Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002.
OBJECTIVE
To evaluate and compare the effects of cardiovascular risk factors (hypertension, smoking, diabetes) and noise exposure (occupational, recreational, firearm) on frequency-specific audiometric thresholds among US adults while assessing synergistic interactions between these exposures.


METHODS
National cross-sectional survey.


METHODS
United States adults aged 20 to 69 years who participated in the 1999 to 2002 National Health and Nutrition Examination Survey (N = 3,527).


METHODS
Air-conduction thresholds at 0.5 to 8 kHz (dB) in the poorer-hearing ear. Multivariate models adjusted for age, sex, race/ethnicity, and educational level.


RESULTS
: Exposure to firearm noise was significantly associated with high-frequency (4-8 kHz) hearing loss (HL), whereas smoking and diabetes were associated with significantly increased hearing thresholds across the frequency range (0.5-8 kHz). A significant interaction was observed between exposure to firearm noise and heavy smoking such that firearm noise was associated with a mean 8-dB hearing loss in heavy smokers compared with a mean 2-dB hearing loss in nonsmokers at 8 kHz. We also observed significant interactions between firearm noise exposure and diabetes.


CONCLUSIONS
Noise exposure was associated with high-frequency HL, whereas cardiovascular risk generated by smoking and diabetes was associated with both high- and low-frequency HL. The frequency-specific effects of these exposures may offer insight into mechanisms of cochlear damage. We demonstrated an interaction between cardiovascular risk and noise exposures, possibly as a result of cochlear vulnerability due to microvascular insufficiency. Such significant interactions provide proof of principle that certain preexisting medical conditions can potentiate the effect of noise exposure on hearing. Data-based stratification of risk should guide our counseling of patients regarding HL.
Agrawal
Yuri
Y
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. yagrawa1@jhmi.edu
Platz
Elizabeth A
EA
Niparko
John K
JK
D000328:Adult; D000368:Aged; D001299:Audiometry; D001309:Auditory Threshold; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004781:Environmental Exposure; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D034381:Hearing Loss / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009622:Noise / Q000009:adverse effects; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult