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| Year : 2006
| Volume
: 8 | Issue : 31 | Page
: 88-94 |
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| Age-related hearing loss and blood pressure |
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Ulf Rosenhall1, Valter Sundh2
1 Department of Clinical Neuroscience, Section of Technical and Clinical Audiology, Karolinska Institute/ Department of Audiology, Karolinska Hospital, Stockholm, Sweden
2 Department of Geriatric Medicine, Göteborg University Göteborg, Sweden
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A review of the literature studying possible correlations between hearing function and cardiovascular disease (CVD) reveals a complex and somewhat contradictory picture. Most studies favor the concept of an association between hearing loss and CVD. The issue of interactions between noise-induced hearing loss and CVD, as well as between age-related hearing loss and CVD, has been discussed in numerous publications. The present study utilizes information from an epidemiological study of elderly people in Gothenburg, Sweden. We found a probable correlation between high systolic blood pressure and hearing loss in the low and mid frequencies in elderly women, 79 years old. A tendency of a similar correlation was also found in a group of 85-year-old women. An association between high diastolic blood pressure and low- and mid-frequency hearing loss was also found in the group of women aged 85 years. No consistent associations between blood pressure or hypertension and auditory function were found in 70- and 75-year-old women or in men 70 to 85 years old. Keywords: Arterial hypertension, diastolic blood pressure, hearing loss, presbyacusis, systolic blood pressure
How to cite this article:
Rosenhall U, Sundh V. Age-related hearing loss and blood pressure. Noise Health 2006;8:88-94 |
Age-related hearing loss is a highly multifactorial process involving a multitude of intrinsic and extrinsic factors. A relationship between cardiovascular disease (CVD) and poor hearing in old age was proposed almost 40 years ago. [1] The issue has been discussed for almost half a century. Even in the earlier literature, there was no consensus regarding the influence of CVD on auditory function. In two large earlier studies, no correlation between hearing and CVD was found. [2],[3]
Many cardiovascular factors have been analyzed in conjuncture with hearing capacity: arterial hypertension and hypotension, coronary heart disease, myocardial infarction, ischemic heart disease, atherosclerosis, intermittent claudication and stroke. Important factors for the development of CVD are rheological properties of blood, e.g., hyperlipidemia, hyperlipoproteinemia, hypercholesterolemia and alterations of blood viscosity. In a number of reports, correlations between auditory function and rheological alterations have been described. [4],[5],[6],[7],[8] However, in a critical review of the literature regarding lipid alterations, Ray [9] summarized that the evidence supporting a relationship between presbyacusis and hyperlipoproteinemia remained questionable. Pyykko et al. [10] found a significant correlation between LDL-cholesterol level and hearing loss but not between systolic blood pressure and hearing loss. However, in another study from the same research group, an association between serum cholesterol levels and blood pressure in the genesis of noise-induced hearing loss (NIHL) was reported. [11]
In an epidemiological study of elderly persons, Gates et al. [12] reported that low-frequency hearing (0.25 to 1 kHz) was related to CVD events in both genders, especially women. Fuortes et al. [13] found that systolic blood pressure and cholesterol level were independently associated with decline in auditory sensitivity.
The role of noise exposure in the etiology of hypertension is unclear. [14] There is a risk for hypertension in men (but not women), associated with high noise annoyance. [15] Since high noise levels might cause NIHL, there might be an interaction between exposure to noise, stress, NIHL and hypertension. One hypothesis is that there may be a population at increased risk for both hearing loss and high blood pressure. This is in accordance to animal studies in which genetically hypertensive rats have been found to be more susceptible to NIHL than normotensive rats. [16] However, animals with induced hypertension showed no correlation between hearing loss and systolic blood pressure. [17],[18] This observation does not support the hypothesis that hypertension directly interacts with noise exposure.
