Hypertension and the development of hearing loss
Hypertension and the development of hearing loss
复制标题
高血压与听力损失的发展
DOI：
10.1038/s41440-021-00789-w
复制
发表时间：
2021
影响因子：
5.4
通讯作者：
Mogi Masaki
中科院分区：
文献类型：
--
作者：
Toyama Kensuke;Mogi Masaki
世界卫生组织警告说，世界上超过5%的人口（4.32亿成年人和3400万儿童）可能需要康复来解决“致残性”听力损失，并估计到2050年将有超过7亿人患有听力损失。听力损失是老年人的常见疾病，不仅仅是“听力不好”的问题。听力损失会抑制沟通和社会互动，导致社会孤立[2]。听力损失最近被描述为痴呆症的最大风险因素[3]，这表明社交孤立和痴呆症可以通过听力障碍交联。因此，听力维护是保持老年人生活质量的重要因素。众所周知，衰老、遗传、噪声暴露和药物引起的耳毒性副作用是听力损失的主要原因[4]，但对听力损伤的其他关键风险因素知之甚少。流行病学研究支持听力损失的发展与血管风险因素（如血脂异常和糖尿病）之间的重要联系[5，6]。此外，最近的研究指出，血小板水平低或下降也是听力损失发展的重要和新的风险因素[7]。管理这些风险因素对于预防听力损伤的发展至关重要，因为没有有效的药物治疗被批准能够保护或恢复听力，并且听力损失的治疗仅限于临床设备[4]。迄今为止，高血压对听力损害发展的影响主要在横断面研究中发现[5]。然而，Miyata等人目前的研究具有几个优势，包括大量参与者、纵向设计以及使用基于机构的测量血压和听力测试结果（非自我报告数据）[8]。作者出色地证明了高血压是听力障碍发展的重要风险因素[8]。高血压和听力损失发展之间的联系机制尚未完全清楚。可能涉及血管损伤，因为它可以减少毛细血管血流量，导致氧气运输减少和组织缺氧，从而导致听力损失[9]。此外，血迷路屏障（BLB）存在于内耳中，类似于大脑中的血脑屏障，将血管系统和内耳液体（内淋巴和外淋巴）分开[4]。耳蜗的血液供应对于维持内淋巴的产生至关重要，并且BLB有助于维持内耳流体离子稳态[10]。如果耳蜗血管纹的BLB功能障碍通过高血压引起的血管损伤（例如，通过破坏紧密连接），这可能会破坏内淋巴中的离子稳态，导致毛细胞去极化损失和听力损失（图1）.鉴于数据表明高血压会加速听力残疾，控制高血压的干预措施可能成为预防或治疗听力障碍的新策略。然而，据我们所知，没有临床指南描述如何最好地管理高血压性听力损失患者。听力损失和高血压之间的联系似乎是确凿的证据，但需要进一步的前瞻性研究来阐明独立于设备辅助的听力损失的适当治疗策略。此外，高血压和听力损失发展之间的分子机制仍然需要研究。
The World Health Organization cautions that over 5% of the world’s population (432 million adults and 34 million children) may require rehabilitation to address ‘disabling’hearing loss and estimates that over 700 million people will be suffering from hearing loss by 2050 [1]. Hearing loss, a common condition in older adults, is not simply a problem of “not hearing well”. A loss of hearing ability inhibits communication and social interactions, resulting in social isolation [2]. Hearing loss was recently described as the greatest risk factor for dementia [3], suggesting that social isolation and dementia could be cross-linked through hearing impairment. Thus, hearing maintenance is an important factor for preserving quality of life in older people. Aging, heredity, noise exposure, and drug-induced ototoxic side effects are well known as the main causes of hearing loss [4], but little is known about other key risk factors for hearing impairment. Epidemiologic studies support significant links between hearing-loss development and vascular risk factors such as dyslipidemia and diabetes [5, 6]. Furthermore, recent studies have noted that low or declining platelet levels are also important and novel risk factors for the development of hearing loss [7]. Managing these risk factors is crucial to prevent the development of hearing impairment, since no effective drug therapies are approved that are capable of protecting or restoring hearing, and treatment for hearing loss is limited to clinical devices [4]. The effects of hypertension on the development of hearing impairment to date have primarily been noted in cross-sectional studies [5]. However, the current investigation by Miyata et al. features several strengths, including a large number of participants, a longitudinal design, and the use of facility-based measured blood pressures and audiometry test results (not self-reported data)[8]. The authors excellently demonstrate that high blood pressure is a significant risk factor for the development of hearing impairment [8]. The mechanisms underlying the association between hypertension and hearing-loss development are not yet fully understood. Vascular injury might be involved, as it can reduce capillary blood flow, resulting in reduced oxygen transport and tissue hypoxia, thus causing hearing loss [9]. In addition, a blood–labyrinth barrier (BLB) exists in the inner ear, similar to the blood–brain barrier in the brain, separating the vasculature and the inner ear fluids (endolymph and perilymph)[4]. Blood supply to the cochlea is critically important for sustaining the production of endolymph, and the BLB is instrumental in maintaining inner ear fluid ionic homeostasis [10]. If the BLB of the stria vascularis in the cochlea becomes dysfunctional (eg, through a disruption of tight junctions) via hypertension-induced vascular injury, this could disrupt ionic homeostasis in the endolymph, resulting in hair cell depolarization loss and hearing loss (Fig. 1).Given that the data indicate that hypertension accelerates hearing disability, interventions to control hypertension could become novel strategies to protect against or treat hearing impairment. However, to the best of our knowledge, there are no clinical guidelines describing how best to manage hypertensive hearing-loss patients. The evidence linking hearing loss and hypertension seems to be conclusive, but further prospective studies are required to clarify appropriate therapeutic strategies for hearing loss independent of device aids. Furthermore, the molecular mechanisms connecting hypertension and hearing-loss development still require investigation.
影响因子：
16.2
作者：
Bainbridge KE;Hoffman HJ;Cowie CC
通讯作者：
Cowie CC
DOI：
10.1007/s12070-013-0630-1
发表时间：
2013-12-01
影响因子：
0.6
作者：
Agarwal, Saurabh;Mishra, Aseem;Nagle, Smita K.
通讯作者：
Nagle, Smita K.
血小板正常值偏低和血小板减少是听力受损的危险因素
DOI：
--
发表时间：
2020
期刊：
The Laryngoscope
影响因子：
--
作者：
Yasunori Abe;Kensuke Toyama;Masaya Kazurayama;Shinji Tanaka;Masamitsu Yamaizumi;M. Ueno;J. Spin;N. Hato;M. Mogi
通讯作者：
M. Mogi