RESEARCH ARTICLE |
https://doi.org/10.5005/jp-journals-10003-1360 |
Sensorineural Hearing Loss among Hypertensive Patients: A Clinical Study
1,3Department of Otorhinolaryngology, Vinayaka Missions Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India
2Department of ENT, Vinayaka Missions Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India
Corresponding Author: Shivakumar Senniappan, Department of Otorhinolaryngology, Vinayaka Missions Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India, Phone: +91 9345761230, e-mail: drshiva73@gmail.com
How to cite this article: Senniappan S, Panicker AM, Paramasivam G. Sensorineural Hearing Loss among Hypertensive Patients: A Clinical Study. Int J Otorhinolaryngol Clin 2020;12(3):48–53.
Source of support: Nil
Conflict of interest: None
ABSTRACT
Sensorineural deafness is a bilateral, progressive hearing loss of gradual onset which predominantly affects the higher frequencies and old patients. Hypertension, being the most common vascular disorder, may facilitate structural changes in the heart and blood vessels. High pressure in the vascular system may cause inner ear hemorrhage, which may cause progressive or sudden hearing loss.
Keywords: Adults, High frequency audiometry, Sensorineural hearing loss.
INTRODUCTION
Hearing is considered one of the important factors which enriches our day-to-day life. One of the most common chronic medical conditions encountered by physicians is hypertension. This condition may be associated with progressive hearing loss of sensorineural type. Chronic hypertension has also been implicated in the development of hearing loss.1,2 Studies have shown that chronic hypertension causes a decrease in cochlear function and leads to histologic cochlear damage.
AIMS AND OBJECTIVES
- To evaluate the prevalence of sensorineural hearing loss among patients 50 years and above who are suffering from hypertension.
- To evaluate sexual preponderance of sensorineural hearing loss in hypertension.
- To evaluate the relationship between sensorineural hearing loss and duration of hypertension
MATERIALS AND METHODS
A cross-sectional study with sample size of 100 patients aged 50 years and above suffering from hypertension, attending Otorhinolaryngology, and General medicine outpatient department of VMKV Medical College and Hospital, Salem from December 2016 to June 2018 was undertaken. Patients of both sexes presenting with hypertension (140/90 mm Hg) where subjected to an audiometric procedure. Hearing assessment was done on all patients with the same audiometer and pure tone thresholds for 250, 500 Hz, 1, 2, 4, 6, 8 KHz for air conduction and bone conduction was determined using Alps Pure Tone Audiometer (Model AD 2000) and recorded in a pure tone average (PTA) report. PTA of 500 Hz, 1 and 2 KHz air conduction threshold was taken and tabulated on data spreadsheet.
RESULTS
Age Distribution
A total of 100 hypertensive patients were enrolled in this study and they were subdivided based on the age into 50–60, 61–70, and 71–80 (Table 1). Out of the total 100 hypertensive patients, 37 patients were in the age-group 51–60, 55 patients in 61–70 age-group, and eight patients in 71–80 age-group (Fig. 1).
Fig. 1: Age distribution of hypertensive patients
| Age | Total | % |
|---|---|---|
| 51–60 | 37 | 37 |
| 61–70 | 55 | 55 |
| 71–80 | 8 | 8 |
| Total | 100 | 100 |
Prevalence of Age and Hypertension
Out of 100 hypertensive patients, 55 patients were found to have hearing loss, in which 20 patients were in the 51–60 age-group, 32 patients in 61–70 age-group, and three patients in 71–80 age-group (Table 2, Fig. 2).
