history of presbycusis.

Another contributing factor to earlier onset of age-related hearing loss is the use of ototoxic medications. Exposure to drugs such as aminoglycoside antibiotics (e.g., streptomycin, gentamicin, amikacin), NSAIDs, loop diuretics, antitumor agents (e.g., cisplatin), or inhalation of toxic gases (carbon monoxide, hydrogen sulfide) can all lead to ARHL [31]. In our study, several patients were taking various medications, including 5% who were using loop diuretics.

The development of age-related hearing impairment (ARHI) is prevalent in the elderly, and multiple factors may interact during its progression. The findings from this study can be valuable for advising high-risk adults about the importance of regular audiological assessments.

Acknowledgments:

We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We are thankful to everyone who participated in this study.

Funding:

This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Ethics approval and consent to participate:

This study was approved by the Institutional Review Board (IRB) at the Syrian Private University (SPU). All Participants confirmed their written consent by signing the consent form. Participation in the study was voluntary and participants were assured that anyone who was not inclined to participate or decided to withdraw after giving consent would not be victimized. All information collected from this study was kept strictly confidential.

Consent for Publication:

Not applicable.

Competing interests:

The authors declare that they have no competing interests.

Authors’ contributions:

OABS was responsible for study design, literature search, and write-up; LDN participated in literature search and write-up; LDN participated in the study design and reviewed the final draft. All authors read and approved the final draft.

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The authors declare no competing interests.

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Factors associated with age related hearing loss

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Abstract

Introduction

Methods

Statistical analysis:

Results

Discussion

Conclusion

Declarations

References

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