Risk Factors For Sensorineural Hearing Loss Research Articles

Lipids and Statin Medication With Sensorineural Hearing Loss: A Mendelian Randomization Study.

Recent insights suggest that lipids and statin medication play a role in the development of sensorineural hearing loss (SNHL), yet the exact role remains controversial. This research applied Mendelian randomization (MR) to assess whether lipids and statin medication are associated with an increased risk of SNHL. A two-sample MR was used in this study. Genetic instruments were constructed from variants associated with risk factors. Data for lipids and statin medication were obtained from the IEU OpenGWAS project, and for SNHL from the Finngen research project, which comprises 32,487 individuals with SNHL and 331,736 control individuals. Genetically predicted higher levels of triglycerides were associated with an increased risk of SNHL. The use of genetically predicted atorvastatin was associated with a lower risk of SNHL. Rosuvastatin has demonstrated potential in treating SNHL, yet further investigations are warranted to elucidate its relationship with SNHL. Insufficient evidence was available to suggest that the genetically predicted level of high-density lipoprotein cholesterol or low-density lipoprotein cholesterol or the use of simvastatin were associated with SNHL. The study provides genetic evidence suggesting that increased levels of triglycerides in the blood could be a risk factor for SNHL and that the use of certain statin medications, including atorvastatin and rosuvastatin, could reduce the risk of SNHL. These results align with findings from previous observational studies that have linked hyperlipidemia with the risk of SNHL. According to the Oxford Centre for Evidence-Based Medicine 2011 levels of Evidence, the study has a third level of Evidence Laryngoscope, 2024.

Mendelian Randomization Reveals: Triglycerides and Sensorineural Hearing Loss.

Sensorineural hearing loss (SNHL) is a multifactorial disorder with potential links to various physiological systems, including the cardiovascular system via blood lipid levels such as triglycerides (TG). This study investigates the causal relationship between TG levels and SNHL using Mendelian randomization (MR), which offers a method to reduce confounding and reverse causality by using genetic variants as instrumental variables. Utilizing publicly available genome-wide association study (GWAS) data, we performed a two-sample MR analysis. The initial analysis unveiled a causal relationship between TG (GWAS ID: ebi-a-GCST90018975) and SNHL (GWAS ID: finn b-H8_HL_SEN-NAS). Subsequent analysis validated this through MR with a larger sample size for TG (GWAS ID: ieu-b-111) and SNHL. To conduct the MR analysis, we utilized several methods including inverse-variance weighted (IVW), MR Egger, weighted median, and weighted mode. We also employed Cochrane's Q test to identify any heterogeneity in the MR results. To detect horizontal pleiotropy, we conducted the MR-Egger intercept test and MR pleiotropy residual sum and outliers (MR-PRESSO) test. We performed a leave-one-out analysis to assess the sensitivity of this association. Finally, a meta-analysis of the MR results was undertaken. Our study found a significant positive correlation between TG and SNHL, with OR values of 1.14 (95% CI: 1.07-1.23, p < 0.001) in the IVW analysis and 1.09 (95% CI: 1.03-1.16, p < 0.006) in the replicate analysis. We also found no evidence of horizontal pleiotropy or heterogeneity between the genetic variants (p > 0.05), and a leave-one-out test confirmed the stability and robustness of this association. The meta-analysis combining the initial and replicate analyses showed a significant causal effect with OR values of 1.11 (95% CI: 1.06-1.16, p = 0.01). These findings indicate TG as a risk factor for SNHL, suggesting potential pathways for prevention and intervention in populations at risk. This conclusion underscores the importance of managing TG levels as a strategy to mitigate the risk of developing SNHL.

Diabetes Mellitus and Hearing Loss: A Complex Relationship.

