Factors associated with age related hearing loss

Factors associated with age related hearing loss | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with age related hearing loss Ola Ahmad Bashar Shaar, Rabeea Mohsen Muhanna, Loui Darjazini Nahas This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5278533/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Age-related hearing impairment (ARHI) is a multifaceted degenerative condition in older adults. Since various factors contribute to the development of ARHI, it is crucial to identify the key influencing elements to better understand and prevent its progression. Methods A cross-sectional study using a questionnaire was carried out with 100 patients. Demographic information was collected during the first visit. Additionally, personal medical history and lifestyle factors, such as smoking and alcohol consumption, were assessed through a structured questionnaire. The patients' histories of cardiovascular disease, diabetes mellitus, and cerebrovascular conditions were recorded, along with any medications they were taking. Furthermore, they were asked about related symptoms, including tinnitus and vertigo. Results The study sample consisted of 100 patients, with a mean age of 73.44 years and a standard deviation of 4.52 years. An analysis of the medical histories revealed that 25 patients had hypertension (25%), while 13 patients had diabetes (13%). Among the auricular symptoms reported, tinnitus emerged as the most common, affecting 45 patients (45%). When asked about previously diagnosed ear conditions, 15 patients reported a diagnosis of tympanic membrane perforation (15%). In terms of genetic background, 16 patients (16%) had a family history of hearing loss. Regarding medication usage, beta-blockers were the most frequently prescribed, with 38 patients currently taking this medication. Conclusion The occurrence of age-related hearing impairment (ARHI) is common among older adults, and various factors may interact throughout its progression. The results of this study can be instrumental in counseling high-risk individuals regarding the significance of regular audiological evaluations. Otorhinolaryngology hearing loss hypertension diabetes. Introduction Age-related hearing impairment (ARHI), also known as presbycusis, is a multifaceted and progressively degenerative condition that impacts cognitive, emotional, and social functioning among older adults [ 1 ]. Research indicates that hearing sensitivity declines markedly with advancing age, with the prevalence of hearing loss approximately doubling every decade from the 20s to the 70s. According to a recent epidemiological study, utilizing a threshold of 25 dB HL to define hearing loss, the prevalence of ARHI in individuals over 70 years of age was found to be 68.1% [ 2 ]. Furthermore, as populations age, a growing proportion of individuals is expected to experience ARHI in the near future. Age-related hearing impairment (ARHI) does not manifest uniformly across all individuals. Despite extensive research over the years, there remains a lack of reliable methods to predict who is at the greatest risk, as well as no definitive strategies for prevention and treatment. While the precise pathophysiological mechanisms underlying ARHI are not fully understood, numerous intrinsic (genetic) and extrinsic (environmental) factors have been suggested to contribute to its development over time [ 3 ]. Given that multiple factors interact to create cumulative effects, it is crucial to identify the key influencing factors associated with ARHI in order to better understand and mitigate its progression. Several cross-sectional studies have identified potential risk factors related to age-related hearing impairment (ARHI), including male gender, advancing age, hypertension, cardiovascular disease, cerebrovascular disease, smoking, diabetes, and exposure to noise [ 4 , 5 ]. However, the risk factors identified in these cross-sectional studies only provide a snapshot of the condition's causality, lacking definitive evidence of a temporal relationship between exposure and outcome. These limitations inherent in cross-sectional studies could be addressed through a longitudinal design. To date, few epidemiological studies have examined the risk factors associated with ARHI over time in adults [ 6 ]. Additionally, there is a lack of studies that have conducted comprehensive laboratory profiling and analysis of risk factors within a large population cohort. The objective of this study was to identify the risk factors linked to the development of age-related hearing impairment (ARHI) in adults. Methods A cross-sectional study utilizing a questionnaire was conducted involving 100 patients. Demographic data were gathered during the initial visit. Furthermore, personal medical history and lifestyle factors, including cigarette smoking and alcohol consumption, were evaluated using a structured questionnaire. The patients' history of cardiovascular diseases, diabetes mellitus, and cerebrovascular diseases was documented, along with any medications they were taking. Additionally, patients were asked about associated symptoms such as tinnitus and vertigo. Statistical analysis: Our study's statistical analysis was completed using SPSS Version 27 for Windows (IBM Corp., Armonk, NY, USA). 5% was chosen as the degree of significance. For continuous variables, means and standard deviations (SDs) were used to describe the sample's characteristics, while for categorical variables, frequencies and percentages were used. Results The study sample comprised 100 patients, with an average age of 73.44 years and a standard deviation of 4.52 years. The youngest participant was 62 years old, while the oldest was 86 years old. Among the patients, 42 were male (42%), and 58 were female (58%). Regarding smoking status, 24 patients identified as smokers (24%), whereas the remaining 76 patients were non-smokers (76%). Examining the medical histories of the sample, we found that 25 patients had hypertension (25%), while 13 patients had diabetes (13%). Hypertension and diabetes co-occurred in 18 patients (18%), and only one patient had diabetes alongside asthma. Additionally, 43 patients reported no history of illness (43%). (Table 1 ). Table 1 Clinical