Abstract
Senile deafness and hearing loss in adults over 50 are major public health issues as a result of the population’s ageing demographic. Menopausal women tend to develop hearing loss, while no clear link has been found between the two. The purpose of this study was to determine how menopause and diabetes mellitus affects hearing loss. We assessed 158 menopausal women in total. Pure Tone Audiometry and HbA1c levels was measured, along with appropriate clinical history and examination. The association between those levels and hearing was researched by chi-square test. There were 158 study participants. Mean age of the study population was 50.5 (± 2.49) years. Onset and duration of hard of hearing was assessed in 41 patients (25.9%). 33% (N = 53) of the patients had history of Diabetes mellitus, of which 52.8% offered history of the disease for more than or equal to five years. On audiological assessment, 74.1% had no hearing loss (N = 117), 4.4% had unilateral sensorineural hearing loss (N = 7) and 21.5% had bilateral sensorineural hearing loss (N = 34). Statistics show that hearing loss is statistically connected with ageing and poor glycemic management. With chi square values of 9.629 and P value 0.002 found a significant correlation between ageing and hearing loss. Poor glycemic control is significantly associated with hearing loss with a chi-square value of 4.304 and P value 0.038. Poor glycemic control and menopause is found to be strongly associated with sensorineural hearing loss. Further prospective, hormonal studies including larger population is recommended.
Keywords: Pure tone audiometry, Hearing loss, Menopause, Oestrogen, Diabetes mellitus
Introduction
Hearing loss can be either incomplete or complete. Hearing loss might develop later or be present from birth. Hearing loss can be unilateral or bilateral, which is the main causes of disability across the world [1]. As the age increases, the prevalence of hearing loss also increases [2]. The three types of hearing loss are conductive, sensorineural, and mixed.
Menopause is described as the menstrual cycle ceasing on its own due to a decrease in ovarian follicular activity [3]. Around 50 years (between 45 and 55 years of age) is the typical age at which menopause begins [4]. It is unclear how oestrogen and progesterone affect hearing function. In contrast, the cochlear fluids electrolyte balance might vary due to receptors in the stria vascularis. The spiral ganglion, outer and inner hair cells, and spiral ganglion all have receptors which suggest that may affect the auditory transmission [5].
In addition to its neuroprotective effects, oestrogen also protects auditory function [4]. The cochlea or adjacent regions of the auditory system may experience a cross-reaction between progesterone and other steroid receptors. Progesterone and its metabolites may affect the auditory system via interacting with the steroid binding sites on GABA-A receptors, which are present throughout the auditory system. It was discovered that progesterone lowers 5-HT (5-hydroxy tryptamine) levels, which may indirectly impair auditory processing [6]. Menopause may signal the start of some people’s hearing loss as they get older. Hearing impairment is not a part of the menopausal syndrome, although the relationship between hearing loss and menopause is still unclear [5].
Diabetes mellitus is a chronic metabolic illness that is non-communicable [7]. Diabetes mellitus is a common non-communicable disease known to affect hearing. Because diabetes mellitus affects a large portion of the population, its effects on the various organs of the body are of the highest importance. High blood sugar levels are thought to harm the stria vascularis blood vessels and nerves, which can impair hearing [8]. Despite extensive research on the association between diabetes and hearing function, no consensus result has yet been reached. Bilateral sensorineural hearing loss, which affects higher frequencies, is the most prevalent kind of hearing loss in diabetics [9]. However, there have been a few instances of lower frequency abrupt onset sensorineural hearing loss (SNHL). This study aims to ascertain if diabetes mellitus causes hearing loss and, if so, what correlation exists between diabetes duration and women in the menopausal age group.
In developing countries like India, Diabetes mellitus being the common non-communicable disease is independently associated with hearing loss. Therefore, it is important to assess how menopause and diabetes mellitus interact to worsen hearing loss. The purpose of this study was to determine how menopause and diabetes mellitus affects hearing loss.
Methodology
The Otorhinolaryngology Department of tertiary care hospital in Chennai, Tamil Nadu, India undertook cross-sectional research from November 2022 to May 2023 after receiving the Ethical Committee’s approval. The sample size was calculated as 158 (1) using 40% prevalence, 8% desired error with power of 80% in the formula.
 |
Inclusion Criteria
Women who have attained menopause with or without diabetes mellitus.
Age less than 55 years.
Exclusion Criteria
History of ototoxic drug intake.
Known case of CSOM.
History of hearing loss due to post viral sequelae.
Previous ear surgeries.
Congenital ear anomalies.
Congenital hearing impairment.