Background and Objectives: Discussion is open about the relationship between diabetes (DM) and hearing loss (HL). There is a lot of evidence in the literature suggesting a causal link between these conditions, beyond being considered simple comorbidities. The difficulty in identifying populations free from confounding factors makes it difficult to reach definitive conclusions on the pathophysiological mechanisms at play. Nonetheless, there is numerous evidence that demonstrates how the population affected by DM is more affected by sensorineural HL (SNHL) and exhibit a higher prevalence of idiopathic sudden sensorineural HL (ISSNHL). Materials and Methods: Articles reporting potentially relevant information were reviewed, and the most significant results are discussed in this article. Starting from the possible mechanisms relating to auditory impairment in the diabetic condition, this article summarizes the studies on auditory evaluation in subjects with DM1 and DM2 and addresses the relationship between DM and ISSNHL. Results: DM is considered a risk factor for SNHL, although some studies have reported no relationship when the associations were adjusted for age, gender, and hypertension. Macro and microvascular insults that cause decreased blood flow, oxygen exchange, and ion transport are major complications of hypertension and DM and can have a direct effect on the sensory and support cells of the cochlea. Conclusions: Given the difficulty of carrying out studies on populations without confounding factors, new laboratory studies are strongly required to clarify which specific physiopathological mechanisms underlie the diabetic damage caused to the hearing organs and how pharmacological management may contribute to counteracting the pathophysiological effects of the diabetic condition on the auditory system.

A prospective cohort study of sensorineural hearing loss associated with Kawasaki disease.

About 60 cases of sensorineural hearing loss (HL) have been reported in patients with Kawasaki disease (KD), but the current estimate of its prevalence is uncertain. The present study aimed to determine the prevalence and risk factors of sensorineural HL associated with KD. The present, prospective cohort study, conducted from May 2019 to May 2020, evaluated patients with a diagnosis of KD who received the initial therapy and underwent two auditory brainstem response (ABR) tests. HL was defined as a threshold of 40dB or more, and borderline hearing was defined as a threshold of 30dB. In total, 107 patients were enrolled, and 75 underwent two ABR tests. Thirty-one patients (30.0%) received prednisolone with their initial intravenous immune globulin and acetylsalicylic acid therapy. HL was present in only one patient who had congenital conductive HL. Five patients had borderline hearing but had normal hearing behavior. There was no significant difference between the patients with normal hearing and those with borderline hearing in terms of the clinical variables. In Japan, the prevalence of sensorineural HL after KD is not high. It may therefore be unnecessary to perform routine hearing tests for all patients with KD. Association between Kawasaki Disease and Sensorineural Hearing Loss. UMIN000037019 (the date of registration: June 11, 2019).