Characteristics. Age Mean (± SD) 73.44 (± 4.52) Lowest value 62 Biggest value 86 Gender N (%) Male 42 (42) Female 58 (58) Smoking Yes 24 (24) No 76 (76) Medical history Hypertension 25 (25) Diabetes 13 (13) Hypertension + diabetes 18 (18) Diabetes + Asthma 1 (1) Nothing 43 (43) Regarding the auricular symptoms reported by the patients, tinnitus was identified as the most prevalent symptom, affecting 45 patients (45%). Vertigo occurred concurrently with tinnitus in 25 patients (25%), while vertigo as an isolated symptom was observed in 14 patients (14%). The remaining 16 patients (16%) did not report any auricular symptoms. When inquired about previously diagnosed ear conditions, 15 patients indicated a diagnosis of tympanic membrane perforation (15%), while 10 patients reported having vestibular vertigo (10%). The remaining 75 patients (75%) did not mention any prior diagnoses of ear diseases. In terms of genetic history, 16 patients (16%) had a positive family history of hearing loss, while the other 84 patients (84%) did not report any such history. Concerning the medications taken by the patients, beta-blockers were the most commonly used, with 38 patients on this medication. Additionally, 33 patients reported using angiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors. Antiplatelet agents and metformin were mentioned by 28 and 27 patients, respectively. (Table 2 ). Table 2 Hearing loss related condition. Auricular symptoms N (%) Vertigo 14 (14) Tinnitus 45 (45) Tinnitus + Vertigo 25 (25) Nothing 16 (16) Previously diagnosed ear conditions Tympanic membrane perforation 15 (15) Vestibular vertigo 10 (10) Nothing 75 (75) Genetic history to age related hearing loss Yes 16 (16) No 84 (84) Taking any medication Yes 66 (66) No 34 (34) Medication Angiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors 33 (16) Antiplatelet 28 (14) Beta-blockers 38 (18) Calcium Channel Blocker 5 (2) Diuretics 11 (5) Gliptin 13 (6) Metformin 27 (13) Statin 13 (6) Discussion More than 5% of the global population experiences hearing loss, defined as a reduction in hearing ability of more than 40 decibels in the better hearing ear for adults, and over 30 decibels for children. According to the World Health Organization, it is projected that by 2050, over 900 million people—approximately one in ten—will have disabling hearing loss [ 7 ]. The most prevalent cause of hearing loss in older adults is age-related hearing decline. Other contributing factors to hearing impairment in adulthood include chronic otitis media and noise-induced trauma [ 8 ]. Hearing loss can have significant health implications, as it is linked to cognitive impairment [ 9 ], an elevated risk of falls [ 10 ], accelerated progression of dementia [ 11 ], social isolation, and mental health disorders such as depression, anxiety, and schizophrenia [ 12 , 13 ]. As a result, hearing loss ranks as the fourth leading cause of years lived with disability for men and the seventh for women in the Global Burden of Disease study [ 14 ], surpassing several other conditions such as stroke, falls, and dementia. Presbycusis, or age-related hearing loss (ARHL), is a gradual loss of hearing that affects most individuals as they age. According to the World Health Organization [ 15 ], nearly one-third of people over 65 experience disruptive hearing loss. By 2025, the global population of individuals aged 60 and above is expected to reach 1.2 billion, with over 500 million suffering from significant age-related deafness [ 15 ]. Epidemiological studies of large cohorts of older adults indicate that hearing sensitivity declines more rapidly in men after the age of 20 to 30, while in women, this acceleration begins after the age of 50 [ 5 , 16 ]. Hearing thresholds for men show a steep increase in high-frequency hearing loss, whereas women’s hearing loss tends to follow a more gradual decline. Presbycusis is the leading cause of hearing loss worldwide, affecting nearly two-thirds of Americans aged 70 and older [ 17 ]. These findings align closely with the results of our study, where the average age of patients with age-related hearing loss was 73.44 years. There is evidence in the literature suggesting that sex may play a role in the development of sensorineural hearing loss (SNHL). Hearing loss is more prevalent in older men compared to older women [ 18 ]. In Europe, the estimated prevalence of presbycusis, the most common sensory disorder in the elderly, is approximately 20% in females and 30% in males over the age of 70 [ 18 ]. Clinical data reveal a distinct sex-related pattern in presbycusis, with men experiencing an earlier decline in hearing thresholds than women [ 18 ]. However, understanding the influence of sex and gender-related factors in the onset of presbycusis is challenging due to the multifactorial nature of age-related hearing loss. Interestingly, the results from our study showed a higher proportion of females affected by presbycusis compared to males (58% versus 42%). Recent research indicates that the sex-related differences in audiometric patterns among older adults have diminished significantly, potentially due to changes in lifestyle and environmental factors between the sexes over the past two decades [ 18 ]. Cigarette smoking may impact hearing by disrupting antioxidant mechanisms or affecting the blood vessels that supply the auditory system [ 19 , 20 ]. Several clinical studies have identified a correlation between smoking and hearing loss in adults. Weiss found that men who smoked more than one pack per day exhibited poorer hearing thresholds at frequencies between 250 and 1,000 Hz compared to non-smokers or "light" smokers, though no differences were observed at higher frequencies [ 21 ]. Siegelaub et al., in a large study involving 33,146 men and women, reported that among men with no history of noise exposure, current smokers were more likely than non-smokers to experience hearing loss at 4,000 Hz, although the effect size was minimal [ 22 ]. No such association was observed among women. Conversely, the Baltimore Longitudinal Study of Aging found no link between smoking and hearing loss in a sample of 531 upper-middle-class white men [ 23 ]. The findings of our study align with previous global research, as only 24% of patients with age-related