Procedure
Patients were informed of the objectives of the study and given a chance to participate after obtaining their informed consent. Based on the proforma, a comprehensive history and a general and systemic evaluation were done. Following a thorough otoscopic examination, serial tuning fork test was carried out using a Gardiner Brown tuning fork and then Pure Tone Audiometry (PTA) was performed. In both ears, pure tone thresholds of 500, 1000, 2000, and 4000 Hz were examined. The audiometric test findings were documented. HbA1c was done in all the patients to classify those with good glycemic control and poor glycemic control. Hearing loss in one ear or both ears was considered as hearing loss.
Statistical Analysis
Microsoft Excel spreadsheet was used for data input. Version 21 of SPSS software was used for data analysis. While qualitative data was reported in frequencies, quantitative variables were reported in mean and standard deviation. With the use of the chi-square test, the degree of association was determined. P value less than 0.05 was considered significant.
Results
The study population, mean age is 50.5 (± 2.49) years. None of the study participants were on hormone replacement therapy. Onset and duration of hard of hearing was assessed in 41 patients (25.9%) who had hard of hearing (Table 1). 33% (N = 53) of the patients had history of Diabetes mellitus, of which 52.8% offered history of the disease for more than or equal to five years. In this study, 7 (4.4%) patients had unilateral hearing loss, whereas 34 (21.5%) patients had bilateral hearing loss (Table 2).
Table 1.
Characteristics of the study population based on history, N = 158
| Characteristics | N | % |
|---|---|---|
| Age | ||
| 50–55 years | 75 | 47.5 |
| 45–50 years | 83 | 52.5 |
| Duration of menopause | ||
| ≥ 3 years | 100 | 63.3 |
| < 3 years | 58 | 36.7 |
| Hard of hearing | ||
| Present | 41 | 25.9 |
| Absent | 117 | 74.1 |
| Onset of hard of hearing (N = 41) | ||
| Gradual | 35 | 85.4 |
| Sudden | 6 | 14.6 |
| Duration of hard of hearing (N = 41) | ||
| ≥ 3 years | 19 | 46.3 |
| < 3 years | 22 | 53.7 |
| History of Diabetes mellitus | ||
| Present | 53 | 33.5 |
| Absent | 105 | 66.5 |
| Duration of Diabetes Mellitus (N = 53 ) | ||
| ≥ 5 years | 28 | 52.8 |
| < 5 years | 25 | 47.2 |
| Complications of diabetes mellitus | ||
| Present | 6 | 3.8 |
| Absent | 152 | 96.2 |
| Glycemic status | ||
| Poor control | 23 | 14.6 |
| Good control | 135 | 85.4 |
Table 2.
Results of Audiological Assessments, N = 158
| Results of Audiological Assessments | N | % |
|---|---|---|
| No hearing loss | 117 | 74.1 |
| Unilateral sensorineural hearing loss | 7 | 4.4 |
| Bilateral sensorineural hearing loss | 34 | 21.5 |
Hearing loss is statistically connected with ageing and poor glycemic management. With chi square value of 9.629 and P value 0.002 (< 0.05), found a significant association between age 51 to 55 years and hearing loss compared to age 45 to 50 years. Poor glycemic control is significantly associated with hearing loss with a chi-square value of 4.304 and P value 0.038 (< 0.05) (Table 3). Hearing loss was not associated with the period of menopause, the history of diabetes, its duration, and its consequences (Table 4).
Table 3.
Association between characteristics of the study population and Hearing loss by Chi-square test, N = 158
| Characteristics | Hearing loss present (N = 41) | No hearing loss (N = 117) | Chi-square value | P value |
|---|---|---|---|---|
| Age | ||||
| 51–55 years | 28 | 47 | 9.629 | 0.002 |
| 45–50 years | 13 | 70 | ||
| Duration of menopause | ||||
| ≥ 3 years | 24 | 76 | 0.539 | 0.463 |
| < 3 years | 17 | 41 | ||
| History of Diabetes mellitus | ||||
| Present | 17 | 36 | 1.558 | 0.212 |
| Absent | 24 | 81 | ||
| Complications of diabetes mellitus | ||||
| Present | 3 | 3 | 1.877 | 0.171 |
| Absent | 38 | 114 | ||
| Glycemic status | ||||
| Poor control | 10 | 13 | 4.304 | 0.038 |
| Good control | 31 | 104 | ||
Table 4.