Hearing Loss in Congenital CMV Disease Post-Ganciclovir

Source: Lanzieri TM, Caviness AC, Blum P, et al. Progressive, long-term hearing loss in congenital CMV disease after ganciclovir therapy. J Pediatric Infect Dis Soc. 2021;piab095. doi:10.1093/jpids/piab095Investigators from the CDC, Atlanta, GA, and Baylor College of Medicine, Houston, TX, conducted a study to assess long-term hearing outcomes in children with symptomatic congenital cytomegalovirus (CMV) infection, and the impact of ganciclovir therapy on hearing loss. For the study, they analyzed data from children born 1983–2005 who were enrolled in the Congenital CMV Longitudinal Study. All study participants had CMV infection detected in urine samples in the first 3 weeks of life and had microcephaly, chorioretinitis, neurologic abnormalities or evidence of reticuloendothelial system involvement (eg, petechiae/purpura). Study children had longitudinal assessments of hearing with auditory brainstem response testing and behavioral audiometry; those with hearing thresholds >20 dB were classified as having sensorineural hearing loss (SNHL). SNHL was defined as congenital if diagnosed in the first month of life. Study children were placed into 3 groups: Group A included patients who had been enrolled in a clinical trial and received ganciclovir; group B included children with SNHL, microcephaly and/or chorioretinitis but who were untreated; and group C comprised those without any of these findings who also were not treated with ganciclovir. The primary study outcome was long-term assessment of hearing loss among children in these 3 groups.Data were analyzed on 76 children; 17 (22%) in group A, 27 (36%) in group B, and 32 (42%) in group C. Among the 17 children in group A, 16 had microcephaly, chorioretinitis, or congenital SNHL; median duration of ganciclovir treatment in these patients was 40 days. Overall, the most common findings in study patients when they were neonates were purpura/petechiae (82% of those in group A, 78% in group B, and 63% in group C); 71% and 70%, respectively, of those in groups A and B had microcephaly. Congenital SNHL was diagnosed in 65% of patients in group A and 56% for those in group B, although hearing was not assessed in the first month of life in all study participants. The median age at last hearing assessment was 13 years for children in groups A and C and 11 years for those in group B. At that time, 16 (94%) patients in group A, 24 (89%) children in group B, and 16 (50%) group C patients had SNHL. SNHL was categorized as severe (>70 dB) in 12 (71%), 16 (59%), and 7 (22%) children, respectively, in groups A, B, and C.The authors conclude that most children in this study with congenital CMV infection developed substantial SNHL with or without ganciclovir treatment.Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The current investigators provide long-term hearing outcomes for infants born 1983–2005 who were enrolled in the Congenital CMV Longitudinal Study. Participants were selected based on having severe disease as newborns.1,2 Not surprisingly, most developed substantial SNHL. As previously discussed, symptomatic congenital CMV infection at birth is a risk factor for SNHL. (See AAP Grand Rounds. 2019;42[5]:57.)3 Many infants also had microcephaly and/or head CT scan findings suggesting tissue destruction or dysplastic growth, which also are associated with an increased risk of SNHL.4 The results of early clinical trials of intravenous ganciclovir1,2 had suggested short-term stabilization or improvement in hearing at 6 months but were not borne out by the current investigation.With the introduction of oral valganciclovir, a phase III, randomized, placebo-controlled clinical trial, conducted during 2008– 2011, evaluated 6 weeks versus 6 months of therapy with valganciclovir.5 There was modest improvement in hearing and developmental outcomes at 12 and 24 months. Based on this trial, the AAP currently recommends 6 months of oral valganciclovir for infants with moderately to severely symptomatic congenital CMV infection who can start treatment in the first month of life.6 The current authors state that their findings cannot be extrapolated to infants who receive current standard of care therapy. Infants receiving valganciclovir are being followed to determine their long-term hearing outcomes.Another area that is not addressed is the role of valganciclovir for infants with congenital CMV infection who have isolated SNHL. The 2017 consensus guidelines do not routinely recommend valganciclovir for these infants based on insufficient evidence. Pasternak et al reported that 12 months of antiviral therapy for infants with congenital CMV infection and isolated SNHL led to improved hearing, but their study did not include a control group.(See AAP Grand Rounds. 2018;40[5]:55.)8Infants with congenital CMV infection are at risk for SNHL despite receipt of antiviral therapy. These infants deserve close audiology follow-up.The apparent lack of major benefit of antiviral therapy in children with symptomatic congenital CMV infection underscores the need for prevention. Neither CMV-IGIV nor investigational vaccines have yet proven efficacious.6

The Link between Gut Dysbiosis Caused by a High-Fat Diet and Hearing Loss.

This review aims to provide a conceptual and theoretical overview of the association between gut dysbiosis and hearing loss. Hearing loss is a global health issue; the World Health Organisation (WHO) estimates that 2.5 billion people will be living with some degree of hearing loss by 2050. The aetiology of sensorineural hearing loss (SNHL) is complex and multifactorial, arising from congenital and acquired causes. Recent evidence suggests that impaired gut health may also be a risk factor for SNHL. Inflammatory bowel disease (IBD), type 2 diabetes, diet-induced obesity (DIO), and high-fat diet (HFD) all show links to hearing loss. Previous studies have shown that a HFD can result in microangiopathy, impaired insulin signalling, and oxidative stress in the inner ear. A HFD can also induce pathological shifts in gut microbiota and affect intestinal barrier (IB) integrity, leading to a leaky gut. A leaky gut can result in chronic systemic inflammation, which may affect extraintestinal organs. Here, we postulate that changes in gut microbiota resulting from a chronic HFD and DIO may cause a systemic inflammatory response that can compromise the permeability of the blood–labyrinth barrier (BLB) in the inner ear, thus inducing cochlear inflammation and hearing deficits.