Pillsbury [19] studied spontaneously hypertensive rats and normotensive rats with regard to effects of noise, hyperlipoproteinemia and hypertension. He described synergistic effects of genetically determined hypertension and atherogenic diet on the pathogenesis of NIHL. Mosnier et al. [20] studied effects of acute and chronic hypertension on labyrinthine barriers in rats. They found that the endocochlear potential was stable in spontaneously hypertensive rats and in 60% of normotensive rats in acute, induced hypertension. A vascular protective mechanism in the cochlea was proposed to explain this observation.
Correlations between hearing loss - above all, NIHL and exposure to noise - and CVD have been investigated. Axelsson and Lindgren [21] found an association between both high- and low-cholesterol levels and NIHL. Talbott et al. [22],[23] reported that severe NIHL was an independent predictor of hypertension in retired metal assembly workers, 64 years or older. Milkovic-Kraus [24] found that systolic and diastolic blood pressure was increased in noise-exposed workers, who also had hearing loss. Tarter and Robins [25] studied industrial workers exposed to noise and reported that hearing loss at 4 kHz was significantly associated with blood pressure and hypertension among black workers but not among white workers. However, there is no general consensus regarding this issue: Hirari et al. [26] did not find any significant relationship between NIHL and hypertension.
Factors other than exposure to noise (e.g., diabetes mellitus and life-style factors like smoking, physical fitness and dietary habits) could also be interactive with CVD for possible development of hearing loss. Duck et al. [27] investigated interactions between diabetes and auditory function in both clinical and animal studies. Insulin-dependent diabetes and hypertension were found to have a synergistic effect on high-frequency hearing loss. Diabetic end-organ damage was intensified by concomitant hypertension. Manson et al. [28] described a synergism between cardiovascular health and hearing. A high fit group had better hearing than a low fit group.
A correlation between arterial hypotension and hearing loss, often affecting the low frequencies, has been proposed. [29] This possible correlation has been observed in cases with sudden hearing loss. [30],[31] To make things more complicated, arterial hypertension has also been associated with sudden deafness. [32]
As can be seen in this review of the literature, the reported results regarding CVD and hearing loss have been highly variable and difficult to amalgamate into a distinct picture. The aim of the present study was to investigate possible associations between blood pressure, as well as arterial hypertension, and hearing in old age by using data from an epidemiological investigation, the longitudinal and cross-sectional gerontological and geriatric population study of 70-year-olds in Gothenburg, Sweden (H70). This investigation offers possibilities to study the influence of various health factors on the hearing capacity in old age. The study, which started in 1971, has the goal to investigate the nature of 'normal' aging processes and to study the prevalence and incidence of different diseases in old age. [33]
Study populations
The participants of the study belong to three age cohorts. The participants were born in 1901-02 (cohort 1), in 1906-07 (cohort 2) and in 1922 (cohort 3). Cohort 1 was studied longitudinally at the age of 70, 75, 79 and 85 years. At age 70, 197 women and 179 men were included. At age 85, the number of participants who had taken part in the entire investigation was small, and an influx of new participants from the same general population was arranged. At 85 years of age, 249 (154 women and 95 men) participants were studied, and of them 197 (79%) were recruited for the first time. For this reason, the 85-year-olds can be regarded as a separate age cohort. Cohort 2 consisted of 297 seventy-year-olds, 171 women and 126 men. Cohort 3 consisted of 276 seventy-year-olds, 163 women and 113 men. The total study sample consisted of 1,146 subjects, 660 women and 486 men, tested on 1,623 occasions. For information regarding sampling procedures and response rates. [34],[35]
| Materials and Methods | |  |
All participants were tested with pure tone audiometry according internationally accepted methods. They were also tested with a comprehensive medical test battery including examination of arterial systolic and diastolic blood pressure. The systolic and diastolic blood pressures were divided into quartiles. One quartile consisted of those with the highest blood pressure. The other three quartiles consisted of those with medium high, medium low and the lowest blood pressures. The pure tone threshold of the different four blood pressure quartiles was estimated. Besides, a thorough medical history was taken, including information about treatment for arterial hypertension, and this information was also compared with the audiometric results.
