Obesity in Teens Linked to Early Hearing Loss

June 20, 2013

Here’s surprising finding by the otolaryngology group at Columbia University: Obese teens had a higher rate of hearing loss. In a comment to the blog post, one person even suggested the possibility that deafness could lead to behaviors that lead to obesity. Regardless of what the actual cause may be, one possibility that’s almost never mentioned is obstructive sleep apnea. There are numerous studies suggesting that obstructive sleep apnea can potentially lead to hearing loss.

One study showed that speech perception and discrimination is affected by sleep disturbed breathing. Another study showed that auditory brain waves were abnormal in children with obstructive sleep apnea. A third study showed that most patients with obstructive sleep apnea had thick (or viscous) blood, and this was associated with abnormal auditory brainstem signals. Correction of this blood thickening using CPAP or hemodilution (lowering blood concentration by removing some blood and adding saline) corrected the brainstem signal abnormalities. These three studies (amongst many others) suggest that untreated obstructive sleep apnea can significantly impair hearing. 

Knowing that obstructive sleep apnea causes poor sleep quality and poor sleep can cause weight gain, and weight gain can aggravate weight gain, the results of this teen hearing loss study are not surprising.

How Second Hand Smoke Can Cause Hearing Loss In Teens

July 20, 2011

Here’s an attention-grabbing headline in Time Magazine—that exposure to second hand smoke significantly increases a teen’s chances of nerve deafness by almost two-fold. It’s already been shown that smoking can cause hearing loss in adults, but the fact that second hand smoke can affect teens’ hearing was quite a surprise.

It’s already known that cigarette smoke can aggravate middle ear infections in teens, leading to reversible hearing loss, but this study reported sensorineural hearing loss, which is generally nonreversible.

The authors of the study from NYU don’t give clear explanations for this finding, so let me put forth a few possible reasons:

  1. Teens probably listen to music at loud levels, which is known to cause nerve deafness, especially at higher frequencies (this study showed hearing loss at the mid to high frequencies).
  2.  The teenage years are a period of massive change in the upper airway. These relative changes will destabilize breathing at night, leading to more frequent partial to total obstructions and arousals. Some teens (especially those with dental crowding and small jaws) will be more susceptible than others. Lack of deep, quality sleep has been shown to have detrimental effects on brain development and repair.
  3. Parents of the teens that smoke probably have a higher chance of snoring or having obstructive sleep apnea. Not sleeping well can predispose to increased stress and addictive activities that can stimulate and calm at the same time (such as alcohol and smoking).
  4. Intermittent brain hypoxia has been shown to cause major neurologic damage in multiple parts of the brain, including memory, executive function, autonomic control, and hearing centers
  5. Delayed sleep phase syndrome is more common in teens, contributing to poor sleep.

It’s conceivable that if you have mild degrees of nerve damage from loud music, the body will have the reserve to reverse or minimize any nerve damage. However, if you add all the other variables such as poor sleep and intermittent hypoxia from breathing pauses, then it’s likely that you’ll be more susceptible to inner ear nerve deafness.

So the next time your teenager seems to be ignoring you, it may be due to hearing loss.

Deafness and Dementia Linked, Through Sleep Apnea?

February 16, 2011

There are a number of studies that associate an increased risk of deafness to sleep apnea, and an increased rate of dementia with sleep apnea, so why can’t deafness and dementia be linked, with sleep apnea being the main cause for both conditions? A study that was recently published in Neurology showed that for every 10 dBL hearing loss, after 12 years, the risk of dementia from all causes rose 27%. I’ve written numerous times about how sleep apnea can cause damage to the auditory cortex areas of the brain, as well as to the inner ear. The same process from sleep apnea that causes brain damage can injure areas that control memory, executive function, autonomic function, and hearing.

The next time someone you love can’t seem to hear you, it could be because he or she can’t process your words properly? Do you know someone who’s severely hard of hearing, and has possible dementia?