Congenital cytomegalovirus infection and its impact on the auditory function

Congenital cytomegalovirus infection contributes substantially to the incidence of sensorineural hearing loss, which may be late-onset, progressive or fluctuating. It leads to delayed diagnostics of hearing impairments in children. The aim is to assess the frequency and time of hearing loss occurrence in children with congenital cytomegalovirus infection and to develop the audiological follow-up algorithm adapted for those children. Materials and methods: 60 children with verified congenital cytomegalovirus infection have been involved into research as the main group. 61 children, with other sensorineural hearing loss risk factors, but excluding congenital cytomegalovirus, were included into the comparison group. The age of children ranged from 2 months to 7 years old. The follow-up duration was up to 4 years. Audiological assessment included: auditory brainstem response, auditory steady state response, otoacoustic emissions, impedancometry, pure tone audiometry (its type depended on the children’s age and development level) and speech tests. Results: Hearing loss was revealed in 17% of the main group, it varied from mild to severe degree. Among these children 30% developed late-onset hearing loss. 5% of children of the comparison group were identified with congenital hearing loss. Assessment of central auditory pathways function has been performed in children elder than 4 years old: 70% of children of the main group and 10% of children of the comparison one were identified with auditory processing disorders. The received data may be used by otolaryngologists, audiologists, pediatricians and infectious diseases physicians. The developed follow-up admits timely diagnostics of sensorineural hearing loss in children with congenital cytomegalovirus.

Hearing Loss With Congenital Cytomegalovirus Infection.

In this study, we determined the prevalence of hearing loss in 157 children with proven congenital cytomegalovirus (cCMV) infection. We looked at possible risk determinants for developing hearing loss and proposed recommendations for screening and follow-up in the newborn. In a prospective 22-year study, 157 children with proven cCMV infection were evaluated for sensorineural hearing loss (SNHL). The development of SNHL was correlated with the type of maternal infection (primary versus nonprimary), the gestational age of maternal primary infection, imaging findings at birth, and the presence of symptomatic or asymptomatic infection in the newborn. Of all children, 12.7% had SNHL, and 5.7% needed hearing amplification because of SNHL. Improvement, progression, and fluctuations of hearing thresholds were seen in 45%, 53.8%, and 5.7% of the children, respectively. Hearing loss was more common in the case of a symptomatic infection at birth (P = .017), after a maternal primary infection in the first trimester of pregnancy (P = .029), and in the presence of abnormalities on a neonatal brain ultrasound and/or MRI (P < .001). SNHL is a common sequela in children with cCMV infection. Risk factors for SNHL were primary maternal infections before the 14th week of pregnancy, the presence of a disseminated infection at birth, and imaging abnormalities in the newborn. These children may benefit from a more thorough investigation for SNHL than children who do not present with those risk factors.

Prevalence of otitis media and risk-factors for sensorineural hearing loss among infants attending Child Welfare Clinics in the Solomon Islands

ObjectivesThe present study aimed to assess the prevalence of otitis media and risk-factors for sensorineural hearing loss among infants in the Solomon Islands, in order to recommend an Infant Ear and Hearing Program that would be suitable to the Pacific Island context. MethodsEar examinations and the JCIH Risk-Factor Questionnaire were administered to 288 infants attending Child Welfare Clinics in the Solomon Islands. ResultsOverall, 150 infants (52.084%) presented with bilateral normal ear examinations and no risk-factors for SNHL. There were 73 infants (25.34%) with ear pathology in at least one ear, 13 (4.5%) of whom required referral to the ENT Clinic for medical management. The most common pathology was otitis media with effusion (OME) (21.87%). Infants aged 7-12 months were significantly more likely to present with OME (p<0.001) and a history of otitis media (p=0.017) than infants aged 0-6 months. There were 71 infants (24.65%) with at least one risk-factor for sensorineural hearing loss. The most common risk-factors were ototoxicity (8.3%), non-elective caesarean delivery (6.59%), and possible in-utero syphilis infection (5.55%). ConclusionsThe prevalence of otitis media and risk-factors for sensorineural hearing loss indicate the importance of initiating Infant Ear and Hearing Programs in the Solomon Islands. Program should facilitate early education on prevention of ear disease, as well as early diagnosis and management of children with hearing loss.