hearing loss were smokers. Hearing loss, tinnitus, and dizziness are linked to factors such as smoking, hypertension, diabetes, lifestyle choices, age, medical history, and occupational noise exposure, with auditory symptoms often correlating with cumulative lifetime noise exposure [ 24 – 26 ]. Our study produced results consistent with these findings, as 25% of patients with age-related hearing loss had hypertension, 13% had diabetes, and 18% had both conditions. Global studies have similarly found an association between diabetes, hypertension, and auditory symptoms such as dizziness, tinnitus, and hearing loss, identifying diabetes and hypertension as the most common conditions related to hearing disorders [ 27 , 28 ]. The most common causes of tinnitus associated with hearing loss are noise-induced hearing loss and age-related hearing loss [ 29 ]. In our study, the largest proportion of patients with presbycusis (45%) experienced tinnitus, which aligns with global findings. A study conducted in Korea examined 1,868 tinnitus patients who visited the hospital during the study period, including 137 patients with presbycusis and 111 with noise-induced hearing loss. There were no statistically significant differences between these two groups in terms of age, sex, diabetes, or hypertension rates (p > 0.05 for each). Additionally, associated symptoms such as dizziness and ear fullness were more common in patients with presbycusis, but the differences were not statistically significant (p > 0.05 for each). Many individuals with age-related hearing loss (presbycusis) report a family history of the condition in their parents, siblings, or other close relatives. However, it is often challenging to document the nature and extent of familial hearing loss, and this information is rarely recorded [ 30 ]. Our study yielded similar results, with only 18% of patients reporting a family history of presbycusis. Another contributing factor to earlier onset of age-related hearing loss is the use of ototoxic medications. Exposure to drugs such as aminoglycoside antibiotics (e.g., streptomycin, gentamicin, amikacin), NSAIDs, loop diuretics, antitumor agents (e.g., cisplatin), or inhalation of toxic gases (carbon monoxide, hydrogen sulfide) can all lead to ARHL [ 31 ]. In our study, several patients were taking various medications, including 5% who were using loop diuretics. Conclusion The development of age-related hearing impairment (ARHI) is prevalent in the elderly, and multiple factors may interact during its progression. The findings from this study can be valuable for advising high-risk adults about the importance of regular audiological assessments. Declarations Acknowledgments: We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We are thankful to everyone who participated in this study. Funding: This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors. Availability of data and materials: All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request. Ethics approval and consent to participate: This study was approved by the Institutional Review Board (IRB) at the Syrian Private University (SPU). All Participants confirmed their written consent by signing the consent form. Participation in the study was voluntary and participants were assured that anyone who was not inclined to participate or decided to withdraw after giving consent would not be victimized. All information collected from this study was kept strictly confidential. Consent for Publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Authors’ contributions: OABS was responsible for study design, literature search, and write-up; LDN participated in literature search and write-up; LDN participated in the study design and reviewed the final draft. All authors read and approved the final draft. References Huang, Q. and J. Tang, Age-related hearing loss or presbycusis. Eur Arch Otorhinolaryngol, 2010. 267 (8): p. 1179-91. Lin, F.R., J.K. Niparko, and L. Ferrucci, Hearing loss prevalence in the United States. Arch Intern Med, 2011. 171 (20): p. 1851-2. Yamasoba, T., et al., Current concepts in age-related hearing loss: epidemiology and mechanistic pathways. Hear Res, 2013. 303 : p. 30-8. Agrawal, Y., E.A. Platz, and J.K. Niparko, Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004. Arch Intern Med, 2008. 168 (14): p. 1522-30. Cruickshanks, K.J., et al., Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study. Am J Epidemiol, 1998. 148 (9): p. 879-86. Johnson, S.L., Research and statistics: a question of time: cross-sectional versus longitudinal study designs. Pediatr Rev, 2010. 31 (6): p. 250-1. WHO, WHO Fact sheet on deafness and hearing loss (2020). 2020. Zahnert, T., The differential diagnosis of hearing loss. Dtsch Arztebl Int, 2011. 108 (25): p. 433-43; quiz 444. Golub, J.S., et al., Association of Subclinical Hearing Loss With Cognitive Performance. JAMA Otolaryngol Head Neck Surg, 2020. 146 (1): p. 57-67. Lubetzky, A.V., Balance, Falls, and Hearing Loss: Is It Time for a Paradigm Shift? JAMA Otolaryngol Head Neck Surg, 2020. 146 (6): p. 535-536. Leverton, T., Hearing loss is important in dementia. Bmj, 2015. 350 : p. h3650. Blazer, D.G., Hearing Loss: The Silent Risk for Psychiatric Disorders in Late Life. Psychiatr Clin North Am, 2018. 41 (1): p. 19-27. Rutherford, B.R., et al., Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline. Am J Psychiatry, 2018. 175 (3): p. 215-224. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2018. 392 (10159): p. 1789-1858. Organization, W.H., Addressing the rising prevalence of hearing loss. 2018. Mościcki, E.K., et al., Hearing loss in the elderly: an epidemiologic study of the Framingham Heart Study Cohort. Ear Hear, 1985. 6 (4): p. 184-90. Cheslock, M. and O. De Jesus, Presbycusis , in StatPearls . 2024, StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.: Treasure Island (FL). Ciorba, A., et al., High frequency hearing loss in the elderly: effect of age and noise exposure in an Italian group. J Laryngol Otol, 2011. 125 (8): p. 776-80. MAFFEI, G. and P. MIANI, Experimental tobacco poisoning: resultant structural modifications of the cochlea and tuba acustica. Archives of Otolaryngology, 1962. 75 (5): p. 386-396. SL, S., Are you smoking more but hearing less? Eye, Ear, Nose & Throat Monthly, 1964. 