Obstructive Sleep Apnea And Hearing Loss

January 22, 2011

I’ve always suspected that nerve deafness may be one of the consequences of obstructive sleep apnea, but there’s been little research in this area. However, a new study out of Korea shows that in the elderly, having obstructive sleep apnea significantly increases your chances of have nerve deafness, particularly due to a problem in the central nervous system.

This finding is not surprising, since sleep apnea causes a hyper-coagulable state, with blood being more stagnant and tending to clot, in addition to additional inflammatory factors that can cause damage. It’s also been shown that blood is thicker and more viscous in people with sleep apnea. In fact, a recent study showed that people with obstructive sleep apnea had thicker blood than normal, and by diluting the blood concentration with saline, auditory brainstem reflexes improved to the point of being normal. Placing these people on CPAP also normalized hearing reflexes.

Recent brain imaging studies have shown that hypoxia in the brain from sleep apnea can cause major vascular and tissue damage, affecting critical areas of the brain, including the brainstem. The risk of stroke is also increased by more than 3 times if you have sleep apnea. Knowing all this, it’s not surprising that you can have either brainstem damage or peripheral inner ear vascular damage from untreated obstructive sleep apnea. One study showed that people with sudden one sided hearing loss from nerve damage have a higher risk of having sleep apnea.

I think that nerve deafness is part of the cardiovascular-metabolic process, going along with hypertension, diabetes, hypertension, high cholesterol, and heart disease. What you you think? If you have sleep apnea, do you have any hearing loss?

Can Sleep Apnea Cause Nerve Deafness?

November 22, 2010

More than a handful of times, whenever someone comes to me with sudden hearing loss on one ear, there’s usually a precipitating event, such as an infection, stressful event, or trauma. Here’s a sequence of events where an underlying sleep-breathing problem clearly caused hearing loss.

A middle aged man with known severe hearing loss in both ears came to see me with sudden worsened hearing loss in his left ear 4 weeks ago. He normally uses hearing aids, but now he can’t understands people as well, even with his hearing aid. It turns out that exactly 4 weeks ago, while lifting something from his driveway, he pulled his back, with resulting severe back pain. He went to see his doctor, who prescribed a strong narcotic, which didn’t help that much. He’s usually a stomach sleeper, but due to his back pain, he had to sleep on his back. The night after he took his pain medication, he woke up and noticed his hearing loss on his left ear. His recent hearing test showed significantly diminished hearing in his left ear.

When I examined him, he had the classic anatomy of someone who has obstructive sleep apnea: small jaws, high arched hard palate, and very narrow posterior airway space (space behind the tongue), especially when on his back. All throughout his life, he naturally preferred to sleep on his stomach, but when suddenly forced to sleep on his back, wasn’t able to sleep efficiently (due to gravity’s effect on his tongue). But when he took his pain medication, his muscles relaxed even further, and he probably stopped breathing much more often. This caused a major and sudden stress response which probably caused either major inflammation or a mini-stroke in his inner ear blood vessels. Studies have shown that the area in the brainstem that controls the ear, as well as blood vessels that supply the inner ear are much more susceptible to damage. In particular, the area that’s responsible for the high frequencies is more prone to injury.

His exam only reinforced my observation that people who suffer from sudden nerve deafness all have very similar upper airway breathing passageways.

The traditional thing to do in this situation is to give oral steroids, but since it’s been about 4 weeks, the evidence for improving his condition is poor. Instead, I ordered a formal sleep study.

Migraines, Heart Disease, & Sleep Apnea

August 26, 2010

One of the most common conditions that I see in my ENT practice is migraines. Not your typical classic migraine with the auras, light sensitivity and nausea, but the variations of migraine that involve the ears and sinuses. In fact, the vast majority of people who suffer from sinus pain and headaches are found to have migraines—if you perform CT scans, the sinuses will be completely normal. However, patients usually won’t believe me until they see the CT images, and after they respond to anti-migraine treatments.

In an often repeated study on migraines, researchers showed again that having migraines is linked with an increased risk of cardiovascular disease and even death.