Sensorineural hearing loss following tympanoplasty surgery: a prospective cohort study

Abstract Sensorineural hearing loss (SNHL) subsequent to middle-ear surgery is an important yet under-reported complication. Our aim is to assess the prevalence of this complication and to identify the risk factors for SNHL after type 1 tympanoplasties. In this prospective cohort study, a total of 312 patients with tubotympanic chronic suppurative otitis media and pure conductive hearing loss were included. The patients were evaluated using case histories, clinical examinations, preoperative and postoperative (3, 6, and 12 months) audiograms, and laboratory investigations. All patients underwent type 1 tympanoplasties, the surgical details were noted, and the prevalence of SNHL as a consequence of the surgical procedure was recorded. Sixteen patients (5.1%) developed SNHL. Fifteen operations were performed by residents, and one was performed by a consultant. We concluded that the most important factor in the development of SNHL after a type 1 tympanoplasty is the surgeon’s experience.

Viral load in children with congenital cytomegalovirus infection identified on newborn hearing screening

BackgroundCongenital cytomegalovirus (CMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. However, congenital SNHL without other clinical abnormalities is rarely diagnosed as CMV-related in early infancy. ObjectivesThe aim of this study was to identify and treat patients with congenital CMV-related SNHL or CMV-related clinical abnormalities other than SNHL. The association between CMV load and SNHL was also evaluated. Study designNewborns who had abnormal hearing screening results or other clinical abnormalities were screened for congenital CMV infection by PCR of saliva or urine specimens, and identified infected patients were treated with valganciclovir (VGCV) for 6 weeks. The CMV load of patients with or without SNHL was compared at regular intervals during as well as after VGCV treatment. ResultsOf 127 infants with abnormal hearing screening results, and 31 infants with other clinical abnormalities, CMV infection was identified in 6 and 3 infants, respectively. After VGCV treatment, 1 case had improved hearing but the other 5 SNHL cases had little or no improvement. Among these 9 patients with or without SNHL at 1 year of age, there was no significant difference in CMV blood or urine load at diagnosis, but both were significantly higher in patients with SNHL during VGCV treatment. ConclusionsSelective CMV screening of newborns having an abnormal hearing screening result would be a reasonable strategy for identification of symptomatic congenital CMV infection. Prolonged detection of CMV in blood could be a risk factor for SNHL.

Hearing loss prevalence and risk factors among Iranian deaf children: The first report from Iran

Background: There are many regional variations in the rate and predisposing factors of hearing loss and these could vary over time. The aim of this study was to describe the characteristics and possible etiology of severe to profound bilateral sensorineural hearing loss (SNHL) among Iranian children who were a candidate for cochlear implantation. Materials and Methods: We designed a cross-sectional study to evaluate children with profound SNHL referred to Baqiyatallah Cochlear Implantation Center from all over the country of Iran. Among 471 referred children, 310 cases with diagnosis of bilateral profound SNHL ranging in age from 6 months to 4 years between 2005 and 2011 were enrolled. Results: The mean (±standard deviation) age of individuals and the mean age of diagnosis was 3.50 ± 1.23 and 164 (53%) were male. Considerable risk factors for SNHL in 218 patients (70.3%) were obvious. A total of 103 (33%) children had one or more close relatives with deafness in their family, so they were considered to be hereditary deafness cases, followed by prematurity 32 (10.3%), syndromic etiology 25 (8%), maternal toxoplasmosis, rubella, cytomegalovirus, herpes infection 12 (3.9%), severe hyperbilirubinemia 9 (3%), eruptive infections 9 (3%), meningitis 8 (2.6%), asphyxia 6 (2%), and oto-toxic drug 6 (2%). Our data showed the prevalence of 65% consanguineous marriage among parents of deaf children. Conclusion: This is the first attempt to describe the risk factor of SNHL in Iran. Among the identifiable causes of severe to profound SNHL in Iranian population, the consanguineous marriage was the most common risk factor. Further analytical studies focusing on the relation between etiology and demographic factors were recommended.

