Ask the Expert – Hearing Loss and Cardiovascular Disorders

Dr. Sarah Sesslar, Au.D

Greater emphasis is being placed on hearing health now than ever before.  Anyone over the age of 55 should have a baseline hearing test performed by a licensed audiologist.  It is important to understand the risks you take if hearing loss and tinnitus are ignored.

”A growing body of research shows that a person’s hearing health and cardiovascular health frequently correspond.”1

Studies have shown that a healthy cardiovascular system has a positive effect on hearing.
A study of our Brigham and Women’s Hospital published online in The American Journal of Medicine found that a higher level of physical activity is associated with the lower risk of hearing loss in women. At the same time, the study found that a higher body mass index (BMI) and larger waist circumference are each associated with higher risk of hearing loss.2

The heart and hearing connection.
Poor cardiovascular health causes inadequate blood flow and blood vessel trauma to the inner ear. The inner ear is so sensitive to blood flow that disorders such as hearing loss, particularly at the lower frequencies, may be an early warning sign of cardiovascular disease.

The two-part Framingham Study3 hypothesized that low-frequency hearing loss was associated with cardiovascular disease. Cardiovascular status was determined for approximately 1,000 patients of the audiology department. Associations between their audiogram patterns and cardiovascular variables were tested and controlled for age and gender. Logistic regression models were used to calculate cardiovascular risk factors from audiogram pattern. The models were applied to a separate group of 90 subjects recruited from cardiology and geriatric medicine clinics, who were also given audiograms.

Results indicated a significant association between low-frequency hearing loss and cardiovascular disease risk factors. When controlling for age, hypertension, diabetes, smoking and hyperlipidemia, low-frequency hearing loss was significantly associated with the following cardiovascular disorders:

• lntracranial vascular pathology (stroke and transient ischemic attacks)
• Peripheral vascular disease
• Coronary artery disease
• Myocardial infarction

Ipso facto, low-frequency hearing loss may be considered a marker indicating the presence or potential development of cardiovascular disease.

“We conclude there is a significant relationship between cardiovascular status and audiometric pattern.” 4

“(There is) significant evidence that impaired cardiovascular health negatively impacts hearing … improved cardiovascular health may contribute to healthier ears, particularly among older adults.” 5

Researchers concluded individuals with cardiovascular disorders may be more prone to hearing loss and therefore in need of hearing evaluations. They also found an association between low-frequency hearing loss and numerous cardiovascular disease events.

The negative influence of impaired cardiovascular health on both the peripheral and central auditory system, and the potential positive influence of improved cardiovascular health on these same systems, has been found through a sizable body of research conducted over more than six decades. The most significant positive relationship between improved cardiovascular health and improvements in those auditory systems has been found in older adults. If that relationship continues to be confirmed, then a potential new avenue for auditory rehabilitation on behalf of adults who possess impaired auditory function may be discovered.

Certain audiogram patterns have been found to correlate strongly with cerebrovascular and peripheral arterial disease. Because of this, audiograms represent a screening test for those at-risk. Patients with low-frequency hearing loss should be regarded as at-risk for cardio or cerebrovascular events, and appropriate referrals should be considered.

Cardiovascular disorder and tinnitus
Another hearing disorder associated with cardiovascular health is pulsatile tinnitus. Due to the number of major blood vessels close by the ear, disorders that affect them sometimes manifest as pulsatile tinnitus that closely matches the heartbeat. Some of these disorders include:
• atherosclerosis
• high blood pressure
• head or neck tumors that press on blood vessels
• turbulent blood flow caused by a narrowing or kinking of the jugular vein or carotid artery
• malformation of capillaries.6

Certain medication also causes tinnitus as a side effect. Therefore, patients who are on medication for cardiovascular disorders may also be at higher risk for tinnitus. A recent study found that that hypertension treatment with diuretics, ACE inhibitors, and calcium channel blockers were more prevalent in tinnitus patients, suggesting that an eventual ototoxicity of these drugs may be involved in tinnitus pathophysiology.7

If a patient has been diagnosed with a cardio or cerebrovascular disorder, it is important to advise them to have their hearing evaluated regularly and to get any hearing loss treated with hearing aids early, in order to preserve hearing levels and improve quality of life. Older patients should routinely be made aware of how important it is to keep their primary physicians informed of any hearing loss or tinnitus because it could be a harbinger of an as of yet undiagnosed cardiovascular disease.

Call today and schedule your complimentary hearing test and consultation.

Decibels Audiology & Hearing Center
Celebrating 12 years as Southwest Florida’s
#1 Hearing Center

239-631-5731
napleshearingaids.com

1. Better Hearing Institute. (2013). Heart Disease and Hearing Loss Linked press release. (http://www.prnewswire.com/news-releases/ heart-disease-and-hearing-loss-linked-so-get-your-hearing-checked­for-world-heart-day-bhi-advises-224502101.html).
2. Curhan, Sharon G. et al. Body Mass Index, Waist Circumference, P hysical Activity, and Risk of Hearing Loss in Women. The American Journal of Medicine Volume 126, Issue 12, 1142.e1 – 1142.eB.
3. Friedland, D.R., Cederberg, C., Tari ma, S. (2009). Audiometric pattern as a predictor of cardiovascular status: development of a model for assessment of risk. The Laryngoscope, 119(3), 473-86.
4. Wysong, P. (2009). Low-Frequency Hearing Loss May Indicate Cardiovascular Disease. ENT Today. (http://www.enttoday.org/ detai Is/ article/ 4969 55/Low-Freq uency _Heari ng_Loss_May _Indicate_ Ca rd iovascu lar _Disease .html).
5. Hall, R.H. & Kerschen, S.R. (2010). The Influence of Cardiovascular Health on Peripheral and Central Auditory Function in Adults: A Research Review. American
Journal of Audiology. American Journal of Audiology, 19, 9-16.
6. Mayo Clinic. (2016). Tinnitus. (http://www.mayoclinic.org/diseases­conditions/tinnitus/symptoms-causes/dxc-20180362).
7. Figueiredo, R.R., Azevedo, A. A, & Penido, N. 0. (2016). Positive Association between Tinnitus and Arterial Hypertension. Frontiers in Neurology, eCollection Oct 5 (7), 171.