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Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women
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American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322 – 325 www.elsevier.com/locate/amjoto
Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women☆ Fatih Oghan, MD a,⁎, Hakan Coksuer, MD b b
Abstract
a Department of Otorhinolaryngology, Dumlupinar University, School of Medicine, Kutahya, Turkey Department of Obstetrics and Gynecology, Dumlupinar University, School of Medicine, Kutahya, Turkey Received 17 May 2011
Aim: The aim of this study was to determine the audiologic status and severity of hearing loss in different frequencies between the premenopausal and postmenopausal period in women. Materials and Methods: This prospective study involved 28 premenopausal and 27 postmenopausal women. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years. The mean age of menopause women with sensorineural hearing loss in our study was not suitable for the age range of presbyacousis that is commonly seen. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000– 8000 Hz) audiometry. For each set of tests, mean values of air conduction at each frequency were calculated for the premenopausal and postmenopausal groups and compared. Results: The mean ages of the women on premenopausal and postmenopausal groups were 42.0 ± 2.4 and 43.4 ± 2.6 years, respectively. Duration of menopausal period in second group was 2.03 ± 0.85 years. The corresponding mean body mass indexes were 29.7 ± 2.9 and 31.1 ± 3.8 kg/m 2. There was no statistical significance between the 2 groups in mean ages and mean body mass indexes. Hearing thresholds at low and high frequencies were analyzed between the 2 groups in Table 2. At low (250, 500, 1000, and 2000 Hz) and high frequencies (4000, 6000, and 8000 Hz), the mean airconduction threshold values between the 2 groups were not statistically significant. Conclusion: Estrogen deficiency may not elevate hearing thresholds in early postmenopausal period; however, further studies of larger series are needed to confirm this. © 2012 Elsevier Inc. All rights reserved.
1. Introduction Presbyacousis is an age-related degeneration of the inner ear. Information about the initial process of presbyacousis is important for the interpretation of hearing problems in old age. It is the most common cause of sensorineural hearing loss (HL) in adults. Thirty percent of those 65 to 70 years old and 40% of those older than 75 years have presbyacousia. We all begin to lose our sense of hearing when we are in our 40s. This almost always starts in the very high-frequency areas above 8000 Hz, and as we ☆
There was no any potential conflict of interest and financial support. ⁎ Corresponding author. Dumlupinar Universitesi, Tip Fakultesi Hastanesi, KBB Anabilim Dalı, Merkez Kampus, Tavsanli Yolu, 10. km., Kutahya, Turkey. Tel.: +90 505 7267375. E-mail address: [email protected] (F. Oghan). 0196-0709/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.amjoto.2011.10.003
approach our mid 50s, most everyone will have some mild HL in the speech range from 250 to 6000 Hz [1]. The menopause seems to be a “starting point” for age-related HL, but very little is known about hearing in women during the period in life before, during, or after menopause [2]. In our study, we investigated HL between 250 and 8000 Hz in postmenopausal and premenopausal women. Coleman et al [3] found that estrogen therapy in young adult rats shortened the latencies of electric responses in several auditory pathways. This suggests that lack of this hormone may play a role in the hearing disorder in postmenopausal women. The mean age of menopause women with sensorineural HL in our study was not suitable for the age range of presbyacousis that is commonly seen. In addition, we tried to find out the incidence and severity of HL especially between the young premenopausal and postmenopausal Turkish women, independently presbyacousis.
