Association between age-related hearing loss and stroke in an older population.
ABSTRACT Very few studies have investigated the association between hearing loss and stroke. A recent article in Stroke reported an increased incidence of stroke among patients with sudden hearing loss over a 5-year follow-up period. Our study aimed to explore this association among subjects with age-related hearing loss from a representative population. Further, we looked at the association between severity of hearing loss and risk of stroke in older persons, acknowledged as a limitation by the authors of the Stroke report.
The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted during 1997 to 1999 and 2002 to 2004, among participants of the Blue Mountains Eye Study. Pure-tone air conduction hearing thresholds from 0.25 to 8.0 kHz were measured by audiologists. Hearing loss was defined as the pure-tone average of frequencies 0.5, 1.0, 2.0, and 4.0 kHz >25 dB HL in the better ear.
Persons with moderate to severe hearing loss had a significantly higher likelihood of reporting previous stroke (OR, 2.04; 95% CI, 1.20-3.49) after multivariable adjustment. However, moderate to severe hearing loss did not predict incident stroke after 5-year follow-up (OR, 1.14; 95% CI, 0.59-2.23).
We observed a strong cross-sectional association between stroke and moderate to severe hearing loss. However, age-related hearing loss did not increase risk of incident stroke in our cohort. Insufficient study power or differing underlying pathologies of sudden sensorineural hearing loss and typical age-related hearing loss may account for the discrepant findings between these studies.
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ABSTRACT: Mean platelet volume (MPV) is one of the platelet function indices which reflects the platelet production rate and functions. While vascular occlusion, acute or chronic syndromes and vasculitis are increasing the MPV levels, infections, autoimmune diseases, and inflammatory situations reduce it. The indicator for idiopathic sudden sensorineural hearing loss (ISHL) etiology remains a matter of debate because it is associated with many different disorders. We evaluated MPV levels in ISHL patients. Forty patients with ISHL and 40 healthy, age and sex matched subjects were enrolled to the study. Audiometer and laboratory results were recorded. Comparative multivariate analyses between indicator factors and hearing outcomes were conducted. MPV and platelet distribution width is significantly higher in ISHL. Platelet count is lower in the ISHL than control group (p < 0.001), (p < 0.001), (p = 0.003), respectively. Our findings indicate that, ISHL appears to be characterized by ischaemic or thrombotic events. Considering the increased MPV levels; MPV may be used to evaluate ISHL as an hepler indicator.Archives of Oto-Rhino-Laryngology 01/2013; · 1.29 Impact Factor
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ABSTRACT: Auditory functional limitations experienced by patients after stroke of the central auditory pathways remain underinvestigated. Purpose- To measure patient-reported hearing difficulties in everyday life in nonaphasic patients with stroke of the auditory brain versus normal control subjects. To examine how hearing difficulties correlate with auditory tests and site of lesion in individual cases. We recruited 21 individuals with auditory brain stroke (excluding those with aphasia) diagnosed on the basis of a brain MRI conducted 1 to 2 weeks after the stroke and assessed in the chronic stage of stroke. Twenty-three controls matched for age and hearing were also recruited. All subjects completed the Amsterdam Inventory for Auditory Disability (consisting of subscales of sound detection, recognition, localization, speech in quiet, speech in noise) and underwent baseline audiometry and central auditory processing tests (dichotic digits, frequency and duration patterns, gaps in noise). Sound recognition and localization subscores of the inventory were significantly worse in case subjects versus control subjects, with severe and significant functional limitation (z score >3) reported by 9 out of 21 case subjects. None of the inventory subscales correlated with audiometric thresholds, but localization and recognition subscales showed a moderate to strong correlation with dichotic digits (left ear) and pattern tests. A substantial proportion of patients may experience and report severe auditory functional limitations not limited to speech sounds after stroke of the auditory brain. A hearing questionnaire may help identify patients who require more extensive assessment to inform rehabilitation plans.Stroke 03/2012; 43(5):1285-9. · 6.16 Impact Factor