Statistical method
A one-sided Pitman permutation test was used to test the statistical significance of correlation coefficients or differences between groups. ' P' < 0.05 was considered as statistically significant. Occasional significant 'P' values were not taken into consideration and only consistent tendencies were accepted. This means that significant differences had to involve two or more neighboring frequencies in order to be accepted or to affect more than one age cohort of the same age and sex. Moreover, a correlation had to be a consistent finding in both ears to be regarded as reliable. Acceptance of an association between auditory function and blood pressure includes the presence of a gradual audiometric change of the four quartiles from high to low blood pressure. A number of significant 'P' values occurred in a sporadic way, wherein this was rejected.
| Results | | |
Systolic blood pressure, 70- to 75-year-olds
In men there was a tendency that those with the lowest systolic blood pressure had the poorest hearing in the high frequency region for both the right and the left ear. The difference between the blood pressure quartiles was statistically significant at 8 kHz, left ear, for men belonging to all three 70-year age cohorts. Regarding cohort 1, there was also a significant difference in the same direction at 2 kHz and a tendency, although not statistically significant, at 4 kHz. At age 75, no consistent difference between the quartiles was observed in the male group. In the female groups, there was no audiometric difference between the blood pressure quartiles at age 70 years. There was a tendency of poorer hearing at 1 kHz in 75-year-old women belonging to the quartile with the highest systolic blood pressure, but the difference was significant for only the right ear [Table - 1].
Systolic blood pressure, 79-year-olds
In the female group of 79-year-olds, cohort 1, there was a significant correlation between low-frequency hearing and systolic blood pressure in both ears. Those belonging to the quartile with the highest blood pressure had significantly higher pure tone thresholds at 0.25, 0.5 and 1 kHz than those belonging to the quartile with the lowest blood pressure, with the corresponding thresholds of those belonging to the middle two quartiles lying in between [Figure - 1],[Figure - 2], [Table - 1]. There was no difference between the quartiles in the high frequency region. In the male group, no difference of auditory function was observed between the blood pressure quartiles.
Systolic blood pressure, 85-year-olds
Within the 85-year-old female group, there was a tendency that those with the highest blood pressure had the poorest pure tone thresholds in the low-frequency area, but only for the right ear. The difference between the quartiles was statistically significant for the frequency 0.25, with a borderline significance value for 0.5 kHz [Figure - 3],[Table - 2]. In the group of 85-year-old men, there was a tendency that the pure tone thresholds were poorest in the quartile with the lowest blood pressure. However, the number of participants in each quartile was too small to allow any conclusions. Besides, some cases with pronounced hearing loss were accumulated in the quartile with the lowest blood pressure, probably by chance.
Diastolic blood pressure
Those 85-year-old women with the highest diastolic blood pressure had the poorest low- and mid-frequency hearing. The differences between the diastolic blood pressure quartiles were statistically significant for 0.25, 0.5, 1 and 2 kHz, both ears; and also at 4 kHz, right ear [Figure - 4],[Table - 2]. In the other groups of women 70 to 79 years old, as well as in all male groups, no consistent correlation between diastolic blood pressure and hearing was observed.
Hypertension
A comparison was done between those who were treated for arterial hypertension and a contrast group. No consistent correlation between hypertension and auditory function was observed.
| Discussion | | |
A review of the scientific literature, including both clinical data and animal studies, favors the hypothesis that there is an association between CVD and hearing loss, both presbyacusis and NIHL. This association is, however, obscure and difficult to interpret. The level of evidence connecting hearing loss to CVD is generally low in the studies cited. Animal studies tend to favor the concept of parallel events rather than a direct influence of hypertension on the cochlea. The present study includes one CVD factor, arterial blood pressure. A correlation between increased systolic blood pressure and increased hearing loss in the low frequency range was found here. This correlation was only observable for women of advanced age, 79 years and, to some extent, 85 years old. These two age groups were mainly composed of different individuals and can therefore be regarded as two different age cohorts. Further indications supporting the consistency of the observation are that both ears showed the same tendency and that the threshold elevation included two or more neighboring frequencies. The same was also the case for diastolic blood pressure, but this finding was restricted to one age group only (85-year-old women). All these observations indicate an association between high systolic blood pressure and low-frequency hearing loss in advanced age in women. The correlation between high blood pressure and hearing is only indicative; a study like the present one cannot provide confirmative evidence. The result of this study strengthens earlier observations, especially those of Gates et al., [12] who correlated CVD to low-frequency hearing, especially affecting women.