F. Oghan, H. Coksuer / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322–325
2. Materials and methods This prospective study involved 28 premenopausal and 27 postmenopausal women who were referred to the otorhinolaryngology and gynecology departments of Dumlupinar University Faculty of Medicine. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years. Postmenopausal status was defined as amenorrhea for at least 1 year, follicle-stimulating hormone (FSH) levels greater than 30 IU/L, and estradiol (E2) levels less than 20 IU/L. Subjects who had FSH levels more than 20 IU/l and E2 levels lower than 40 IU/L were considered as climacteric patients [4]. The inclusion criteria for postmenopausal women were an intact uterus and a diagnostically valid negative Papanicolaou smear or, if inadequate tissue was available for analysis, an endometrial thickness of less than 5 mm, as determined by vaginal ultrasonography. Exclusion criteria included abnormal cervical smear result, undiagnosed genital bleeding, known or suspected malignant or premalignant disease, uncontrolled thyroid disorders, depression, stroke, diabetes mellitus, alcohol abuse, smoking, hypertension, idiopathic thrombophlebitis or thromboembolic disease, severe renal insufficiency, and adrenal insufficiency. Patients who had previously had otologic symptoms and those who had previously had any neurologic disease that can affect hearing were excluded. Women with medical histories that could have affected auditory functions were not included in this study. In addition, when we questioned the history of HL, an early-beginning familial presbyacousia history was not detected in our patients with sensorineural HL. The study was approved by the medical ethics committee of the Medical School of Dumlupinar University. Otoscopic examination revealed normal tympanic membranes in all 55 subjects. All participants had normal middle ear function, as determined by conventional immittance audiometry. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000–8000 Hz) audiometry. The standard battery of hearing tests consisted of pure tone, speech, and impedance audiometry. The same audiometry technician performed all audiologic examinations in the same audiology laboratory. For each set of tests, mean values of air conduction at each frequency were calculated for the climacteric, and postmenopausal groups and graphs of decibels vs frequency were drawn to compare hearing between the 2 groups. Analysis of variance was used to analyze differences in baseline data among the 2 groups. Distribution of the continuous variables was checked by using the Kolmogorov-Smirnov test. After testing the normal distribution, comparisons between the groups were tested using the t test. P b .05 was considered to indicate statistical significance. Data were analyzed with the software SPSS for Windows
323
version 9.05 (SPSS Inc, Chicago, IL). Results are expressed as mean ± SD. 3. Results The clinical characteristics and hormonal and biochemical profile of the subjects in the premenopausal and postmenopausal groups are presented in Table 1. The mean ages of the women on premenopausal and postmenopausal groups were 42.0 ± 2.4 and 43.4 ± 2.6 years, respectively. Duration of menopausal period in second group was 2.03 ± 0.85 years. The corresponding mean body mass indexes (BMIs) were 29.7 ± 2.9 kg/m 2 and 31.1 ± 3.8 kg/m 2. There was no statistical significance between the 2 groups in mean ages and mean BMIs (Table 1). Hearing thresholds at low and high frequencies were analyzed between the 2 groups in Table 2. At low (250, 500, 1000, and 2000 Hz) and high frequencies (4000, 6000, and 8000 Hz), the mean air conduction threshold values between the 2 groups were not statistically significant (Table 2). Graphs of decibels vs frequencies were drawn to compare hearing between the 2 groups as Fig. 1. 4. Discussion The sex and age differences in human hearing function are well documented, and women are known to exhibit shorter auditory brainstem response (ABR) latencies [5,6]. Experiments have shown that estrogen treatment can specifically alter ABR latencies [7]. A study by Coleman et al [3] revealed that estrogen replacement prolonged ABR latencies in ovariectomized rats. This suggests that hormonal changes at menopause may affect hearing. Most HL that occurs because of presbyacousis, ototoxicity, exposure to noise, or traumatic effects of middle ear surgery is in the high-frequency range; thus, the loss is usually first detected in this range [8,9]. There are many proposed causes of presbyacousis, ranging from unavoidable intrinsic degenerative processes to exposure to agents that damage hearing over a person's life. The postulated mechanisms include mechanical, sensorineural, and vascular and biochemical causes [10]. Schuknecht [11] theorized that genetic factors might influence neuronal loss in the cochlea Table 1 Clinical characteristics and hormonal and biochemical profile
Age (y) BMI (kg/m 2) FSH (IU/L) Estradiol (IU/L) Fasting glucose (mg/dl)