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ABSTRACT: We aimed to investigate predictors of change in pure-tone hearing thresholds in older adults. Data were drawn from a pooled sample from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project (N = 4,221, mean age = 73.6, range: 50-103 years). Pure-tone hearing thresholds were tested for frequencies between 0.5 and 8 kHz, on up to four occasions over a period of 11 years. Linear mixed models tested for predictors of change in hearing. Hearing loss for high-range frequencies preceded decline in low-range frequencies. Men had higher baseline hearing thresholds, but women experienced faster rates of decline in hearing for mid- to high-range frequencies. The estimated rate of change for a 75-year-old adult was 0.91 decibel hearing level (dB HL) per year for pure-tone thresholds averaged over frequencies ranging between 0.5 and 4 kHz in the better ear. Baseline age (β = 0.03, p < .01), hypertension (β = 0.15, p < .01), and probable cognitive impairment (β = 0.40, p = .01) were independent predictors of annual rate of change in hearing thresholds. Incidence of probable cognitive impairment was also associated with higher hearing thresholds. Other known correlates for prevalence of hearing impairment, including low education, noise damage, diabetes, and history of stroke were independently associated with baseline levels of hearing but were not predictive of change in hearing thresholds. Faster rates of decline in hearing are predicted by probable cognitive impairment and hypertension.The Journals of Gerontology Series A Biological Sciences and Medical Sciences 03/2012; 67(9):997-1003. · 4.31 Impact Factor
Association Between Age-Related Hearing Loss and Stroke
in an Older Population
Bamini Gopinath, PhD; Julie Schneider, PhD; Elena Rochtchina, MSc;
Stephen R. Leeder, PhD, MD; Paul Mitchell, PhD, MD
Background and Purpose—Very few studies have investigated the association between hearing loss and stroke. A recent
article in Stroke reported an increased incidence of stroke among patients with sudden hearing loss over a 5-year
follow-up period. Our study aimed to explore this association among subjects with age-related hearing loss from a
representative population. Further, we looked at the association between severity of hearing loss and risk of stroke in
older persons, acknowledged as a limitation by the authors of the Stroke report.
Methods—The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted during
1997 to 1999 and 2002 to 2004, among participants of the Blue Mountains Eye Study. Pure-tone air conduction hearing
thresholds from 0.25 to 8.0 kHz were measured by audiologists. Hearing loss was defined as the pure-tone average of
frequencies 0.5, 1.0, 2.0, and 4.0 kHz ?25 dB HL in the better ear.
Results—Persons with moderate to severe hearing loss had a significantly higher likelihood of reporting previous stroke
(OR, 2.04; 95% CI, 1.20–3.49) after multivariable adjustment. However, moderate to severe hearing loss did not predict
incident stroke after 5-year follow-up (OR, 1.14; 95% CI, 0.59–2.23).
Conclusions—We observed a strong cross-sectional association between stroke and moderate to severe hearing loss.
However, age-related hearing loss did not increase risk of incident stroke in our cohort. Insufficient study power or
differing underlying pathologies of sudden sensorineural hearing loss and typical age-related hearing loss may account
for the discrepant findings between these studies. (Stroke. 2009;40:1496-1498.)
Key Words: Blue Mountains Eye Study ? hearing loss ? stroke incidence
by Lin et al2investigated the incidence of stroke in persons
experiencing sudden sensorineural hearing loss. After adjust-
ing for other factors, the hazard risk for stroke over 5 years
was 1.64-fold (95% CI, 1.31–2.07; P?0.001) greater in
patients with sudden hearing loss than in controls. This study,
however, did not assess the association between stroke and
hearing loss severity, and did not adjust for smoking, a
documented risk factor for both conditions.
We explored prevalent and incident stroke among older
persons with hearing loss (both gradual and sudden) at
baseline and 5-year follow-up, among participants of Blue
Mountains Hearing Study (BMHS), a community-based
cohort. We also investigated severity of sensorineural
hearing loss and also included smoking in the multi-vari-
ecent reports indicate that sudden sensorineural hearing
loss may be an early sign of stroke.1An article in Stroke
Materials and Methods
The BMHS is a population-based survey of hearing loss con-
ducted during 1997 to 1999 and 2002 to 2004, among participants
of the Blue Mountains Eye Study. Methods to ascertain this
population are described.3During 1992 to 1994, 3654 participants
aged 49 years or older were examined (82.4% participation).
