Abstract
Background:
Noise sensitivity results from a series of variables and processes, and it can be used to predict the annoyance caused by noise and health-related outcomes. This study aimed to compare the noise sensitivity between cataract patients and healthy subjects and explore the effect of high noise sensitivity on cataract patients.
Methods:
A retrospective analysis was conducted on the clinical data of 100 cataract patients and 78 healthy subjects who underwent physical examination in Jiaozhou Central Hospital of Qingdao from February 2020 to February 2023. Noise sensitivity was evaluated by adopting the 8-Item Weinstein Noise Sensitivity Scale (WNSS-8). Comparisons were conducted on the psychological state scores, blood pressure (BP), and heart rate (HR) of the high- (HG) and low-noise-sensitivity (LG) groups.
Results:
Cataract patients exhibited lower visual acuity (P < 0.001) and higher WNSS-8 scores than the healthy subjects (P < 0.05). On the basis of the median of WNSS-8, the cataract patients were divided into HG (n = 42) and LG (n = 58). Compared with the LG, the HG presented higher Generalized Anxiety Disorder-7 scores, Beck Depression Inventory scores, systolic BP, diastolic BP and HR (P < 0.05).
Conclusions:
High noise sensitivity in cataract patients may be associated with vision disorders, and it may affect their BP and HR and damage physical and mental health.
Keywords: Cataract, Noise, Blood pressure, Heart rate, Mental health, Vision disorders
KEY MESSAGES:
-
(1)
Cataract patients have higher noise sensitivity than healthy subjects.
-
(2)
The visual acuity may be the influencing factor of noise sensitivity in cataract patients.
-
(3)
The noise sensitivity of cataract patients may affect the blood pressure and heart rate.
-
(4)
There seems to be a certain correlation between noise sensitivity and healthy mental status of cataract patients.
INTRODUCTION
Noise comprises sounds unwanted by people. Long-term exposure to environmental noise causes serious interference with people’s sleep, communication, and daily life and induces or aggravates brain cardiovascular and psychological diseases.[1,2] Environmental noise contributes to the risk of hypertension, myocardial infarction, depression, and death.[3,4,5] Noise sensitivity moderates the association between exposure to road traffic noise and mental health, which may be a part of a wide construct of environmental susceptibility.[6] According to Shepherd et al.,[7] noise sensitivity includes the differences in psychological and physiological responses of individuals to noise. Therefore, noise sensitivity results from a series of variables and processes, and it exerts a moderating effect on noise-related physical and mental health.
Cataract is a major challenge in global public health, especially in Western Pacific countries.[8] According to statistics, cataract is ranked first among the causes of visual loss in persons aged 50 years and over worldwide in 2020.[9] Some researchers reported that compared with sighted participants, blind participants exhibited a stronger functional activation of the occipital cortex in response to sound (independent of sound position) but reduced activation of the medial temporal cortex.[10] Thus, visual loss may cause hearing to become practical for use.
In accordance with the above theory, cataract patients show increasing susceptibility to noise after hearing changes. Their noise sensitivity may vary from that of normal persons. However, the noise sensitivity of cataract patients remains unclear. Thus, in this retrospective study, the relationship between vision disorders and noise sensitivity was clarified, and the effect of high noise sensitivity on cataract patients was investigated.
MATERIALS AND METHODS
Screening Process
As per the collected data, 103 cataract patients and 85 healthy subjects who underwent physical examination in Jiaozhou Central Hospital of Qingdao from February 2020 to February 2023 for eligibility assessment were included in this work. Three cataract patients and five healthy subjects were excluded due to incomplete clinical data, and two healthy subjects with invalid scale filling were also eliminated from the study. Finally, 100 cataract patients and 78 healthy subjects were enrolled in this research.
Inclusion and Exclusion Criteria
Inclusion criteria
The following were the inclusion criteria for the patients: (1) aged 20–65 years old, (2) complete clinical data; (3) normal hearing, without ear diseases, such as otitis media and tympanic membrane perforation.