43 : p. 96-100. Weiss, W., How smoking affects hearing. Medical times, 1970. 98 (11): p. 84-88. Siegelaub, A.B., et al., Hearing loss in adults: relation to age, sex, exposure to loud noise, and cigarette smoking. Archives of Environmental Health: An International Journal, 1974. 29 (2): p. 107-109. Pearson, J.D. and C.H. Morrell, Risk factors related to age-associated hearing loss in the speech frequencies. J Am Acad Audiol, 1996. 7 : p. 152-60. de Moraes Marchiori, L.L., E. de Almeida Rego Filho, and T. Matsuo, Hypertension as a factor associated with hearing loss. Braz J Otorhinolaryngol, 2006. 72 (4): p. 533-40. Marchiori, L.L.d.M. and E.d.A. Rego Filho, Queixa de vertigem e hipertensão arterial. Revista CEFAC, 2007. 9 : p. 116-121. Melo, J.J., C.L. Meneses, and L.L. Marchiori, Prevalence of tinnitus in elderly individuals with and without history of occupational noise exposure. Int Arch Otorhinolaryngol, 2012. 16 (2): p. 222-5. Baraldi, G.S., L.C. Almeida, and A.C.L. Borges, Perda auditiva e hipertensão: achados em um grupo de idosos. Revista Brasileira de Otorrinolaringologia, 2004. 70 : p. 640-644. Gibrin, P.C., J.J. Melo, and L.L. Marchiori, Prevalence of tinnitus complaints and probable association with hearing loss, diabetes mellitus and hypertension in elderly. Codas, 2013. 25 (2): p. 176-80. Paul, W.F., et al., Cummings otolaryngology: head and neck surgery. Los Angeles: Mosby, 2010. 2674 . Gates, G.A., N.N. Couropmitree, and R.H. Myers, Genetic Associations in Age-Related Hearing Thresholds. Archives of Otolaryngology–Head & Neck Surgery, 1999. 125 (6): p. 654-659. Li, Y., R.B. Womer, and J.H. Silber, Predicting cisplatin ototoxicity in children: the influence of age and the cumulative dose. Eur J Cancer, 2004. 40 (16): p. 2445-51. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5278533","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":366961476,"identity":"bd1fe194-782f-419a-83ed-5634a260a853","order_by":0,"name":"Ola Ahmad Bashar Shaar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDACdiBmbAAxQEQBA4MEQS3MMC08BxgYDhiQpEUigUgt/MzMDxh+7rCTN5/5+Jj0BwMbOckG5oePbuDRItnMZsDYeybZcM7ttDSJAwZpxtIMbMbGOXi0GBxmMGBmbGNmnCGdYwbUcjhxHgMPmzR+LewfgFrq7WdIniFaCw/IlsOJMyR4IFpmE9Ii2cxTcLC37XjyDJ60ZIszQL8AfYffL/zs7Rsf/Gyrtp3BfvjgjYoKGzmJ480PH+PTAgIHULnMBJSPglEwCkbBKCAMAKhEQ3ZGAum3AAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of medicine, Syrian Private University, Damascus, Syria","correspondingAuthor":true,"prefix":"","firstName":"Ola","middleName":"Ahmad Bashar","lastName":"Shaar","suffix":""},{"id":366961477,"identity":"59c784df-d0a0-4591-8709-0b12d77af5d6","order_by":1,"name":"Rabeea Mohsen Muhanna","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Rabeea","middleName":"Mohsen","lastName":"Muhanna","suffix":""},{"id":366961478,"identity":"bbea64b8-59f5-444e-bf88-d30332b8509a","order_by":2,"name":"Loui Darjazini Nahas","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Loui","middleName":"Darjazini","lastName":"Nahas","suffix":""}],"badges":[],"createdAt":"2024-10-16 22:24:36","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5278533/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5278533/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66926994,"identity":"302fbd80-0dca-4718-a9e2-80f220f69a4a","added_by":"auto","created_at":"2024-10-18 06:20:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":371050,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5278533/v1/fb9c22db-8bcd-461d-9395-3d94df7ec9a2.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eFactors associated with age related hearing loss\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAge-related hearing impairment (ARHI), also known as presbycusis, is a multifaceted and progressively degenerative condition that impacts cognitive, emotional, and social functioning among older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Research indicates that hearing sensitivity declines markedly with advancing age, with the prevalence of hearing loss approximately doubling every decade from the 20s to the 70s. According to a recent epidemiological study, utilizing a threshold of 25 dB HL to define hearing loss, the prevalence of ARHI in individuals over 70 years of age was found to be 68.1% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, as populations age, a growing proportion of individuals is expected to experience ARHI in the near future.\u003c/p\u003e \u003cp\u003eAge-related hearing impairment (ARHI) does not manifest uniformly across all individuals. Despite extensive research over the years, there remains a lack of reliable methods to predict who is at the greatest risk, as well as no definitive strategies for prevention and treatment. While the precise pathophysiological mechanisms underlying ARHI are not fully understood, numerous intrinsic (genetic) and extrinsic (environmental) factors have been suggested to contribute to its development over time [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Given that multiple factors interact to create cumulative effects, it is crucial to identify the key influencing factors associated with ARHI in order to better understand and mitigate its progression.\u003c/p\u003e \u003cp\u003eSeveral cross-sectional studies have identified potential risk factors related to age-related hearing impairment (ARHI), including male gender, advancing age, hypertension, cardiovascular disease, cerebrovascular disease, smoking, diabetes, and exposure to noise [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the risk factors identified in these cross-sectional studies only provide a snapshot of the condition's causality, lacking definitive evidence of a temporal relationship between exposure and outcome. These limitations inherent in cross-sectional studies could be addressed through a longitudinal design. To date, few epidemiological studies have examined the risk factors associated with ARHI over time in adults [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, there is a lack of studies that have conducted comprehensive laboratory profiling and analysis of risk factors within a large population cohort.