Premenopausal (n = 28)
Postmenopausal (n = 27)
Mean ± SD
Mean ± SD
42.0 ± 29.7 ± 25.4 ± 31.6 ± 87.9 ±
43.4 ± 2.6 31.1 ± 3.8 49.3 ± 13.4 13.8 ± 4.4 91.2 ± 5.7
2.4 2.9 3.5 8.0 7.6
P
.054 .18 b.001 b.001 .07
324
F. Oghan, H. Coksuer / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322–325
Table 2 Hearing thresholds at low and high frequencies for premenopausal and postmenopausal patients Premenopausal (n = 28) Postmenopausal (n = 27) P
Low frequencies 250 Hz Right Left 500 Hz Right Left 1000 Hz Right Left 2000 Hz Right Left High frequencies 4000 Hz Right Left 6000 Hz Right Left 8000 Hz Right Left
Mean ± SD
Mean ± SD
12.5 ± 8.3 13.3 ± 10.5 12.8 ± 8.8 13.5 ± 10.0 15.5 ± 10.1 14.1 ± 9.0 11.6 ± 8.6 15.1 ± 11.4
14.6 ± 7.5 14.4 ± 9.2 12.9 ± 6.5 15.7 ± 9.4 15.9 ± 8.7 17.5 ± 7.6 12.0 ± 5.9 14.4 ± 10.4
17.3 ± 13.4 21.4 ± 16.7 25.1 ± 13.5 25.5 ± 15.6 28.0 ± 12.4 27.1 ± 12.2
15.0 ± 8.4 18.7 ± 9.2 23.5 ± 12.4 25.1 ± 12.5 28.3 ± 7.4 27.2 ± 9.7
.32 .69 .96 .41 .87 .12 .83 .80
Frequencies(Hz) Hearing 11 Thresholds 12
(dB)
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
→ Pre-menopausal, Right → Pre-menopausal, Left → Post-menopausal, Right → Post-menopausal, Left
.44 .46 .63 .92 .91 .97
and in acoustic pathways. The mechanism by which hormonal changes alter auditory thresholds is not clear, but the literature on the physiologic and biologic effects of sex hormones indicates 2 possible modes of action [3]: 1. Direct effects on the cochlea and various pathways in the central auditory system and 2. Modulation of blood flow in cochlea and brain. Normal inner ear function depends on maintenance of hemostasis in the inner ear fluids and on the biochemical integrity of auditory receptor cells. Altered electrolyte balance in these fluids caused by decreased estrogen levels and the subsequent osmolality changes that occur might at least partially explain shifts in auditory thresholds in the postmenopausal period. Estrogen therapy may help maintain the ion and fluid balance of the inner ear, which is impaired in the postmenopausal period [12]. In addition to potential direct effects, it has also been theorized that sex hormones alter blood flow in the cochlea and the brain [3]. Estrogenrelated changes in cerebral blood flow may affect the auditory response. There are age-related sex differences in cerebral blood flow. Before menopause, women have higher cerebral blood flow volume than men of the same age [13]. After menopause, the flow volume decreases to parallel to that in age-matched men [14]. On the other hand, there was no sufficient knowledge that shows effects of estrogen levels on cochlea in early menopausal period. In addition, the effects of duration of menopausal period on HL are not well documented especially in young women. Genetic factors are significant in the development of agerelated HL [15]. There are indications that the “genetic influence” is more pronounced in women, and the “extrinsic influence” is more apparent in men. Endocrinologic differences between men and women might also be of
Fig. 1. Graphs of decibels vs frequencies.
importance, especially concerning the effect of estrogens, but further investigation is needed regarding the role of this hormone on HL [2]. There was not any study in the literature degree of HL in early postmenopausal women. In our study, we tried to find out the severity of HL between the young premenopausal and postmenopausal women, independently presbyacousis. The mean age of menopause women with sensorineural HL in our study was not suitable for the age range of presbyacousis that is commonly seen. In addition, there was no statistical significance between the 2 groups in mean ages. Hederstierna et al [2] emphasized that menopause seems to be a “starting point” for age-related HL, but very little is known about hearing in women during the period in life before, during, or after menopause. We concluded that there was not any difference between in young premenopausal and postmenopausal women in respect with HL. Duration of postmenopausal period could affect HL; for this reason, early menopause women must be alert about the E2 deficiency. Estrogen replacement therapy may slow down the process of HL in young postmenopausal women, but we do not believe that menopause seems to be a “starting point” for age-related HL especially in early menopausal women. Further prospective studies are needed to clarify the definite role of sex steroids after menopause in young women on the auditory system.
References [1] Ak E, Harputluoglu U, Oghan F, et al. Behçet's disease and hearing loss. Auris Nasus Larynx 2004;31:29-33. [2] Hederstierna C, Hultcrantz M, Collins A, et al. Hearing in women at menopause. Prevalence of hearing loss, audiometric configuration and relation to hormone replacement therapy. Acta Oto-Laryngologica 2007;127:149-55. [3] Coleman JR, Campbell D, Cooper A, et al. Auditory brainstem response after ovariectomy and estrogen replacement in rat. Hear Res 1994;80:209-15.