Exclusion criteria
Patients were excluded if they met the following: (1) occupational noise exposure, (2) recent intake of drugs that affect hearing, (3) inability to communicate normally or having a history of mental illness, (4) presence of malignant tumors or dysfunction of important organs.
Data collection
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(1)
The general information of the subjects, including age, body mass index, sex, smoking status, hypertension, marital status, educational background, residence, and E visual acuity chart (Suzhou Aiweishi Biological Technology Co., Ltd., Suzhou, Jiangsu, China), were obtained through the hospital medical record information system.
-
(2)
The noise sensitivity of patients during a hospital visit and healthy subjects during physical examination was assessed through administration of the traditional Chinese version of 8-Item Weinstein Noise Sensitivity Scale (WNSS-8).[11] The scale consists of eight items: ((1) If my study place is noisy, I will try to open the door and window or move to another place; (2) when my neighbors are noisy, I will feel annoyed; (3) sometimes noise can make me feel upset and angry; (4) when I am focused, even my favorite music can make me feel annoyed; (5) when I want to be alone, external sounds can disturb me; (6) I find it difficult to relax in a noisy place; (7) I am angry with those who make noise that prevents me from falling asleep or completing work; (8) I am very sensitive to noise). Each item is given a score of 1–6 points (strongly disagree–strongly agree), including a general attitude toward noise and an emotional response to various sounds. The total score ranges between 8 and 48 points, with a median score of 28 points. The higher the score, the higher the noise sensitivity of patients. Given the vision disorders among cataract patients, face-to-face question-answering method was applied in answering the scale.
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(3)
All cataract patients received assistance in filling out the Generalized Anxiety Disorder-7 (GAD-7)[12] and Beck Depression Inventory (BDI)[13] via the face-to-face–question-answering method. The scale scores were used as a basis in the evaluation of the mental health status. GAD-7 consists of seven items: nervous anxiety, uncontrollable worry, excessive worry, inability to relax, inability to sit still, irritability, and foreboding. The items are scored using a four-level scoring method (0–3 points), with a total score of 0–21 points (0–4 points, no anxiety; 5–9 points, mild anxiety; 10–14 points, moderate anxiety; ≥15 points, severe anxiety). BDI comprises 13 items: depression, pessimism, sense of failure, lack of satisfaction, self-guilt, self-disappointment, negative tendency, social withdrawal, indecision, self-image change, work difficulty, fatigue and loss of appetite. The items are scored using a four-level scoring method (0–3 points), with a total score of 0–39 points (0–4 points, no depression; 5–7 points, mild depression; 8–15 points, moderate depression; ≥16 points, severe depression).
-
(4)
A YE660F arm electronic sphygmomanometer (X910056, Jiangsu Yuwell Medical Equipment Co., Ltd., Danyang, Jiangsu, China) was adopted to detect the sitting blood pressure (BP), including systolic BP (SBP, normal level: 90–139 mmHg) and diastolic BP (DBP, normal level: 60–80 mmHg), of all cataract patients at the time of treatment. The heart rate (HR, normal level: 60–100 beats/min) of all cataract patients was also measured using an SE-1200 Express electrocardiograph (601335, Shenzhen Edan Instrument Co., Ltd., Shenzhen, Guangdong, China).
-
(5)
Noise levels in the wards were measured using an SW-525B wall-mounted noise meter (800780, Sndway Technology Co., Ltd., Dongguan, Guangdong, China) at 8:00, 12:00, 16:00, and 20:00, and the average value was obtained.
Data Analysis
The data were collated using Office Excel 2006 (Microsoft Corporation, Redmond, WA, USA) and analyzed on SPSS25.0 software (International Business Machines Corporation, Armonk, NY, USA). Categorical variables were expressed as (n [%]). After Fisher’s exact test, chi-square test was employed when the “minimum expected count” was >5. The continuous variables that did not conform to normal distribution according to the Shapiro–Wilk test were subjected to Mann–Whitney U test and expressed as M (P25, P75). P < 0.05 indicated a significant difference.