Clinical analysis of risk factors for sensorineural hearing loss in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy

Objective To investigate the risk factors for sensorineural hearing loss (SNHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).Methods From January 2012 to January 2013,29 patients with histopathologically confirmed NPC who received radiotherapy alone or concurrent chemoradiotherapy were included in this study.All patients underwent hearing tests,including pure tone audiometry and acoustic immittance measurement,before and after the IMRT.The cochlear doses for each ear were also collected for analysis.A prospective analysis was performed to investigate the relationship between cochlear dose and SNHL in patients with NPC,and the effects of other factors,including time after radiotherapy,chemotherapy,T stage,and age,were also analyzed.Results Of the 58 ears studied,6(10％) had low-frequency SNHL,and 17 (29％) had highfrequency SNHL.There were significant differences in mean cochlear doses between the patients who developed SNHL after radiotherapy and those who did not (left ears:46.1 Gy vs.35.5 Gy,P =0.006;right ears:45.0 Gy vs.35.8 Gy,P =0.009).When the mean cochlear dose was less than 44 Gy,only 15％ (6/38) of ears had high-frequency SNHL.The invasion of skull base bone was also a significant risk factor for SNHL(P =0.047),but age,chemotherapy,and time after IMRT were not significant risk factors.Conclusions The mean cochlear dose and invasion of skull base bone are significant risk factors for SNHL in patients with NPC after radiotherapy.It is recommended that the mean cochlear dose should be limited to 44 Gy to minimize the incidence of SNHL after IMRT. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Sensori-neural hearing loss; Pure tone audiometry; Acoustic immittance

Otologic manifestations from blast injuries among military personnel in Thailand

BackgroundFrom November 2008 to October 2010, 565 military personnel sustained blast injury in Southernmost Thailand and 99 personnel, affected by multiple injuries, were transferred to Phramongkutklao Hospital. No data on the effect of blast injury to the ears among Thai military personnel have been reported. This study aims 1) to determine the prevalence of Sensorineural Hearing Loss (SNHL) and otologic manifestations from primary blast injury among military personnel, in Pattani, Yala and Narathiwat Provinces, and 2) to evaluate the impact of explosive devices and distance from explosion on SNHL under various conditions. Materials and methodsA cross-sectional study was conducted among 76 military personnel injured from blast injury in Southernmost Thailand. They were divided into three groups representing the bomb blast settings; open-space referred to an area without barrier, semi-open space referred to a room open on at least one side and closed space referred to a room enclosed with four walls and ceiling. ResultsThe otologic manifestations from 76 patients were tinnitus, tympanic membrane perforation, bleeding and open wound. The prevalence of SNHL among patients in the open-, semi-open and closed space groups was 62.77%, 67.86% and 73.33%, respectively. The most common type of explosive was Improvised Explosive Devices (IEDs) 72 (94.74%). The average IED weighed 11.42kg and mean distance from explosion was 5.66m. ConclusionCorrelation among all three incident areas and two factors: impact of explosive devices and distance from explosion are risk factors of SNHL without significance.

Characteristics of radiation-induced sensorineural hearing loss in head and neck cancer: A systematic review

Patients receiving radiotherapy (RT) for head and neck tumors are at risk of developing sensorineural hearing loss. The objective of this study was to analyze the literature regarding sensorineural hearing loss after RT for head and neck cancer. Seven databases were searched to identify eligible studies. Eligible articles were independently assessed for quality by 2 authors. Fourteen articles were evaluated. There was considerable heterogeneity among studies. The reported incidence of sensorineural hearing loss (SNHL) varied from 0% to 85% for the speech frequencies and from 27% to 95% for high frequencies. As the follow-up increased, an increase in the incidence of SNHL was observed. The minimum cochlear dose reported to be a risk factor for SNHL was 45 Gy. High quality literature in the topic is lacking. Radiation-induced SNHL is progressive, permanent, and dose-dependent. Total dose and follow-up time are important factors affecting incidence rates.