\u003c/p\u003e \u003cp\u003eThe objective of this study was to identify the risk factors linked to the development of age-related hearing impairment (ARHI) in adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA cross-sectional study utilizing a questionnaire was conducted involving 100 patients. Demographic data were gathered during the initial visit. Furthermore, personal medical history and lifestyle factors, including cigarette smoking and alcohol consumption, were evaluated using a structured questionnaire. The patients' history of cardiovascular diseases, diabetes mellitus, and cerebrovascular diseases was documented, along with any medications they were taking. Additionally, patients were asked about associated symptoms such as tinnitus and vertigo.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eOur study's statistical analysis was completed using SPSS Version 27 for Windows (IBM Corp., Armonk, NY, USA). 5% was chosen as the degree of significance. For continuous variables, means and standard deviations (SDs) were used to describe the sample's characteristics, while for categorical variables, frequencies and percentages were used.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study sample comprised 100 patients, with an average age of 73.44 years and a standard deviation of 4.52 years. The youngest participant was 62 years old, while the oldest was 86 years old. Among the patients, 42 were male (42%), and 58 were female (58%). Regarding smoking status, 24 patients identified as smokers (24%), whereas the remaining 76 patients were non-smokers (76%).\u003c/p\u003e \u003cp\u003eExamining the medical histories of the sample, we found that 25 patients had hypertension (25%), while 13 patients had diabetes (13%). Hypertension and diabetes co-occurred in 18 patients (18%), and only one patient had diabetes alongside asthma. Additionally, 43 patients reported no history of illness (43%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.44 (\u0026plusmn;\u0026thinsp;4.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLowest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiggest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u0026thinsp;+\u0026thinsp;diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u0026thinsp;+\u0026thinsp;Asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the auricular symptoms reported by the patients, tinnitus was identified as the most prevalent symptom, affecting 45 patients (45%). Vertigo occurred concurrently with tinnitus in 25 patients (25%), while vertigo as an isolated symptom was observed in 14 patients (14%). The remaining 16 patients (16%) did not report any auricular symptoms.\u003c/p\u003e \u003cp\u003eWhen inquired about previously diagnosed ear conditions, 15 patients indicated a diagnosis of tympanic membrane perforation (15%), while 10 patients reported having vestibular vertigo (10%). The remaining 75 patients (75%) did not mention any prior diagnoses of ear diseases.\u003c/p\u003e \u003cp\u003eIn terms of genetic history, 16 patients (16%) had a positive family history of hearing loss, while the other 84 patients (84%) did not report any such history.\u003c/p\u003e \u003cp\u003eConcerning the medications taken by the patients, beta-blockers were the most commonly used, with 38 patients on this medication. Additionally, 33 patients reported using angiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors. Antiplatelet agents and metformin were mentioned by 28 and 27 patients, respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHearing loss related condition.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuricular symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertigo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTinnitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTinnitus\u0026thinsp;+\u0026thinsp;Vertigo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreviously diagnosed ear conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTympanic membrane perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVestibular vertigo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGenetic history to age related hearing loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTaking any medication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiplatelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeta-blockers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium Channel Blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiuretics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGliptin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetformin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMore than 5% of the global population experiences hearing loss, defined as a reduction in hearing ability of more than 40 decibels in the better hearing ear for adults, and over 30 decibels for children. According to the World Health Organization, it is projected that by 2050, over 900\u0026nbsp;million people\u0026mdash;approximately one in ten\u0026mdash;will have disabling hearing loss [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The most prevalent cause of hearing loss in older adults is age-related hearing decline. Other contributing factors to hearing impairment in adulthood include chronic otitis media and noise-induced trauma [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHearing loss can have significant health implications, as it is linked to cognitive impairment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], an elevated risk of falls [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], accelerated progression of dementia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], social isolation, and mental health disorders such as depression, anxiety, and schizophrenia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. As a result, hearing loss ranks as the fourth leading cause of years lived with disability for men and the seventh for women in the Global Burden of Disease study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], surpassing several other conditions such as stroke, falls, and dementia.