Surviving participants were invited to follow-up examinations
after 5 (1997–1999) and 10 (2002–2004) years, at which 2334
(75.1% of survivors) and 1952 (75.6% of survivors) were reex-
Pure-tone audiometry at both visits was performed by audiol-
ogists in sound-treated booths, using TDH-39 earphones and
Madsen OB822 audiometers (Madsen Electronics). Hearing im-
pairment was determined as the pure-tone average of audiometric
hearing thresholds at 500, 1000, 2000, and 4000 Hz (PTA0.5 to 4KHz),
defining any hearing loss as PTA0.5 to 4KHz?25 dB HL, and moderate
to severe hearing loss as PTA0.5 to 4KHz?40 dB HL) in the better ear.
Subjects were asked whether their hearing loss had a gradual or
Persons reporting a stroke during this period had medical records
cross-checked. Stroke diagnoses used MONICA criteria. Most had
either CT or MRI performed. Incident or prevalent stroke was
defined if typical clinical symptoms were reported and mostly
confirmed by neuroimaging.
SAS statistical software (SAS Institute) was used, including t tests,
?2tests, and logistic regression. Multivariable logistic regression
analysis calculated adjusted OR and 95% CI. P?0.05 indicated
Received August 26, 2008; accepted September 12, 2008.
From Centre for Vision Research (B.G., E.R., P.M.), Department of Ophthalmology, and Westmead Millennium Institute and Australian Health Policy
Institute (B.G., J.S., S.R.L.), University of Sydney, New South Wales, Australia.
Correspondence to Paul Mitchell, MD, PhD, Centre for Vision Research, University of Sydney, Westmead Hospital, Westmead, NSW, 2145, Australia.
© 2009 American Heart Association, Inc.
Stroke is available at http://stroke.ahajournals.orgDOI: 10.1161/STROKEAHA.108.535682
Of the 2956 BMHS-1 (first hearing survey) participants, 62
were excluded as they had incomplete audiological or stroke
data, and 92 were excluded on the basis that they had
conditions such as conductive or middle ear hearing loss,
resulting in 2802 BMHS-1 subjects with complete audiologi-
cal and stroke data. Of these, 921 had hearing loss and 119
reported a history of stroke. Participants who did not report a
history of stroke at BMHS-1 and had complete audiological
data (n?1394) were included for incident stroke analysis at
the second hearing survey (BMHS-2; Figure). Of these, 474
had hearing loss and 43 reported incident stroke. Table 1
shows the baseline characteristics of participants involved in
The likelihood of reporting stroke was 1.6-fold higher
among subjects with than without sensorineural hearing loss
(OR, 1.55; 95% CI, 1.01–2.38), but was marginally nonsig-
nificant after multivariable adjustment (Table 2). The odds of
reporting stroke increased 2-fold with increasing hearing loss
severity, and persisted after multivariable adjustment (OR,
2.04; 95% CI, 1.20–3.49). Compared to subjects without
sensorineural hearing loss, those with any hearing loss had no
increased stroke risk during follow-up after multivariable
adjustment. We also assessed the association between prev-
alent stroke in persons with any hearing loss who reported
gradual decline in hearing function (n?43) compared to
persons who reported sudden hearing loss at BMHS-1 (n?6).
Participants with sudden hearing loss had 2-fold greater
nonsignificant odds of reporting stroke (OR, 2.23; 95% CI,
0.91–5.63) after adjusting for age and sex. At BMHS-2, 13
subjects with stroke history reported gradual loss of hearing,
whereas 3 reported sudden hearing loss. The increased odds
of incident stroke after follow-up in those reporting sudden or
gradual hearing loss at baseline was not significant (OR, 2.44;
95% CI, 0.67–8.94; and OR, 1.01; 95% CI, 0.48–2.12,
We observed a significant association between moderate to
severe sensorineural hearing loss and prevalent stroke. How-
ever, unlike the study by Lin et al,2we could not demonstrate
that either gradual or sudden hearing loss predicted incident
stroke after 5 years in our cohort. In persons reporting sudden
hearing loss at baseline, the odds of reporting incident stroke
increased 2-fold, but this was not significant.
The disagreement between our findings and those of Lin et
al2may relate to differences in underlying pathologies for
2956 BMHS–1 participants had audiometric
testing performed in 1997-9 (mean age ±
standard deviation: 67.4 ± 9.2)
2015 survivors from baseline
941 participants in
1556 participated in BMHS-2 in
2002-4 (mean age ± standard
deviation: 73.8 ± 7.7)
178 refused to
53 excluded †
63 reported a
history of stroke at
1394 did not report a
history of stroke at
BMHS-1 and were
included in incident
stroke analysis at
43 reported incident
stroke at BMHS-2
1351 did not report a history of
stroke at BMHS-2
Figure. Distribution of BMHS-1 and BMHS-2 par-
ticipants included for incident stroke analysis.