Association between duration of Diabetes Mellitus and hearing loss among menopausal women by Chi-square test, N = 53
| Duration of Diabetes Mellitus | Hearing loss present (N = 17) | No hearing loss (N = 36) | Chi-square value | P value |
|---|---|---|---|---|
| ≥ 5 years | 10 | 18 | 0.361 | 0.548 |
| < 5 years | 7 | 18 |
Discussion
As the average life expectancy of most countries rises, hearing impairment prevalence rates are one of the leading causes of disability in the globe. Different types of hearing loss include conductive, sensorineural, and mixed types. Since female sex hormones are deficient at the menopause due to the physiological reduction of ovarian function, various problems are known to arise during this phase. It is unclear how hormonal changes affect auditory thresholds. Research on the physiologic and biologic impacts of sex hormones leads to two possible modes of action: regulation of blood flow in the cochlea and brain, and direct effects on the cochlea and different pathways in the central auditory system [10].
Menopausal women’s hearing loss has an unclear pathogenesis that is still being studied. Both the peripheral and central auditory structures have oestrogen receptors [11]. Low oestrogen levels have been linked to hearing loss in humans. This might be brought on by modifications in the otic capsule’s bone metabolism, neuroregulatory mechanisms, cochlear blood flow, neuronal physiology, or other factors. Women who experience hearing loss after menopause may also have lower oestrogen levels. Menopause and hearing loss are both strongly correlated with age, however cross-sectional studies that found postmenopausal women had worse hearing when compared to premenopausal women. Progestogens may reduce hearing through a number of ways, such as oestrogen receptors down-regulation or reduced cochlear blood flow. However, it is unclear if progestogens directly affect the cochlea [12].
Similarly, there are various theories causing diabetes to harm the hearing system, including microangiopathy, atrophic alterations in organ of Corti cells, advanced end products of glycation, reactive oxidative stress, and dysfunction of mitochondria [8]. According to Akinpelu et al., meta-analysis on possible link between diabetes mellitus and alterations in hearing, revealed that persons with diabetes mellitus experienced mild hearing loss much more frequently than those in controls [13]. Ren et al. in 2017 showed that minimal hearing loss is prevalent in diabetes mellitus with high frequency involvement. In this population study, those with hearing loss were older and more likely to be men than those with normal hearing thresholds among diabetes mellitus patients. In diabetes mellitus patients, the mean pure tone audiometric thresholds were greater for all frequencies, especially for high frequencies. Hearing impairment was minimal for high-frequency hearing loss, but worsened when low-frequency involvement was included [14].
According to the most current literature, the majority of studies have substantiated the link between SNHL and diabetes. The results are similar to those of Friedman et al. (55.0%) and Aggarwal et al. (64.86%) [15]. As a result, diabetes and ageing may combine to increase hearing thresholds. Microvascular angiopathy in the stria vascularis capillaries, which results in these vessels thickening more than normal, is what causes the increase in hearing threshold. Alterations to the blood arteries supplying other parts of the auditory system are also possible [15]. The factors that could be involved in diabetics’ hearing thresholds being poorer were examined by the researchers. The duration of diabetes was one of them. Research has shown that as diabetes mellitus duration increases, so does the hearing threshold [16]. The sensorineural hearing loss is generally gradual and involves high-frequency thresholds.
In research done by Rajendran et al. in the age range of 40 to 50, it was discovered that 73.3% more persons with diabetes than controls had sensorineural hearing loss. HbA1c and hearing loss were observed to be significantly correlated by Kurien M et al. (1989), Tay HL et al. (1995), Panchuet al., and Srinivas et al. (2016). They discovered that poorly managed diabetes and higher HbA1c levels were associated with severe hearing loss [7]. The likelihood that diabetics may experience hearing issues rises with age, according to Axelson et al. [15]. The above-mentioned studies were done in both genders.
In the current study we studied the synergistic effect of diabetes and menopause on hearing. Postmenopausal women under the age of 55 were enrolled in our study because ageing is a potential risk for sensorineural hearing loss. Age 51 to 55 is observed to be substantially related with hearing loss compared to age groups 45 to 50. Hearing loss is closely associated with poor glycemic control in postmenopausal women. However, there was no statistically significant link between diabetes mellitus diagnosis and duration with hearing loss. Lack of awareness in non-communicable diseases screening leading to undiagnosed cases in the general population may be the cause.
Conclusion
Poor glycemic control and menopause is found to be strongly associated with sensorineural hearing loss. Ageing is factor well known to affect hearing. Further prospective, hormonal studies including larger population is recommended. Opportunistic screening for non-communicable diseases must be encouraged.
Funding
No funding was received to conduct the above study.
Declarations
Conflict of interest
The authors hereby declare that there is no potential conflict of interest with respect to research and publication of this article.
Ethical Approval
Institutional Ethical clearance was obtained for this research, as it is a study involving human participants.
Informed Consent
Informed consent was obtained from all the participants included in the study.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Change history
8/26/2023
A Correction to this paper has been published: 10.1007/s12070-023-04137-x
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