RESULTS
Comparison of General Data Between Cataract Patients and Healthy Subjects
In addition to visual acuity, no significant differences were observed in age, gender. and smoking status among 100 cataract patients and 78 healthy subjects (P > 0.05; Table 1).
Table 1.
Comparison of General Data Between Cataract Patients and Healthy Subjects.
| Items | Cataract Patients (n = 100) | Healthy Subjects (n = 78) | Statistics/P value |
|---|---|---|---|
| Age (years, M (P25, P75)) | 59.00 (49.25, 64.75) | 57.00 (49.00, 61.25) | Z = −1.127/P = 0.260 |
| Body mass index (kg/m2, M (P25, P75)) | 23.55 (21.73, 24.68) | 22.95 (21.40, 24.73) | Z = −0.474/P = 0.636 |
| Sex (n [%]) | χ2 = 3.642/P = 0.056 | ||
| Male | 37 (37.00) | 40 (51.28) | |
| Female | 63 (63.00) | 38 (48.72) | |
| Smoking status (n [%]) | χ2 = 0.206/P = 0.650 | ||
| Never | 87 (87.00) | 66 (84.62) | |
| Occasionally | 13 (13.00) | 12 (15.38) | |
| Hypertension (n [%]) | χ2 = 0.421/P = 0.517 | ||
| Yes | 12 (12.00) | 7 (8.97) | |
| No | 88 (88.00) | 71 (91.03) | |
| Marital status (n [%]) | χ2 = 0.567/P = 0.451 | ||
| Married | 86 (86.00) | 70 (89.74) | |
| Single | 14 (14.00) | 8 (10.26) | |
| Educational background (n [%]) | χ2 = 0.473/P = 0.492 | ||
| Below high school | 37 (37.00) | 25 (32.05) | |
| High school and above | 63 (63.00) | 53 (67.95) | |
| Residence (n [%]) | χ2 = 0.091/P = 0.763 | ||
| Urban areas | 51 (51.00) | 38 (48.72) | |
| Rural areas | 49 (49.00) | 40 (51.28) | |
| Visual acuity (M (P25, P75)) | 0.60 (0.50, 0.70) | 1.10 (0.98, 1.30) | Z = −11.331/P < 0.001 |
Comparison of Noise Sensitivity Between Cataract Patients and Healthy Subjects
The cataract patients and healthy subjects attained WNSS-8 scores of 26.00 (22.25, 33.00) and 25.00 (21.00, 31.25), respectively, with significant differences observed in the noise sensitivity in both groups (Z = −2.048/P = 0.041). On the basis of the median of WNSS-8, the 100 cataract patients were divided into the high- (HG, n = 42, WNSS-8 score ≥ 28 points) and low-noise-sensitivity groups (LG, n = 58, WNSS-8 score < 28 points).
Comparison of General Data in HG and LG
In addition to visual acuity, general data showed no significant difference existed in both groups (P > 0.05; Table 2).
Table 2.
Comparison of General Data in Both Groups.