*Participants who completed questionnaires at
both hearing studies but had incomplete stroke or
audiological data. †Participants excluded because
they had conductive hearing loss, middle ear hear-
ing loss, childhood hearing loss, or a history of
and BMHS-2 Participants With Complete Audiological and
Stroke Data Included in the 5-Year Incidence Analyses
Demographic and Clinical Characteristics of BMHS-1
Participants Included for
No Hearing Loss
Sex, n (%)
Age, mean?SD, yr
Current smoker, n (%)
BMI, mean?SD, kg/m2
Hypertension, grade ?2, n (%)
Type 2 diabetes, n (%)
No tertiary qualifications, n (%)
Gopinath et alAge-Related Hearing Loss and Stroke
age-related vs sudden hearing loss. In sudden hearing loss,
strong evidence exists for vascular involvement, infection, or
autoimmune disease, among other factors contributing to its
pathogenesis.2,4Age-related hearing loss is caused by deficits
in hair cells, cochlear neurons, stria vascularis, a combina-
tion, or aging itself.5Age-related hearing loss is also influ-
enced by genetic risk factors, exposure to occupational noise,
and toxins.5Vascular occlusion has not been clearly estab-
lished as an underlying cause of age-related hearing loss, in
contrast to sudden hearing loss. This may explain why
sensorineural hearing loss among older subjects in our study
did not predict development of stroke at follow-up. Second,
our study power may have been insufficient to detect an
association between hearing loss and stroke attributable to the
smaller number of surviving participants. Third, the differing
age–gender distributions between the 2 studies may account
for the discrepant findings. Finally, we acknowledge that 281
(14%) subjects died between BMHS-1 and BMHS-2; this
could have introduced survival bias into the analysis and we
may have underestimated incident stroke in our population.
In conclusion, we observed a significant cross-sectional
association between moderate to severe hearing loss and
stroke. Sudden or gradual hearing loss at baseline did not
increase risk of incident stroke after 5 years of follow-up, in
contrast to findings by Lin et al,2possibly reflecting differing
underlying pathologies of these 2 types of sensorineural
hearing loss, or a different onset of hearing loss compared
with physician-diagnosed sudden hearing loss. Our study
highlights the need for awareness of these 2 types and to
clearly distinguish between them before requesting detailed
clinical examinations to identify patients at potential risk of
stroke, as suggested by Lin et al.
Sources of Funding
The Blue Mountains Eye Study was supported by the National
Health and Medical Research Council (Grants. 974159, 991407,
211069, and 262120).
B.G. interpreted the data and drafted the article. J.S. revised data
critically for important intellectual content. E.R. performed analysis
of the data. S.R.L. revised data critically for important intellectual
content. P.M. designed the study and directed its implementation and
revised it critically for important intellectual content.
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Baloh RW. Sudden deafness and anterior inferior cerebellar artery
infarction. Stroke. 2002;33:2807–2812.
2. Lin HC, Chao PZ, Lee HC. Sudden sensorineural hearing loss increases the
risk of stroke. A 5-year follow-up study. Stroke. 2008;39:2744–2748.
3. Attebo K, Mitchell P, Smith W. Visual acuity and the causes of visual loss
in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996;103:
4. Merchant SN, Adams JC, Nadol JB Jr. Pathology and pathophysiology of
idiopathic sudden sensorineural hearing loss. Otol Neurotol. 2005;26:
5. Van Eyken E, Van Camp G, Van Laer L. The complexity of age-related
hearing impairment: contributing environmental and genetic factors.
Audiol Neurootol. 2007;12:345–358.
5-Year Follow-Up for Subjects With Sensorineural Hearing Loss
Adjusted OR for Stroke During Cross-Sectional and
OR (95% CI)
No hearing loss
Any (?25 dB HL)
Moderate to severe
(?40 dB HL)
No hearing loss
Any (?25 dB HL)
Moderate to severe
(?40 dB HL)
*Adjusted for age, sex, type 2 diabetes, smoking, and hypertension.