F. Oghan, H. Coksuer / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322–325 [4] Ozturk O, Eraslan D, Mete HE, et al. The risk factors and symptomatology of perimenopausal depression. Maturitas 2006;55: 180-6. [5] Jerger J, Hall J. Effects of age and sex on auditory brainstem response. Arch Otolaryngol 1980;106:387-91. [6] Jerger J, Johnson K. Interactions of age, gender, and sensorineural hearing loss on ABR latency. Ear Hear 1988;9:168-76. [7] Elkind-Hirsch KE, Stoner WR, Stach BA, et al. Estrogen influences auditory brainstem responses during the normal menstrual cycle. Hear Res 1992;60:143-8. [8] Fausti SA, Frey RH, Erickson DA, et al. A system for evaluating auditory function from 8000-20000 Hz. J Acoust Soc Am 1979;66:1713-8. [9] Tonndorf J, Kurman B. High frequency audiometry. Ann Otol Rhinol Laryngol 1984;93:576-82.
325
[10] Hinchcliffe R. The age function of hearing: aspects of the epidemiology. Acta Otolaryngol 1991;476:7-11. [11] Schuhnecht HF. Further observations on the pathology of presbycousis. Arch Otolaryngol 1964;80:373-82. [12] Kilicdag EB, Yavuz H, Bagis T, et al. Effects of estrogen therapy on hearing in postmenopausal women. Am J Obstet Gynecol 2004;190:77-82. [13] Shaw TG, Mortel KF, Meyer JS, et al. Cerebral blood flow changes in benign aging and cerebrovascular disease. Neurology 1984;34: 855-62. [14] Rodriguez G, Warkentin S, Risberg J, et al. Sex differences in regional cerebral blood flow. J Cereb Blood Flow Metab 1988;8:783-9. [15] Gates GA, Couropmitree NN, Myers RH. Genetic associations in agerelated hearing thresholds. Arch Otolaryngol Head Neck Surg 1999;125:654-9.
American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322 – 325 www.elsevier.com/locate/amjoto
Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women☆ Fatih Oghan, MD a,⁎, Hakan Coksuer, MD b b
Abstract
a Department of Otorhinolaryngology, Dumlupinar University, School of Medicine, Kutahya, Turkey Department of Obstetrics and Gynecology, Dumlupinar University, School of Medicine, Kutahya, Turkey Received 17 May 2011
Aim: The aim of this study was to determine the audiologic status and severity of hearing loss in different frequencies between the premenopausal and postmenopausal period in women. Materials and Methods: This prospective study involved 28 premenopausal and 27 postmenopausal women. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years. The mean age of menopause women with sensorineural hearing loss in our study was not suitable for the age range of presbyacousis that is commonly seen. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000– 8000 Hz) audiometry. For each set of tests, mean values of air conduction at each frequency were calculated for the premenopausal and postmenopausal groups and compared. Results: The mean ages of the women on premenopausal and postmenopausal groups were 42.0 ± 2.4 and 43.4 ± 2.6 years, respectively. Duration of menopausal period in second group was 2.03 ± 0.85 years. The corresponding mean body mass indexes were 29.7 ± 2.9 and 31.1 ± 3.8 kg/m 2. There was no statistical significance between the 2 groups in mean ages and mean body mass indexes. Hearing thresholds at low and high frequencies were analyzed between the 2 groups in Table 2. At low (250, 500, 1000, and 2000 Hz) and high frequencies (4000, 6000, and 8000 Hz), the mean airconduction threshold values between the 2 groups were not statistically significant. Conclusion: Estrogen deficiency may not elevate hearing thresholds in early postmenopausal period; however, further studies of larger series are needed to confirm this. © 2012 Elsevier Inc. All rights reserved.