| Items | HG (n = 42) | LG (n = 58) | Statistics/P value |
|---|---|---|---|
| Age (years, M (P25, P75)) | 58.00 (49.75, 64.25) | 59.00 (48.00, 65.25) | Z = −0.140/P = 0.889 |
| Body mass index (kg/m2, M (P25, P75)) | 23.35 (21.68, 24.58) | 23.65 (21.78, 24.73) | Z = −0.028/P = 0.978 |
| Sex (n [%]) | χ2 = 0.051/P = 0.821 | ||
| Male | 15 (35.71) | 22 (37.93) | |
| Female | 27 (64.29) | 36 (62.07) | |
| Smoking status (n [%]) | χ2 = 0.861/P = 0.354 | ||
| Never | 35 (83.33) | 52 (89.66) | |
| Occasionally | 7 (16.67) | 6 (10.34) | |
| Hypertension (n [%]) | χ2 = 0.001/P = 0.980 | ||
| Yes | 5 (11.90) | 7 (12.07) | |
| No | 37 (88.10) | 51 (87.93) | |
| Marital status (n [%]) | χ2 = 0.425/P = 0.513 | ||
| Married | 35 (83.33) | 51 (87.93) | |
| Single | 7 (16.67) | 7 (12.07) | |
| Educational background (n [%]) | χ2 = 0.037/P = 0.847 | ||
| Below high school | 16 (38.10) | 21 (36.21) | |
| High school and above | 26 (61.90) | 37 (63.79) | |
| Residence (n [%]) | χ2 = 0.055/P = 0.814 | ||
| Urban areas | 22 (52.38) | 29 (50.00) | |
| Rural areas | 20 (47.62) | 29 (50.00) | |
| Visual acuity (M (P25, P75)) | 0.50 (0.40, 0.60) | 0.60 (0.50, 0.70) | Z = −4.230/P < 0.001 |
| Ward noise level (decibels, M (P25, P75)) | 50.00 (45.75, 54.00) | 49.00 (47.00, 53.00) | Z = −0.252/P = 0.801 |
HG = high noise sensitivity group; LG = low noise sensitivity group.
Comparison of Mental Health Scores in Both Groups
The HG achieved higher GAD-7 (P < 0.05) and BDI scores than the LG (P < 0.01; Table 3).
Table 3.
Comparison of Mental Health Scores in Both Groups (Points, M (P25, P75)).
| Groups | n | Generalized Anxiety Disorder-7 scores | Beck Depression Inventory scores |
|---|---|---|---|
| HG | 42 | 7.50 (6.00, 11.00) | 8.50 (6.00, 12.00) |
| LG | 58 | 7.00 (5.00, 8.00) | 7.00 (5.00, 9.00) |
| Z | −2.140 | −3.236 | |
| P | 0.032 | 0.001 |
HG = high noise sensitivity group; LG = low noise sensitivity group.
Comparison of SBP, DBP and HR in Both Groups
The HG had higher SBP (P < 0.01), DBP, and HR than the LG (P < 0.05; Table 4).
Table 4.
Comparison of SBP, DBP, and HR in Both Groups (M (P25, P75)).
| Groups | n | SBP (mmHg) | DBP (mmHg) | HR (beats/min) |
|---|---|---|---|---|
| HG | 42 | 120.00 (106.00, 126.00) | 80.50 (73.75, 84.25) | 81.50 (72.75, 87.00) |
| LG | 58 | 112.00 (102.00, 120.00) | 75.00 (68.50, 82.00) | 74.00 (66.00, 85.00) |
| Z | −2.956 | −2.566 | −2.366 | |
| P | 0.003 | 0.010 | 0.018 |
DBP = diastolic blood pressure; HG = high noise sensitivity group; HR = heart rate; LG = low noise sensitivity group; SBP = systolic blood pressure.