Fig. 2: Prevalence of age and hypertension
| Age | SNHL | % |
|---|---|---|
| 51–60 | 20 | 36.36 |
| 61–70 | 32 | 58.18 |
| 71–80 | 3 | 5.45 |
| Total | 55 | 100 |
Grading of Hearing Loss
Out of 54 patients with hearing loss, 22 patients (40%) had mild hearing loss, 27 patients (49.09%) had moderate hearing loss, and six patients (10.9%) had moderately severe hearing loss (Fig. 3). In the age-group 51–60, nine patients were having mild hearing loss and 10 patients were having moderate hearing loss, and one patient was having moderately severe hearing loss. In the age-group 61–70, 13 patients were having mild hearing loss, 14 patients were having moderate hearing loss, and five patients were having moderately severe hearing loss. In the age-group 71–80, three patients were having mild hearing loss. Statistical analysis revealed that there was no significant association between the age of the patient and hearing loss (p value >0.05) (Table 3, Fig. 4).
Fig. 3: Grading of hearing loss in hypertensive patients
Fig. 4: Relationship between age of hypertensive patients and degree of hearing loss
| Age-group | Normal | Mild HL | Moderate HL | Moderately severe HL |
|---|---|---|---|---|
| 51–60 | 17 | 9 | 10 | 1 |
| 61–70 | 23 | 13 | 14 | 5 |
| 71–80 | 5 | 3 | 0 | 0 |
Sex Distribution
Out of the 100 hypertensive patients, 57% were males and 43% were females. In the age-group 51–60, 17 were males and 20 were females. In the age-group 61–70, 36 were males and 19 were females. In the age-group 71–80, four were males and four were females (Table 4, Fig. 5).
Fig. 5: Gender distribution in hypertensive patients
| Age-group | Male | Female |
|---|---|---|
| 51–60 | 17 | 20 |
| 61–70 | 36 | 19 |
| 71–80 | 4 | 4 |
| Total | 57 | 43 |
Out of the 55 hypertensive patients with hearing loss 31 were males and 24 were females. 13 males and nine females had mild hearing loss, 17 males and 10 females had moderate hearing loss, and one male and five females had moderately severe hearing loss. Statistical analysis revealed that there was no significant association between the sex of hypertensive patients and the prevalence of hearing loss (p value >0.05) (Table 5, Fig. 6).
Fig. 6: Relationship between sex and hearing loss in hypertensive patients
| Hearing threshold | Sex | Total | |||||
|---|---|---|---|---|---|---|---|
| Male | Female | N | % | ||||
| N | % | N | % | ||||
| Hyper tension | Normal | 26 | 46 | 19 | 44 | 45 | 45 |
| Mild | 13 | 23 | 9 | 21 | 22 | 22 | |
| Moderate | 17 | 30 | 10 | 23 | 27 | 27 | |
| Moderately severe | 1 | 2 | 5 | 12 | 6 | 6 | |
| Total | 57 | 100 | 43 | 100 | 100 | 100 | |
Duration of Hypertension
Out of the 55 hypertensive patients with hearing loss, nine patients were having hypertension of 1–5 years of duration, 26 patients were having hypertension of 6–10 years of duration, 16 patients were having hypertension of 11–15 years of duration and four patients were having hypertension of 16–20 years of duration. Statistical analysis revealed that there was no significant association between duration of hypertension and prevalence of hearing loss (Table 6, Fig. 7).
Fig. 7: Relationship between duration of hypertension and hearing loss
| Duration | Normal | Hearing loss |
|---|---|---|
| 1–5 | 10 | 9 |
| 6–10 | 21 | 26 |
| 11–15 | 11 | 16 |
| 16–20 | 3 | 4 |
| Total | 45 | 55 |
Severity of Hypertension with Hearing Loss
Out of the 55 patients with grade 1 hypertension, 39 patients were having no hearing loss, seven patients were having mild hearing loss, and nine patients were having moderate hearing loss (Table 7, Fig. 8).