1. Introduction Presbyacousis is an age-related degeneration of the inner ear. Information about the initial process of presbyacousis is important for the interpretation of hearing problems in old age. It is the most common cause of sensorineural hearing loss (HL) in adults. Thirty percent of those 65 to 70 years old and 40% of those older than 75 years have presbyacousia. We all begin to lose our sense of hearing when we are in our 40s. This almost always starts in the very high-frequency areas above 8000 Hz, and as we ☆
There was no any potential conflict of interest and financial support. ⁎ Corresponding author. Dumlupinar Universitesi, Tip Fakultesi Hastanesi, KBB Anabilim Dalı, Merkez Kampus, Tavsanli Yolu, 10. km., Kutahya, Turkey. Tel.: +90 505 7267375. E-mail address: [email protected] (F. Oghan). 0196-0709/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.amjoto.2011.10.003
approach our mid 50s, most everyone will have some mild HL in the speech range from 250 to 6000 Hz [1]. The menopause seems to be a “starting point” for age-related HL, but very little is known about hearing in women during the period in life before, during, or after menopause [2]. In our study, we investigated HL between 250 and 8000 Hz in postmenopausal and premenopausal women. Coleman et al [3] found that estrogen therapy in young adult rats shortened the latencies of electric responses in several auditory pathways. This suggests that lack of this hormone may play a role in the hearing disorder in postmenopausal women. The mean age of menopause women with sensorineural HL in our study was not suitable for the age range of presbyacousis that is commonly seen. In addition, we tried to find out the incidence and severity of HL especially between the young premenopausal and postmenopausal Turkish women, independently presbyacousis.
F. Oghan, H. Coksuer / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322–325
2. Materials and methods This prospective study involved 28 premenopausal and 27 postmenopausal women who were referred to the otorhinolaryngology and gynecology departments of Dumlupinar University Faculty of Medicine. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years. Postmenopausal status was defined as amenorrhea for at least 1 year, follicle-stimulating hormone (FSH) levels greater than 30 IU/L, and estradiol (E2) levels less than 20 IU/L. Subjects who had FSH levels more than 20 IU/l and E2 levels lower than 40 IU/L were considered as climacteric patients [4]. The inclusion criteria for postmenopausal women were an intact uterus and a diagnostically valid negative Papanicolaou smear or, if inadequate tissue was available for analysis, an endometrial thickness of less than 5 mm, as determined by vaginal ultrasonography. Exclusion criteria included abnormal cervical smear result, undiagnosed genital bleeding, known or suspected malignant or premalignant disease, uncontrolled thyroid disorders, depression, stroke, diabetes mellitus, alcohol abuse, smoking, hypertension, idiopathic thrombophlebitis or thromboembolic disease, severe renal insufficiency, and adrenal insufficiency. Patients who had previously had otologic symptoms and those who had previously had any neurologic disease that can affect hearing were excluded. Women with medical histories that could have affected auditory functions were not included in this study. In addition, when we questioned the history of HL, an early-beginning familial presbyacousia history was not detected in our patients with sensorineural HL. The study was approved by the medical ethics committee of the Medical School of Dumlupinar University. Otoscopic examination revealed normal tympanic membranes in all 55 subjects. All participants had normal middle ear function, as determined by conventional immittance audiometry. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000–8000 Hz) audiometry. The standard battery of hearing tests consisted of pure tone, speech, and impedance audiometry. The same audiometry technician performed all audiologic examinations in the same audiology laboratory. For each set of tests, mean values of air conduction at each frequency were calculated for the climacteric, and postmenopausal groups and graphs of decibels vs frequency were drawn to compare hearing between the 2 groups. Analysis of variance was used to analyze differences in baseline data among the 2 groups. Distribution of the continuous variables was checked by using the Kolmogorov-Smirnov test. After testing the normal distribution, comparisons between the groups were tested using the t test. P b .05 was considered to indicate statistical significance. Data were analyzed with the software SPSS for Windows
323