DISCUSSION
The rapid development of world economy promotes urbanization construction, and the aggravated condition of noise pollution has attracted people’s attention. The main pathological mechanism underlying noise exposure involves the induction of endothelial dysfunction, oxidative stress, and inflammation (e.g., through activation of nicotinamide adenine dinucleotide phosphate oxidase and uncoupling of endothelial nitric oxide synthase).[14] The effects of environmental noise are not only limited to those influencing hearing and sleep but also include those that indirectly trigger cognitive and emotional changes, which lead to sympathetic and endocrine stress responses (i.e. elevated stress hormone levels) and psychological disorders, such as depression and anxiety, all of which further cause impairment of cardiovascular function.[15,16,17]
Noise sensitivity plays a crucial role in the noise response system; individuals with a high noise sensitivity show vulnerability to the adverse effects of noise.[18] The results of this study show the higher noise sensitivity of cataract patients compared with the healthy subjects, with a significant difference noted in visual acuity. This finding may be related to the vision disorders caused by cataract. Vision disorders cause nonvisual sensory organs to exert a compensatory effect that increases the sensitivity of auditory response. Clinical evidence reveals that after vision disorders in cataract patients, auditory input occupies most of the occipital cortex, which causes this part of the brain to be more responsive to sound activation. By compensating plasticity, the high-order visual area can adapt to auditory input and retain its special function after visual loss.[19] In short, the central mechanisms of auditory processing and noise discrimination contribute to and particularly affect noise sensitivity. These properties possibly explain the change in noise sensitivity in cataract patients. In addition, baseline data of both groups were compared in this study, and the significant differences observed in visual acuity further confirm our above analysis results.
This study revealed that SBP, DBP, and HR of the HG were higher than those of the LG. Noise triggers sympathetic excitation, which results in the release of a large number of stress hormones, such as catecholamines through the hypothalamic–pituitary–adrenal axis, increases the levels of norepinephrine, angiotensin II, and endothelin-1, and ultimately accelerates HR and increases BP.[20] Cataract patients with high noise sensitivity are more susceptible to noise. Although the patients in both groups were in an environment with little difference in noise level, the patients in HG felt stronger noise stimulation and presented more obvious body stress response, which may be the reason for the significant difference between BP and HR in the two groups.
Vision disorders are the most common clinical symptom in cataract patients. Vision deprivation may cause certain psychological torture to patients, resulting in irritability and depression.[21] A study revealed that noise exposure likely influences mental health given that the brain serves as the primary target organ of noise-mediated effects.[22] Another research showed that patients with eye diseases commonly suffer from anxiety symptoms and disorders, and poor mental health status exerts a potential negative effect on their ophthalmic condition and general well-being; thus, emotional management should be considered to achieve optimal treatment.[23] This study also indicated that cataract patients with a high noise sensitivity are likely to experience stress, as well as cognitive and emotional responses due to unwanted sounds, which leads to mental health problems. Such finding may be due to increased attention paid by cataract patients with a high noise sensitivity to noise (regardless of loudness) and their slow adaption, which result in a series of physiological stress reactions that may persist and not disappear with habituation. However, a clear pathophysiological mechanism has not been found.
This study encountered some shortcomings. First, this study may have selective bias given its retrospective nature. Limited by the research conditions and available data, this work was unable to directly determine the potential association between noise sensitivity and hearing in cataract patients. Secondly, all study subjects originated from the same hospital and were not representative. Finally, large number of studies are needed to demonstrate the relationship between the duration of vision disorders and the onset of auditory function changes. Prospective research should be carried out in the future to obtain more in-depth findings.
CONCLUSIONS
High noise sensitivity in cataract patients may be associated with vision disorders, and it may affect their BP and HR and damage physical and mental health. Therefore, the noise management of cataract patients must be strengthened and a quieter diagnosis and treatment environment must be provided for patients.
Financial support and sponsorship
This research received no external funding.
Conflicts of interest
The authors have no conflicts of interest to declare.
Author contributions
Ning Ma: concepts, design, literature search, clinical studies, experimental studies, statistical analysis, manuscript editing.
Bo Feng: definition of intellectual content, data acquisition, data analysis, manuscript preparation, manuscript editing, manuscript review.
Ming Li: clinical studies, experimental studies, manuscript preparation, manuscript editing.
Ethics approval
This study conforming to the principles of Declaration of Helsinki (2013) has been approved by the ethical committee of Jiaozhou Central Hospital of Qingdao (approval No.: 20191204).
Availability of data and materials
Data to support the findings of this study are available on reasonable request from the corresponding author.
Informed consent
This study obtained an informed consent of patients.
Acknowledgment
Not applicable.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data to support the findings of this study are available on reasonable request from the corresponding author.