These results are not surprising, since obstructive sleep apnea is strongly linked to cardiovascular disease and increased risk of death (46% in people with severe sleep apnea). Poor sleep quality that results leads to hypersensitivity of various nerve endings. If it happens in your sinuses, you’ll feel pain, pressure, headaches, nasal congestion and post-nasal drip. If in your ears, hearing loss, ringing, dizziness, fullness and sensitivity.

Having a migraine is not normal. If you suffer from migraines, it’s you’re body’s way of telling you that something is wrong, that you’re not getting quality deep sleep.

Do you suffer from migraines? If so, do your parents have heart disease or died early from cardiovascular complications? Is like to hear your response in the response box below.

Top Ten Do’s and Don’ts of Ear Remedies

June 10, 2010

Patients always ask what they can do on their own to prevent chronic ear problems. Here’s a Top Ten List of my Do’s and Don’ts for your ears. It’s a condensed version of what I tell my patients all the time. Hope they help you to avoid ear problems from plaguing you.

1. DO…use a blow dryer to keep ears dry after water sports.
1. DON’T…undergo ear candling to remove ear wax—it doesn’t work.
2. DO…use nasal saline to keep nasal passageways clear during allergy season to prevent ear and sinus blockage.
2. DON’T…use a Q-tip to clean out your ears. Better yet, remove them entirely from your bathroom medicine cabinet.
3. DO…apply sunscreen to the back of your ears as the skin there is prone to sun exposure.
3. DON’T...expose your ears to continuous loud noises. Translation: turn your iPod down.
4. DO…use a 50:50 alcohol and vinegar solution as ear drops to evaporate excess water and keep your ears dry if you’re prone to swimmer’s ear.
4. DON’T…smoke
5. DO…see a physician if you experience sudden onset hearing loss
5. DON’T…ignore sudden hearing loss
6. DO… cover your ears when exposed to loud noises
6. DON’T… use ear plugs if you have wax problems
7. DO…have a qualified physician remove ear wax
7. DON’T…try to remove ear wax on your own
8. DO…use hydrogen peroxide or mineral oil to periodically loosen ear wax
8. DON’T…use anything smaller than your elbow to clean inside your ears.
9. DO…use OTC decongestants while flying if prone to ear popping
9. DON’T…eat right before you go to bed—eat at least 3 hours before instead.
10. DO…use mineral or olive oil to drown live insects that get stuck in your ears (& get the dead insect removed by an ENT)
10. DON’T…scratch the inside of your ear with a pen or any sharp object.

Sleep Apnea, Hearing Loss, and Thick Blood

May 21, 2009

I came across this interesting article in Sleep Medicine, where they showed that in patients with obstructive sleep apnea, a significant number were hemodynamically hyperviscosity positive (282/610 patients). Hyperviscous means that blood is thicker and more prone to clog arteries. Of these 282 patients, 239 had brainstem AEP abnormalities. AEPs are tests for ear neurologic reflexes where clicks are given in one ear and brain waves are measured in response. It tests for inner ear and brainstem function.

Ones that didn’t have hyperviscosity all had normal AEPs. Of these 239 patients, 57 had bilateral sensorineural hearing changes (no waves at all), and 182 patients had significant bilateral signal changes. After 6 months of CPAP, hyperviscosity was normalized in 159 patients. In 112 of these 159 patients a repeat AEP became normal. Of the 80 patients on CPAP that did not normalize, hemodilution therapy resulted in normalization in 61 patients. Hemodilution is when blood is made thinner by removing some blood and adding some saline.

This paper talks about bilateral conditions but also brings up the possibility of unilateral sudden sensorineural hearing loss being explained by this mechanism. It’s in line with my personal observation that every patient that I see with sudden sensorineural hearing loss has a history and exam consistent with an underlying sleep-breathing disorder. The handful that agreed to undergo sleep studies showed significant obstructive sleep apnea in all cases. I think the implications of this paper are enormous.

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