The audiometric configuration resulting from presbyacusis and CVD influence has a flat loss characteristic, affecting not only the high frequency regions but also low and mid frequencies. This type of age-related hearing loss resembles strial and intermediate presbyacusis according to morphological classification described by Schuknecht and Gacek. [36]
Another tendency in the present study is that of arterial hypotension, expressed by low systolic blood pressure, being associated to poor high-frequency hearing in 70-year-old men. However, this association seems to be coincidental since a significant correlation was observed for one frequency only, viz., 8 kHz. This frequency has an inherent variability in the test situation. Moreover, this finding lacks support in the literature, in which high blood pressure has been related to high-frequency hearing loss. A few reports of arterial hypotension correlated to hearing loss have found this association in the low-frequency region only. [29],[31] The present finding, including lack of association between hypertension and hearing loss, is perhaps more in accordance with the study by Drettner et al., [3] who did not find any correlation between CVD (including blood pressure) and hearing loss in men.
Since age-related hearing loss includes a variety of different intrinsic as well as extrinsic factors, the exact influence of one single factor is extremely difficult to evaluate. This is certainly the case for CVD, which seems to contain ototraumatic factors of importance, but the nature and extent of this influence is difficult to estimate.
| Acknowledgments | | |
This study was supported by grants from the Swedish Association of Hard of Hearing, Hjalmar Svensson Foundation, the Lions Foundation, the Swedish National Board of Health and Welfare, Wilhelm and Martina Lundgren's Foundation, the Gothenburg Medical Services Administration and Karolinska Institute, Stockholm, Sweden. Paper presented at a Consensus Meeting and Ageing, 4 th to 6 th November 2002, in Nottingham, UK.
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Correspondence Address:
Ulf Rosenhall
Department of Audiology, Karolinska Hospital, SE-171 76 Stockholm
Sweden
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1463-1741.33539
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2] |
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| Hwang, J.-H., Wu, C.-C., Hsu, C.-J., Liu, T.-C., Yang, W.-S. | | Obesity. 2009; 17(9): 1796-1801 | | [Pubmed] | | | 32 |
Endothelin-1 gene polymorphism and hearing impairment in elderly Japanese |
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| Uchida, Y., Sugiura, S., Nakashima, T., Ando, F., Shimokata, H. | | Laryngoscope. 2009; 119(5): 938-943 | | [Pubmed] | | | 33 |
Association of Central Obesity With the Severity and Audiometric Configurations of Age-related Hearing Impairment |
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| Juen-Haur Hwang,Chen-Chi Wu,Chuan-Jen Hsu,Tien-Chen Liu,Wei-Shiung Yang | | Obesity. 2009; 17(9): 1796 | | [Pubmed] | [DOI] | | | 34 |
Audiometric pattern as a predictor of cardiovascular status: Development of a model for assessment of risk |
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| David R. Friedland, Christopher Cederberg, Sergey Tarima | | The Laryngoscope. 2009; 119(3): 473-486 | | [Pubmed] | [DOI] | | | 35 |
Endothelin-1 gene polymorphism and hearing impairment in elderly Japanese |
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| Yasue Uchida,Saiko Sugiura,Tsutomu Nakashima,Fujiko Ando,Hiroshi Shimokata | | The Laryngoscope. 2009; 119(5): 938 | | [Pubmed] | [DOI] | |
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