Risk Factors of Sensorineural Hearing Loss in Patients With Ischemic Stroke

We investigated risk factors of sensorineural hearing loss (SHL) in patients with early stage of ischemic stroke (IS). Our study consisted of 60 patients with IS who were treated at Department of Neurology, Medical University of Gdansk between 2006 and 2007. A multivariate stepwise linear regression was used to identify the risk factors that were related to SHL as measured by pure-tone average (0.5, 1, and 2 kHz), the high-tone average (4, 6, and 8 kHz), the pure-tone middle-tone average (0.5, 1, 2, and 4 kHz), and the overall average (0.5, 1, 2, 4, 6, and 8 kHz). The following factors were included in the analysis: age, sex, smoking habit, addiction to alcohol, presence of tinnitus and vestibular symptoms, arterial hypertension, cardiac ischemic disease, hyperlipidemia, diabetes, number of risk factors, neurologic state at the admission, localization of stroke, cause of stroke, number of ischemic focuses, the side and diameter of ischemic focuses, the result of directional hearing acuity angle test, results of certain laboratory tests, blood morphology parameters, and coagulogram. Values for p less than 0.05 were considered significant. Our analysis suggests the presence of the following risk factors of SHL in patients with IS: 1) older age (>60 yr); 2) male sex; 3) presence of tinnitus; 4) arterial hypertension; 5) lacunar type of stroke; 6) presence of multiple ischemic focuses; 7) presence of bilateral ischemic focuses; 8) changes in blood cell count; and 9) disturbances of agglutination. The highest risk of hearing loss in the group of IS patients occurred at older people, particularly men with tinnitus, lacunar stroke, multiple, bilateral ischemic focuses, and arterial hypertension. A negative statistically significant influence of decreased level of red cells, platelets, and hematocrit value on hearing loss was found. Abnormally lowered levels of activated partial thromboplastin time, activated partial thromboplastin time ratio, prothrombin index, and abnormal lowered level of international normalized ratio statistically impaired hearing.

Risk factors for sensorineural hearing loss in survivors with severe congenital diaphragmatic hernia

Recent improvements in perinatal management have improved the prognosis in patients with severe congenital diaphragmatic hernia (CDH). However, in surviving patients with severe CDH, hearing loss has sometimes been reported to occur during the follow-up period. Although some of the risk factors for developing sensorineural hearing loss (SNHL) have been reported in CDH, no definitive risk factors have yet been reported. We, therefore, investigated the risk factors regarding postnatal management in patients with severe CDH. In 16 surviving patients with severe CDH, which had all been detected antenatally, and whose lung-to-thoracic ratio was less than 0.2, four patients demonstrated late onset SNHL, which occurred between 1.5 and 5 years of age. The risk factors for SNHL regarding the postnatal treatment for CDH were analyzed between the four patients with SNHL and the remaining 12 patients without SNHL, regarding such factors as the use of ototoxic drugs, neuromuscular blocking agents, high-frequency oscillation (HFO), and inhaled nitric oxide, the duration of hypocapnia, hypoxia, severe acidosis, severe alkalosis, and mechanical ventilation. In addition, the types of neuromuscular blocking agents were also analyzed, including the administration of pancuronium bromide (PB) and vecuronium bromide (VB). The patients with SNHL were found to have a significantly higher risk than the patients without SNHL regarding the duration of loop diuretics usage and the duration of usage of both mechanical ventilation and HFO. Furthermore, all four patients with SNHL used PB. In contrast, none of the five patients using VB developed SNHL The duration and cumulative dose of PB used in the patients with severe CDH showed a significant correlation to the occurrence of SNHL. Although this study was retrospective, based on our data, the prolonged use of PB, in addition to the duration of treatment by loop diuretics, mechanical ventilation, and HFO usage, might, thus, be suggested to be a possible risk factor for late onset SNHL in patients with severe CDH.

Hereditary Hearing Loss - the Role of Environmental Factors

A large family with mid onset sensorineural hearing loss (HL) was used to study the effect of environmental factors on progression HL. Data from five-generations of one family were traced and 104 living members were included in the study. Audiograms were measured for 60 family members. We used an expert program to study the individual risk factors, which included the known risk factors for sensorineural HL. The pattern of inheritance in this HL family was autosomal dominant and 22 individuals were affected. The HL among affected individuals was symmetrical and varied from mild to severe. The mean age at onset of HL was 22 years. The mean deterioration of hearing at 2 kHz frequency was 1 dB/year. In the risk analysis the use of NSAID-analgetics and military noise exposure correlated with HL. There was no correlation between occupational and free time noise-exposure and HL. Analgetics may aggravate the HL in subjects with inherited HL. This type of genetic lesion is new and is not in those chromosomal areas already documented in the literature.