\u003c/p\u003e \u003cp\u003ePresbycusis, or age-related hearing loss (ARHL), is a gradual loss of hearing that affects most individuals as they age. According to the World Health Organization [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], nearly one-third of people over 65 experience disruptive hearing loss. By 2025, the global population of individuals aged 60 and above is expected to reach 1.2\u0026nbsp;billion, with over 500\u0026nbsp;million suffering from significant age-related deafness [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEpidemiological studies of large cohorts of older adults indicate that hearing sensitivity declines more rapidly in men after the age of 20 to 30, while in women, this acceleration begins after the age of 50 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Hearing thresholds for men show a steep increase in high-frequency hearing loss, whereas women\u0026rsquo;s hearing loss tends to follow a more gradual decline. Presbycusis is the leading cause of hearing loss worldwide, affecting nearly two-thirds of Americans aged 70 and older [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These findings align closely with the results of our study, where the average age of patients with age-related hearing loss was 73.44 years.\u003c/p\u003e \u003cp\u003eThere is evidence in the literature suggesting that sex may play a role in the development of sensorineural hearing loss (SNHL). Hearing loss is more prevalent in older men compared to older women [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In Europe, the estimated prevalence of presbycusis, the most common sensory disorder in the elderly, is approximately 20% in females and 30% in males over the age of 70 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Clinical data reveal a distinct sex-related pattern in presbycusis, with men experiencing an earlier decline in hearing thresholds than women [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, understanding the influence of sex and gender-related factors in the onset of presbycusis is challenging due to the multifactorial nature of age-related hearing loss. Interestingly, the results from our study showed a higher proportion of females affected by presbycusis compared to males (58% versus 42%). Recent research indicates that the sex-related differences in audiometric patterns among older adults have diminished significantly, potentially due to changes in lifestyle and environmental factors between the sexes over the past two decades [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCigarette smoking may impact hearing by disrupting antioxidant mechanisms or affecting the blood vessels that supply the auditory system [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Several clinical studies have identified a correlation between smoking and hearing loss in adults. Weiss found that men who smoked more than one pack per day exhibited poorer hearing thresholds at frequencies between 250 and 1,000 Hz compared to non-smokers or \"light\" smokers, though no differences were observed at higher frequencies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Siegelaub et al., in a large study involving 33,146 men and women, reported that among men with no history of noise exposure, current smokers were more likely than non-smokers to experience hearing loss at 4,000 Hz, although the effect size was minimal [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. No such association was observed among women. Conversely, the Baltimore Longitudinal Study of Aging found no link between smoking and hearing loss in a sample of 531 upper-middle-class white men [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The findings of our study align with previous global research, as only 24% of patients with age-related hearing loss were smokers.\u003c/p\u003e \u003cp\u003eHearing loss, tinnitus, and dizziness are linked to factors such as smoking, hypertension, diabetes, lifestyle choices, age, medical history, and occupational noise exposure, with auditory symptoms often correlating with cumulative lifetime noise exposure [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our study produced results consistent with these findings, as 25% of patients with age-related hearing loss had hypertension, 13% had diabetes, and 18% had both conditions. Global studies have similarly found an association between diabetes, hypertension, and auditory symptoms such as dizziness, tinnitus, and hearing loss, identifying diabetes and hypertension as the most common conditions related to hearing disorders [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most common causes of tinnitus associated with hearing loss are noise-induced hearing loss and age-related hearing loss [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In our study, the largest proportion of patients with presbycusis (45%) experienced tinnitus, which aligns with global findings. A study conducted in Korea examined 1,868 tinnitus patients who visited the hospital during the study period, including 137 patients with presbycusis and 111 with noise-induced hearing loss. There were no statistically significant differences between these two groups in terms of age, sex, diabetes, or hypertension rates (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for each). Additionally, associated symptoms such as dizziness and ear fullness were more common in patients with presbycusis, but the differences were not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for each).\u003c/p\u003e \u003cp\u003eMany individuals with age-related hearing loss (presbycusis) report a family history of the condition in their parents, siblings, or other close relatives. However, it is often challenging to document the nature and extent of familial hearing loss, and this information is rarely recorded [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Our study yielded similar results, with only 18% of patients reporting a family history of presbycusis.\u003c/p\u003e \u003cp\u003eAnother contributing factor to earlier onset of age-related hearing loss is the use of ototoxic medications. Exposure to drugs such as aminoglycoside antibiotics (e.g., streptomycin, gentamicin, amikacin), NSAIDs, loop diuretics, antitumor agents (e.g., cisplatin), or inhalation of toxic gases (carbon monoxide, hydrogen sulfide) can all lead to ARHL [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, several patients were taking various medications, including 5% who were using loop diuretics.