Fig. 8: Relationship between severity of hypertension with hearing loss
| BP | Normal | Mild HL | Moderate HL | Moderately severe HL | Total |
|---|---|---|---|---|---|
| Grade 1 | 39 | 7 | 9 | – | 55 |
| Grade 2 | 6 | 9 | 12 | 1 | 28 |
| Grade 3 | – | 6 | 6 | 5 | 17 |
Out of the 28 patients with grade 2 hypertension, six patients were having no hearing loss, nine patients were having mild hearing loss, 12 patients were having moderate hearing loss, and one patient was having moderately severe hearing loss.
Out of the 17 patients with grade 3 hypertension, six patients were having mild hearing loss, six patients were having moderate hearing loss, and five patients were having moderately severe hearing loss. Statistical analysis revealed that there was significant association between blood pressure levels and degree of hearing loss.
High-frequency Hearing Loss
Out of the 55 hypertensive patients with hearing loss, 51 patients had high-frequency loss. Statistical analysis revealed that there was significant association between hypertension and increase in hearing thresholds at higher frequencies (Table 8, Fig. 9).
Fig. 9: Relationship between hypertension and high-frequency hearing loss
| Hearing loss | High frequency loss | Total | |
|---|---|---|---|
| Present | Absent | ||
| Mild | 20 | 2 | 22 |
| Moderate | 26 | 1 | 27 |
| Moderately severe | 5 | 1 | 6 |
DISCUSSION
In the present study 55% of the hypertensive patients had sensorineural hearing loss and a significant association was found between systemic hypertension and hearing loss (Fig. 7). Rosen3 initially found relationship between hypertension and SNHL. Similar association was later found in the studies by Markova et al., Nazar et al.,4 Chen and Ding,5 Brohem et al.,6 and Marchiori et al.7 Some studies justify that the sensorineural hearing loss that happens with aging is related to a microcirculatory insufficiency that occurs due to vascular occlusion caused by emboli,8 hemorrhage or vasospasm, and these happen because of a syndrome of hyperviscosity or microangiopathy caused by diabetes or hypertension,14 and the latter could, through histopathological mechanisms cause the sensorineural hearing loss.1,10 However, Leitschuh and Chobanian9 argued that isolated systemic arterial hypertension would not cause hearing loss higher than that is observed in normotensive population. This argument is supported by the studies of Hansen et al.,10 Rey et al.,11 Yan-Lin and Ding,12 and Baraldi et al.13 Our study revealed that there was no significant association between the age of the patient and hearing loss (Fig. 4). Marchiori et al. 7 also considered systemic hypertension and advanced age as independent risk factors for hearing loss. Many studies however have reported male gender as an independent risk factor for hearing loss.6,16 The present study also did not reveal any significant association between the duration of hypertension and hearing loss which was contrary to the findings of Karmarkar16 who commented that hypertension for a duration of 7–9 years could lead to sensorineural hearing loss. The present study also shows a significant association between the severity of hypertension and hearing loss.9 This was in accordance with the findings of Agarwal et al.14 who reported an increase in hearing threshold in patients with grade 3 hypertension. The audiometric analysis of the hypertensive patients with hearing loss in the present study revealed a pattern of increased hearing threshold for higher frequencies.12 The studies done by Rosen,3 Tan et al.,15 and Agarwal et al.14 also report similar findings. However, Gates et al.1 have shown that hypertensive males have high-frequency hearing loss while hypertensive females have higher hearing thresholds for lower frequencies when compared to their normotensive counterparts.
CONCLUSION
India has a large number of hypertensive patients. Among the various complications, hearing loss is the least studied. Among the hypertensive patients, 55% had hearing loss. Bilateral sensorineural hearing loss was noted at all frequencies, but significantly in higher frequencies. Severity of hypertension was found to have a strong association with hearing loss. As hypertension often causes high-frequency nature of hearing loss, it commonly goes undetected and unreported. On the other hand, routine screening for hearing loss in hypertensive patients may also be helpful to diminish comorbidities among them and improve their quality of life. Awareness among public regarding hearing loss, usefulness of hearing aid, control of hypertension is essential.
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