The effect of osteoporosis on cochlear function in postmenopausal women: An observational study

Year 2018, , 273 - 277, 01.09.2018

Saime Sağıroğlu , Tuba Tülay Koca

https://doi.org/10.28982/josam.429059

Abstract

Aim: Hearing loss and osteoporosis are common geriatric syndromes. Evidence suggests that osteoporosis may have an effect on cochlear function in a small number of clinical trials. Here, cochlear function in osteoporosis patients was assessed by otoacoustic emission test measurements.

Methods: The study designed as cross-sectional and observational. Forty female patients were included in the postmenopausal period at the age of 40-75 years. Age, body mass index (BMI), vitamin D level were recorded in all patients. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. Bone mineral density (BMD) of the hip and vertebra was measured using dual-energy X-ray absorptiometry (DEXA). According to vertebra L1-4 t score <-2.5 osteoporosis, -2.5 to -1 osteopenic, the group divided into two and all parameters were compared. Transiently evoked (TE), and distortion-product (DP) otoacoustic emissions were recorded.

Results: The mean age of the whole group was 58.6 ± 7.9 years. Accordingly, TE left was significantly different in the higher frequency in the osteopenic group at 0.75 Hz (p = 0.015). In audiometric tests, only the osteopenic group at 6,000 dB was significantly different in the higher frequency of both ears (p = 0.049 / p = 0.016).

When the group divided into two according to femur t score <-1.0; TEright_3.5 (p = 0,04), TEright_overall (p = 0,030), TEleft_1.7.5 (p = 0,043) and TEleft_overall (p = p = 0.046), DPright_1 (p = 0.049) and DPleft_6 (p = 0.039) were observed to occur at higher frequencies in the osteoporotic group. Lomber t score was positively correlated with BMI (p = 0.042 / r = 0.288). BMI was lower in the osteoporotic group. The tympanogram results of all patients were Type A. The TE positivity rate (S / N> 3) was 60.8% and the DP positivity rate (S / N> 3) was 39.2%.

Conclusion: According to hip BMD scores, osteopenic-osteoporotic (T scor <-1) group showed higher frequencies in both cochlear and hearing tests than normal subjects. The high frequencies in both OAET results and odiologic data in osteoporotic group support the adverse effect of osteoporosis on cochlear and hearing function. Individuals with hearing loss should be screened for osteoporosis.

Keywords

Bone mineral density, Osteoporosis, Hearing loss, Cochlear function

Postmenapozal kadınlarda koklear fonksiyona osteoporozun etkisi: Gözlemsel bir çalışma

Abstract

Amaç: İşitme kaybı ve osteoporoz sık görülen geriatrik sendromlardandır. Az sayıda klinik çalışmada osteoporozun koklear fonksiyona etkisi olabileceği yönünde delil bulunmuştur. Burada osteoporoz hastalarında kohlear fonksiyon, otoaküstik emisyon test (OAET) ölçümleri ile değerlendirildi. 

Yöntemler: Çalışma kesitsel gözlemsel olarak diüzenlendi. Çalışmaya 40-75 yaş aralığında postmenapozal dönemde 50 kadın hasta dahil edildi. Tüm hastalarda yaş, vücut kitle indeksi (BMI), vitamin D düzeyi kayıt edildi. Hava ve kemik iletimli işitme hassasiyetini ölçmek için odiyometrik eşik testi kullanıldı. Kalça ve omurganın kemik mineral yoğunluğu (BMD) dual enerji X-ışını absorpsiyometri (DEXA) kullanılarak ölçüldü. Vertebra L1-4 t skor<-2,5 osteoporoz, -2,5 ila -1 arası osteopenik olarak grup ikiye ayrıldı ve tüm parametreler karşılaştırıldı. Geçici olarak uyarılmış (TE) ve distorsiyon ürünü (DP) otoakustik emisyonları kaydedildi.

Bulgular: Tüm grup yaş ortalaması 58,6±7,9 yıl idi. Buna göre TE left 0.75 Hz’de osteopenik grupta daha yüksek frekansda anlamlı farklı idi (p=0,015). İşitme testlerinde sadece her iki kulak 6.000 db’de osteopenik grup daha yüksek frekansda anlamlı farklı idi (p=0,049 / p=0,016).