version 9.05 (SPSS Inc, Chicago, IL). Results are expressed as mean ± SD. 3. Results The clinical characteristics and hormonal and biochemical profile of the subjects in the premenopausal and postmenopausal groups are presented in Table 1. The mean ages of the women on premenopausal and postmenopausal groups were 42.0 ± 2.4 and 43.4 ± 2.6 years, respectively. Duration of menopausal period in second group was 2.03 ± 0.85 years. The corresponding mean body mass indexes (BMIs) were 29.7 ± 2.9 kg/m 2 and 31.1 ± 3.8 kg/m 2. There was no statistical significance between the 2 groups in mean ages and mean BMIs (Table 1). Hearing thresholds at low and high frequencies were analyzed between the 2 groups in Table 2. At low (250, 500, 1000, and 2000 Hz) and high frequencies (4000, 6000, and 8000 Hz), the mean air conduction threshold values between the 2 groups were not statistically significant (Table 2). Graphs of decibels vs frequencies were drawn to compare hearing between the 2 groups as Fig. 1. 4. Discussion The sex and age differences in human hearing function are well documented, and women are known to exhibit shorter auditory brainstem response (ABR) latencies [5,6]. Experiments have shown that estrogen treatment can specifically alter ABR latencies [7]. A study by Coleman et al [3] revealed that estrogen replacement prolonged ABR latencies in ovariectomized rats. This suggests that hormonal changes at menopause may affect hearing. Most HL that occurs because of presbyacousis, ototoxicity, exposure to noise, or traumatic effects of middle ear surgery is in the high-frequency range; thus, the loss is usually first detected in this range [8,9]. There are many proposed causes of presbyacousis, ranging from unavoidable intrinsic degenerative processes to exposure to agents that damage hearing over a person's life. The postulated mechanisms include mechanical, sensorineural, and vascular and biochemical causes [10]. Schuknecht [11] theorized that genetic factors might influence neuronal loss in the cochlea Table 1 Clinical characteristics and hormonal and biochemical profile
Age (y) BMI (kg/m 2) FSH (IU/L) Estradiol (IU/L) Fasting glucose (mg/dl)
Premenopausal (n = 28)
Postmenopausal (n = 27)
Mean ± SD
Mean ± SD
42.0 ± 29.7 ± 25.4 ± 31.6 ± 87.9 ±
43.4 ± 2.6 31.1 ± 3.8 49.3 ± 13.4 13.8 ± 4.4 91.2 ± 5.7
2.4 2.9 3.5 8.0 7.6
P
.054 .18 b.001 b.001 .07
324
F. Oghan, H. Coksuer / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322–325
Table 2 Hearing thresholds at low and high frequencies for premenopausal and postmenopausal patients Premenopausal (n = 28) Postmenopausal (n = 27) P
Low frequencies 250 Hz Right Left 500 Hz Right Left 1000 Hz Right Left 2000 Hz Right Left High frequencies 4000 Hz Right Left 6000 Hz Right Left 8000 Hz Right Left
Mean ± SD
Mean ± SD
12.5 ± 8.3 13.3 ± 10.5 12.8 ± 8.8 13.5 ± 10.0 15.5 ± 10.1 14.1 ± 9.0 11.6 ± 8.6 15.1 ± 11.4
14.6 ± 7.5 14.4 ± 9.2 12.9 ± 6.5 15.7 ± 9.4 15.9 ± 8.7 17.5 ± 7.6 12.0 ± 5.9 14.4 ± 10.4
17.3 ± 13.4 21.4 ± 16.7 25.1 ± 13.5 25.5 ± 15.6 28.0 ± 12.4 27.1 ± 12.2
15.0 ± 8.4 18.7 ± 9.2 23.5 ± 12.4 25.1 ± 12.5 28.3 ± 7.4 27.2 ± 9.7
.32 .69 .96 .41 .87 .12 .83 .80
Frequencies(Hz) Hearing 11 Thresholds 12
(dB)
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
→ Pre-menopausal, Right → Pre-menopausal, Left → Post-menopausal, Right → Post-menopausal, Left
.44 .46 .63 .92 .91 .97
and in acoustic pathways. The mechanism by which hormonal changes alter auditory thresholds is not clear, but the literature on the physiologic and biologic effects of sex hormones indicates 2 possible modes of action [3]: 1. Direct effects on the cochlea and various pathways in the central auditory system and 2. Modulation of blood flow in cochlea and brain. Normal inner ear function depends on maintenance of hemostasis in the inner ear fluids and on the biochemical integrity of auditory receptor cells. Altered electrolyte balance in these fluids caused by decreased estrogen levels and the subsequent osmolality changes that occur might at least partially explain shifts in auditory thresholds in the postmenopausal period. Estrogen therapy may help maintain the ion and fluid balance of the inner ear, which is impaired in the postmenopausal period [12]. In addition to potential direct effects, it has also been theorized that sex hormones alter blood flow in the cochlea and the brain [3]. Estrogenrelated changes in cerebral blood flow may affect the auditory response. There are age-related sex differences in cerebral blood flow. Before menopause, women have higher cerebral blood flow volume than men of the same age [13]. After menopause, the flow volume decreases to parallel to that in age-matched men [14]. On the other hand, there was no sufficient knowledge that shows effects of estrogen levels on cochlea in early menopausal period. In addition, the effects of duration of menopausal period on HL are not well documented especially in young women. Genetic factors are significant in the development of agerelated HL [15]. There are indications that the “genetic influence” is more pronounced in women, and the “extrinsic influence” is more apparent in men. Endocrinologic differences between men and women might also be of
Fig. 1. Graphs of decibels vs frequencies.