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe development of age-related hearing impairment (ARHI) is prevalent in the elderly, and multiple factors may interact during its progression. The findings from this study can be valuable for advising high-risk adults about the importance of regular audiological assessments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments:\u003c/p\u003e\n\u003cp\u003eWe are thankful to the management of the Syrian Private University and for their support in the field\u0026nbsp;of\u0026nbsp;medical\u0026nbsp;training\u0026nbsp;and\u0026nbsp;research.\u0026nbsp;We\u0026nbsp;are\u0026nbsp;thankful\u0026nbsp;to\u0026nbsp;everyone\u0026nbsp;who\u0026nbsp;participated\u0026nbsp;in\u0026nbsp;this\u0026nbsp;study.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.\u003c/p\u003e\n\u003cp\u003eAvailability\u0026nbsp;of\u0026nbsp;data\u0026nbsp;and\u0026nbsp;materials:\u003c/p\u003e\n\u003cp\u003eAll data related to this paper\u0026rsquo;s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;study\u0026nbsp;was\u0026nbsp;approved\u0026nbsp;by\u0026nbsp;the\u0026nbsp;Institutional\u0026nbsp;Review\u0026nbsp;Board\u0026nbsp;(IRB)\u0026nbsp;at\u0026nbsp;the\u0026nbsp;Syrian\u0026nbsp;Private\u0026nbsp;University (SPU).\u0026nbsp;All\u0026nbsp;Participants\u0026nbsp;confirmed\u0026nbsp;their\u0026nbsp;written\u0026nbsp;consent\u0026nbsp;by\u0026nbsp;signing\u0026nbsp;the\u0026nbsp;consent\u0026nbsp;form.\u0026nbsp;Participation in the study was voluntary and participants were assured that anyone who was not inclined to participate or decided to withdraw after giving consent would not be victimized. All information collected from this study was kept strictly confidential.\u003c/p\u003e\n\u003cp\u003eConsent\u0026nbsp;for\u0026nbsp;Publication:\u003c/p\u003e\n\u003cp\u003eNot\u0026nbsp;applicable.\u003c/p\u003e\n\u003cp\u003eCompeting\u0026nbsp;interests:\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;authors declare\u0026nbsp;that they\u0026nbsp;have\u0026nbsp;no\u0026nbsp;competing\u0026nbsp;interests.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo;\u0026nbsp;contributions:\u003c/p\u003e\n\u003cp\u003eOABS was responsible for study design, literature search, and write-up; LDN participated in literature search and write-up; LDN participated in the study design and reviewed the final draft. All authors read and approved the final draft.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHuang, Q. and J. Tang, \u003cem\u003eAge-related hearing loss or presbycusis.\u003c/em\u003e Eur Arch Otorhinolaryngol, 2010. \u003cstrong\u003e267\u003c/strong\u003e(8): p. 1179-91.\u003c/li\u003e\n \u003cli\u003eLin, F.R., J.K. Niparko, and L. Ferrucci, \u003cem\u003eHearing loss prevalence in the United States.\u003c/em\u003e Arch Intern Med, 2011. \u003cstrong\u003e171\u003c/strong\u003e(20): p. 1851-2.\u003c/li\u003e\n \u003cli\u003eYamasoba, T., et al., \u003cem\u003eCurrent concepts in age-related hearing loss: epidemiology and mechanistic pathways.\u003c/em\u003e Hear Res, 2013. \u003cstrong\u003e303\u003c/strong\u003e: p. 30-8.\u003c/li\u003e\n \u003cli\u003eAgrawal, Y., E.A. Platz, and J.K. Niparko, \u003cem\u003ePrevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004.\u003c/em\u003e Arch Intern Med, 2008. \u003cstrong\u003e168\u003c/strong\u003e(14): p. 1522-30.\u003c/li\u003e\n \u003cli\u003eCruickshanks, K.J., et al., \u003cem\u003ePrevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study.\u003c/em\u003e Am J Epidemiol, 1998. \u003cstrong\u003e148\u003c/strong\u003e(9): p. 879-86.\u003c/li\u003e\n \u003cli\u003eJohnson, S.L., \u003cem\u003eResearch and statistics: a question of time: cross-sectional versus longitudinal study designs.\u003c/em\u003e Pediatr Rev, 2010. \u003cstrong\u003e31\u003c/strong\u003e(6): p. 250-1.\u003c/li\u003e\n \u003cli\u003eWHO, \u003cem\u003eWHO Fact sheet on deafness and hearing loss (2020).\u003c/em\u003e 2020.\u003c/li\u003e\n \u003cli\u003eZahnert, T., \u003cem\u003eThe differential diagnosis of hearing loss.\u003c/em\u003e Dtsch Arztebl Int, 2011. \u003cstrong\u003e108\u003c/strong\u003e(25): p. 433-43; quiz 444.\u003c/li\u003e\n \u003cli\u003eGolub, J.S., et al., \u003cem\u003eAssociation of Subclinical Hearing Loss With Cognitive Performance.\u003c/em\u003e JAMA Otolaryngol Head Neck Surg, 2020. \u003cstrong\u003e146\u003c/strong\u003e(1): p. 57-67.\u003c/li\u003e\n \u003cli\u003eLubetzky, A.V., \u003cem\u003eBalance, Falls, and Hearing Loss: Is It Time for a Paradigm Shift?\u003c/em\u003e JAMA Otolaryngol Head Neck Surg, 2020. \u003cstrong\u003e146\u003c/strong\u003e(6): p. 535-536.\u003c/li\u003e\n \u003cli\u003eLeverton, T., \u003cem\u003eHearing loss is important in dementia.\u003c/em\u003e Bmj, 2015. \u003cstrong\u003e350\u003c/strong\u003e: p. h3650.\u003c/li\u003e\n \u003cli\u003eBlazer, D.G., \u003cem\u003eHearing Loss: The Silent Risk for Psychiatric Disorders in Late Life.\u003c/em\u003e Psychiatr Clin North Am, 2018. \u003cstrong\u003e41\u003c/strong\u003e(1): p. 19-27.\u003c/li\u003e\n \u003cli\u003eRutherford, B.R., et al., \u003cem\u003eSensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline.\u003c/em\u003e Am J Psychiatry, 2018. \u003cstrong\u003e175\u003c/strong\u003e(3): p. 215-224.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eGlobal, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.\u003c/em\u003e Lancet, 2018. \u003cstrong\u003e392\u003c/strong\u003e(10159): p. 1789-1858.\u003c/li\u003e\n \u003cli\u003eOrganization, W.H., \u003cem\u003eAddressing the rising prevalence of hearing loss.\u003c/em\u003e 2018.\u003c/li\u003e\n \u003cli\u003eMościcki, E.K., et al., \u003cem\u003eHearing loss in the elderly: an epidemiologic study of the Framingham Heart Study Cohort.\u003c/em\u003e Ear Hear, 1985. \u003cstrong\u003e6\u003c/strong\u003e(4): p. 184-90.\u003c/li\u003e\n \u003cli\u003eCheslock, M. and O. De Jesus, \u003cem\u003ePresbycusis\u003c/em\u003e, in \u003cem\u003eStatPearls\u003c/em\u003e. 2024, StatPearls Publishing Copyright \u0026copy; 2024, StatPearls Publishing LLC.: Treasure Island (FL).\u003c/li\u003e\n \u003cli\u003eCiorba, A., et al., \u003cem\u003eHigh frequency hearing loss in the elderly: effect of age and noise exposure in an Italian group.\u003c/em\u003e J Laryngol Otol, 2011. \u003cstrong\u003e125\u003c/strong\u003e(8): p. 776-80.