Femur t skor<-1,0 göre grup ikiye ayrıldığında TEright_2.5 (p=0,015), TEright_3.5 (p=0,04), TEright_overall (p=0,030), TEleft_1.7.5 (p=0,043), TEleft_overall (p=0,046), DPright_1 (p=0.049), DPleft_6 (p=0,039) osteoporotik grupta daha yüksek frekanslarda sonuçlar olduğu gözlendi. Lomber t skor BMI ile pozitif korele (p=0,042/r=0,288) idi. Osteoporotik grubda BMI daha düşük idi. Hastaların tamamında timpanogram sonuçları Tip A idi. TE pozitiflik oranı (S/N>3) %60,8, DP pozitiflik oranı (S/N>3) %39,2 idi. 

Sonuç: Kalça BMD skorlarına göre, osteopenik_osteoporotik grup (T skor<-1) hem koklear hem da işitme testlerinde normal kişilere göre yüksek frekanslar gösterdiler. Osteoporotik grupta hem OAET sonuçları hemde odiyolojik verilerin daha yüksek frekanslarda olması osteoporozun koklear ve işitme fonksiyonuna olumsuz etkisini desteklemektedir.  İşitme kaybı olan bireyler osteoporoz yönünden taranmalıdır.

Keywords

Kemik mineral yoğunluğu, Osteoporoz, İşitme kaybı, Koklear fonksiyon

References

• 1. Patricia B. Kricos AE. Holmest Efficacy of Audiologic Rehabilitation for Older Adults. J Am Acad Audiol.1996;7:219-29.
• 2. Saunders GH, Chisolm TH. Connected Audiological Rehabilitation: 21st Century Innovations. J Am Acad Audiol. 2015;26(9):768-76. doi:10.3766/jaaa.14062.
• 3. Grenness C, Hickson L, Laplante-Lévesque A, Davidson B. Patient-centred audiological rehabilitation: perspectives of older adults who own hearing aids. Int J Audiol. 2014;53(1):68-75. doi:10.3109/14992027.2013.866280.
• 4. Martin GK, Probst R, Lonsbury-Martin BL. Otoacoustic emissions in human ears: normative fmdings. Ear Hear. 1990;11:106-20.
• 5. Trine MT, Hirsch JE, Margolis RH. The effect of middle ear pressure on transient evoked otoacoustic emissions. Ear Hear. 1993;14:401-7.
• 6. Satoh Y, Kanzaki J, O-Uchi T, Yoshihara S. Age-related changes in transiently evoked otoacoustic emissions and distortion product otoacoustic emissions in normal-hearing ears. Auris Nasus Larynx. 1998;25:121-30.
• 7. Gates GA, Mills D, Nam B, D’Agostino R, Rubel EW. Effects of age on the distortion product otoacoustic emission growth functions. Hear Res. 2002;163:53-60.
• 8. Lonsbury-Martin BL, Martin GK, Luebke AE: İşitme ve vestibüler sistemlerin fizyolojisi. Otolaringoloji Baş ve Boyun Cerrahisi. Ballenger JJ (ed), Doğan Şenocak (ç.ed). Nobel Tıp Kitabevi, İstanbul. 2000;879-929.
• 9. Zatoński T, Temporale H, Krecicki T. [Hearing and balance in metabolic bone diseases].Pol Merkur Lekarski. 2012;32(189):198-201.
• 10. Parham K, Kuchel GA. A Geriatric Perspective on Benign Paroxysmal Positional Vertigo. J Am Geriatr Soc. 2016;64(2):378-85. doi: 10.1111/jgs.13926. Epub 2016 Jan 25.
• 11. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S. Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom. 2013;16(4):455-66.
• 12. Gosfield E 3rd, Bonner FJ Jr. Evaluating bone mineral density in osteoporosis. Am J Phys Med Rehabil. 2000;79(3):283-91.
• 13. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42(3):467-75.
• 14. Silverman SL. Selecting patients for osteoporosis therapy. Ann N Y Acad Sci. 2007;1117:264-72.
• 15. Czerwinski E, Badurski JE, Marcinowska-Suchowierska E, Osieleniec J. Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil. 2007;9(4):337-56.
• 16. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368-81.
• 17. Kemp DT , Ryan S , Bray P A guide to the effective use of otoacoustic emissions. Ear and Hearing 1990;11(2):93-105.