importance, especially concerning the effect of estrogens, but further investigation is needed regarding the role of this hormone on HL [2]. There was not any study in the literature degree of HL in early postmenopausal women. In our study, we tried to find out the severity of HL between the young premenopausal and postmenopausal women, independently presbyacousis. The mean age of menopause women with sensorineural HL in our study was not suitable for the age range of presbyacousis that is commonly seen. In addition, there was no statistical significance between the 2 groups in mean ages. Hederstierna et al [2] emphasized that menopause seems to be a “starting point” for age-related HL, but very little is known about hearing in women during the period in life before, during, or after menopause. We concluded that there was not any difference between in young premenopausal and postmenopausal women in respect with HL. Duration of postmenopausal period could affect HL; for this reason, early menopause women must be alert about the E2 deficiency. Estrogen replacement therapy may slow down the process of HL in young postmenopausal women, but we do not believe that menopause seems to be a “starting point” for age-related HL especially in early menopausal women. Further prospective studies are needed to clarify the definite role of sex steroids after menopause in young women on the auditory system.
References [1] Ak E, Harputluoglu U, Oghan F, et al. Behçet's disease and hearing loss. Auris Nasus Larynx 2004;31:29-33. [2] Hederstierna C, Hultcrantz M, Collins A, et al. Hearing in women at menopause. Prevalence of hearing loss, audiometric configuration and relation to hormone replacement therapy. Acta Oto-Laryngologica 2007;127:149-55. [3] Coleman JR, Campbell D, Cooper A, et al. Auditory brainstem response after ovariectomy and estrogen replacement in rat. Hear Res 1994;80:209-15.
F. Oghan, H. Coksuer / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 322–325 [4] Ozturk O, Eraslan D, Mete HE, et al. The risk factors and symptomatology of perimenopausal depression. Maturitas 2006;55: 180-6. [5] Jerger J, Hall J. Effects of age and sex on auditory brainstem response. Arch Otolaryngol 1980;106:387-91. [6] Jerger J, Johnson K. Interactions of age, gender, and sensorineural hearing loss on ABR latency. Ear Hear 1988;9:168-76. [7] Elkind-Hirsch KE, Stoner WR, Stach BA, et al. Estrogen influences auditory brainstem responses during the normal menstrual cycle. Hear Res 1992;60:143-8. [8] Fausti SA, Frey RH, Erickson DA, et al. A system for evaluating auditory function from 8000-20000 Hz. J Acoust Soc Am 1979;66:1713-8. [9] Tonndorf J, Kurman B. High frequency audiometry. Ann Otol Rhinol Laryngol 1984;93:576-82.
325
[10] Hinchcliffe R. The age function of hearing: aspects of the epidemiology. Acta Otolaryngol 1991;476:7-11. [11] Schuhnecht HF. Further observations on the pathology of presbycousis. Arch Otolaryngol 1964;80:373-82. [12] Kilicdag EB, Yavuz H, Bagis T, et al. Effects of estrogen therapy on hearing in postmenopausal women. Am J Obstet Gynecol 2004;190:77-82. [13] Shaw TG, Mortel KF, Meyer JS, et al. Cerebral blood flow changes in benign aging and cerebrovascular disease. Neurology 1984;34: 855-62. [14] Rodriguez G, Warkentin S, Risberg J, et al. Sex differences in regional cerebral blood flow. J Cereb Blood Flow Metab 1988;8:783-9. [15] Gates GA, Couropmitree NN, Myers RH. Genetic associations in agerelated hearing thresholds. Arch Otolaryngol Head Neck Surg 1999;125:654-9.