Effect of hyperinsulinism on sensorineural hearing impairment in Ménière's disease: a cohort study.
OBJECTIVE
To compare the degree of sensorineural hearing loss in patients with Ménière's disease (MD) with and without hyperinsulinism by different methods of assessment.


METHODS
Historical cohort study.


METHODS
Ménière's Disease Care and Research Clinics of Hospital de Clinicas de Porto Alegre, a tertiary care university hospital in Southern Brazil.


METHODS
Patients with a definite diagnosis of MD based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines.


METHODS
Patients were assessed by glucose overload tests (5-h glucose and insulin curves) and under baseline physiological conditions (Homeostasis Model Assessment/Insulin Resistance [HOMA-IR], Quantitative Insulin Sensitivity Check Index [QUICKI], and glucose/insulin ratio). These patients underwent annual pure-tone audiometry and were analyzed using 4-tone average (FTA), that is, arithmetic mean of 500, 1,000, 2,000, and 3,000 Hz, during the third, fourth, and fifth years of disease progression.


METHODS
Hearing loss assessed by FTA and classified in Stages I to IV (AAO-HNS).


RESULTS
Forty-nine (76.6%) patients were defined as hyperinsulinemic and 15 (23.4%) as normoinsulinemic. Impairment on FTA was higher in the hyperinsulinemic group (52.04 ± 17.5 versus 39.75 ± 9.20, p = 0.027) when assessed by the 5-hour insulin curve. Hyperinsulinemic subjects were 3.5 times more likely to develop hearing damage greater than 40 dB (i.e., Stages III and IV) than normoinsulinemic subjects (OR = 3.52; 95% CI, 1.05-11.76). A moderate correlation between the insulin curve and the HOMA-IR was found (r = 0.524, p = 0.001).


CONCLUSIONS
Hyperinsulinism in MD is associated with greater clinical hearing damage.
*Graduate Program in Medicine, Surgical Sciences, Universidade Federal do Rio Grande do Sul; †Otolaryngology Service, Hospital de Clínicas de Porto Alegre; ‡Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul; and §School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Joel
J
Lavinsky
Michelle Lavinsky
ML
Wolff
Andrea Ruschel
AR
Trasel
Marcel Machado
MM
Valerio
Luiz
L
Lavinsky
D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D015331:Cohort Studies; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008575:Meniere Disease / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D012720:Severity of Illness Index