• 18. BLL Martin, GK Martin. A review of otoacoustic emissions. The Jour of Acoustic Society of Amer. 1991;89:2027. https://doi.org/10.1121/1.400897
• 19. Tella SH, Gallagher JC. Prevention and treatment of postmenopausal osteoporosis.J Steroid Biochem Mol Biol. 2014;142:155-70. doi:10.1016/j.jsbmb.2013.09.008.
• 20. Baccaro LF, Conde DM, Costa-Paiva L, Pinto-Neto AM. The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil.Clin Interv Aging. 2015;10:583-91. doi: 10.2147/CIA.S54614.
• 21. Diab DL, Watts NB. Postmenopausal osteoporosis. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):501-9. doi: 10.1097/01.med.0000436194.10599.94.
• 22. Jaul E, Barron J. Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population.Front Public Health. 2017;5:335. doi:10.3389/fpubh.2017.00335.
• 23. 23.Y İnanç, Y Beckman, Y Seçil, M Başoğlu. The frequency of dementia and mild cognitive disorder in the nursing home population. Int J Surg Med. 2018;4(2):85-7.
• 24. Laudisio A, Navarini L, Margiotta DPE, Gemma A, Giovannini S, Saviano A, et al. Inflammation as a mediator of the association between osteoporosis and hearing loss in older subjects: a population-based study.Eur Rev Med Pharmacol Sci. 2018;22(5):1451-6. doi:10.26355/eurrev_201803_14492.
• 25. Kshithi K, Vijendra Shenoy S, Panduranga Kamath M, Sreedharan S, Manisha N, Khadilkar MN, et al. Audiological profiling in postmenopausal women with osteoporosis. Am J Otolaryngol. 2018;39(3):271-6. doi: 10.1016/j.amjoto.2018.03.004.
• 26. Upala S, Rattanawong P, Vutthikraivit W, Sanguankeo A. Significant association between osteoporosis and hearing loss: a systematic review and meta-analysis.Braz J Otorhinolaryngol. 2017;83(6):646-52. doi: 10.1016/j.bjorl.2016.08.012.
• 27. Jung DJ, Cho HH, Lee KY. Association of Bone Mineral Density With Hearing Impairment in Postmenopausal Women in Korea. Clin Exp Otorhinolaryngol. 2016;9(4):319-25.
• 28. Caffarelli C, Alessi C, Nuti R, Gonnelli S. Divergent effects of obesity on fragility fractures. Clin Interv Aging. 2014;9:1629-36. doi:10.2147/CIA.S64625.
• 29. Singh NK, Jha RH, Gargeshwari A, Kumar P. Altered auditory and vestibular functioning in individuals with low bone mineral density: a systematic review.Eur Arch Otorhinolaryngol. 2018;275(1):1-10. doi: 10.1007/s00405-017-4768-4.
• 30. Clark K, Sowers MR, Wallace RB, Jannausch ML, Lemke J, Anderson CV. Age-related hearing loss and bone mass in a population of rural women aged 60 to 85 years. Ann Epidemiol. 1995;5(1):8-14.
• 31. Helzner EP, Cauley JA, Pratt SR, Wisniewski SR, Talbott EO, Zmuda JM, et al. Hearing sensitivity and bone mineral density in older adults: the Health, Aging and Body Composition Study.Osteoporos Int. 2005;16(12):1675-82.
• 32. Kahveci OK, Demirdal US, Yücedag F, Cerci U. Patients with osteoporosis have higher incidence of sensorineural hearing loss. Clin Otolaryngol. 2014;39(3):145-9. doi: 10.1111/coa.12242.
• 33. Chen J, Chu H, Xiong H, Yu Y, Huang X, Zhou L et al. Downregulation of Cav1.3 calcium channel expression in the cochlea is associated with age-related hearing loss in C57BL/6J mice.Neuroreport. 2013;24(6):313-7. doi: 10.1097/WNR.0b013e32835fa79c.
• 34. El-Zarea GA, Abdel-Mottaleb AH, Mustafa Aİ, Hesse ALA. Hearing Function in Osteoporotic Patients. J Am Sci 2017;13(12):76-83.
• 35. Yamanaka T, Shirota S, Sawai Y, Murai T, Fujita N, Hosoi H. Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope. 2013;123:2813–6. https://doi.org/10.1002/lary.24099