\u003c/li\u003e\n \u003cli\u003eMAFFEI, G. and P. MIANI, \u003cem\u003eExperimental tobacco poisoning: resultant structural modifications of the cochlea and tuba acustica.\u003c/em\u003e Archives of Otolaryngology, 1962. \u003cstrong\u003e75\u003c/strong\u003e(5): p. 386-396.\u003c/li\u003e\n \u003cli\u003eSL, S., \u003cem\u003eAre you smoking more but hearing less?\u003c/em\u003e Eye, Ear, Nose \u0026amp; Throat Monthly, 1964. \u003cstrong\u003e43\u003c/strong\u003e: p. 96-100.\u003c/li\u003e\n \u003cli\u003eWeiss, W., \u003cem\u003eHow smoking affects hearing.\u003c/em\u003e Medical times, 1970. \u003cstrong\u003e98\u003c/strong\u003e(11): p. 84-88.\u003c/li\u003e\n \u003cli\u003eSiegelaub, A.B., et al., \u003cem\u003eHearing loss in adults: relation to age, sex, exposure to loud noise, and cigarette smoking.\u003c/em\u003e Archives of Environmental Health: An International Journal, 1974. \u003cstrong\u003e29\u003c/strong\u003e(2): p. 107-109.\u003c/li\u003e\n \u003cli\u003ePearson, J.D. and C.H. Morrell, \u003cem\u003eRisk factors related to age-associated hearing loss in the speech frequencies.\u003c/em\u003e J Am Acad Audiol, 1996. \u003cstrong\u003e7\u003c/strong\u003e: p. 152-60.\u003c/li\u003e\n \u003cli\u003ede Moraes Marchiori, L.L., E. de Almeida Rego Filho, and T. Matsuo, \u003cem\u003eHypertension as a factor associated with hearing loss.\u003c/em\u003e Braz J Otorhinolaryngol, 2006. \u003cstrong\u003e72\u003c/strong\u003e(4): p. 533-40.\u003c/li\u003e\n \u003cli\u003eMarchiori, L.L.d.M. and E.d.A. Rego Filho, \u003cem\u003eQueixa de vertigem e hipertens\u0026atilde;o arterial.\u003c/em\u003e Revista CEFAC, 2007. \u003cstrong\u003e9\u003c/strong\u003e: p. 116-121.\u003c/li\u003e\n \u003cli\u003eMelo, J.J., C.L. Meneses, and L.L. Marchiori, \u003cem\u003ePrevalence of tinnitus in elderly individuals with and without history of occupational noise exposure.\u003c/em\u003e Int Arch Otorhinolaryngol, 2012. \u003cstrong\u003e16\u003c/strong\u003e(2): p. 222-5.\u003c/li\u003e\n \u003cli\u003eBaraldi, G.S., L.C. Almeida, and A.C.L. Borges, \u003cem\u003ePerda auditiva e hipertens\u0026atilde;o: achados em um grupo de idosos.\u003c/em\u003e Revista Brasileira de Otorrinolaringologia, 2004. \u003cstrong\u003e70\u003c/strong\u003e: p. 640-644.\u003c/li\u003e\n \u003cli\u003eGibrin, P.C., J.J. Melo, and L.L. Marchiori, \u003cem\u003ePrevalence of tinnitus complaints and probable association with hearing loss, diabetes mellitus and hypertension in elderly.\u003c/em\u003e Codas, 2013. \u003cstrong\u003e25\u003c/strong\u003e(2): p. 176-80.\u003c/li\u003e\n \u003cli\u003ePaul, W.F., et al., \u003cem\u003eCummings otolaryngology: head and neck surgery.\u003c/em\u003e Los Angeles: Mosby, 2010. \u003cstrong\u003e2674\u003c/strong\u003e.\u003c/li\u003e\n \u003cli\u003eGates, G.A., N.N. Couropmitree, and R.H. Myers, \u003cem\u003eGenetic Associations in Age-Related Hearing Thresholds.\u003c/em\u003e Archives of Otolaryngology\u0026ndash;Head \u0026amp; Neck Surgery, 1999. \u003cstrong\u003e125\u003c/strong\u003e(6): p. 654-659.\u003c/li\u003e\n \u003cli\u003eLi, Y., R.B. Womer, and J.H. Silber, \u003cem\u003ePredicting cisplatin ototoxicity in children: the influence of age and the cumulative dose.\u003c/em\u003e Eur J Cancer, 2004. \u003cstrong\u003e40\u003c/strong\u003e(16): p. 2445-51.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Syrian Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hearing loss, hypertension, diabetes.","lastPublishedDoi":"10.21203/rs.3.rs-5278533/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5278533/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAge-related hearing impairment (ARHI) is a multifaceted degenerative condition in older adults. Since various factors contribute to the development of ARHI, it is crucial to identify the key influencing elements to better understand and prevent its progression.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study using a questionnaire was carried out with 100 patients. Demographic information was collected during the first visit. Additionally, personal medical history and lifestyle factors, such as smoking and alcohol consumption, were assessed through a structured questionnaire. The patients' histories of cardiovascular disease, diabetes mellitus, and cerebrovascular conditions were recorded, along with any medications they were taking. Furthermore, they were asked about related symptoms, including tinnitus and vertigo.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study sample consisted of 100 patients, with a mean age of 73.44 years and a standard deviation of 4.52 years. An analysis of the medical histories revealed that 25 patients had hypertension (25%), while 13 patients had diabetes (13%). Among the auricular symptoms reported, tinnitus emerged as the most common, affecting 45 patients (45%). When asked about previously diagnosed ear conditions, 15 patients reported a diagnosis of tympanic membrane perforation (15%). In terms of genetic background, 16 patients (16%) had a family history of hearing loss. Regarding medication usage, beta-blockers were the most frequently prescribed, with 38 patients currently taking this medication.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe occurrence of age-related hearing impairment (ARHI) is common among older adults, and various factors may interact throughout its progression. The results of this study can be instrumental in counseling high-risk individuals regarding the significance of regular audiological evaluations.\u003c/p\u003e","manuscriptTitle":"Factors associated with age related hearing loss","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-18 06:12:47","doi":"10.21203/rs.3.rs-5278533/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09d279c3-4217-4d49-a9cc-549bc154101c","owner":[],"postedDate":"October 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39047097,"name":"Otorhinolaryngology"}],"tags":[],"updatedAt":"2024-10-18T06:12:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-18 06:12:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5278533","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5278533","identity":"rs-5278533","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}