Hyperglycemia, Hearing Loss and Vestibular Dysfunction: The CARDIA Study

项目总结/摘要 听力损失（HL）和前庭功能障碍（VeD）是内耳损伤引起的常见疾病。 功能障碍，往往是未被发现，直到赤字是明显的。此外，HL最初与糖尿病相关 导致高频率HL，沟通缺陷可能导致孤立，抑郁和低生活质量。 更长时间和更严重的高血糖可能会影响低/中频HL，但目前这种关系尚不清楚。 不清楚生理损伤是永久性的，感觉神经性的，因此，预防是 通过早期发现和干预来实现。前庭功能障碍是通过相同的 机制如HL，并可能导致失衡和头晕，这与福尔斯和丧失 独立虽然2型糖尿病（T2 D）和HL之间的关联已得到充分证实，但了解较少 2型糖尿病和前庭功能障碍关于糖尿病前期（preD）和内耳功能障碍的数据也很有限。 年轻人35年冠状动脉风险发展（CARDIA）研究诊所访视（2020- 2021年）将用于招募参与者进行辅助研究，以检查跨部门和 从HL和VeD的年轻成年人游戏中收集了35年以上的preD和T2 D纵向测量结果， 在一群特征鲜明的黑人和白色男性和女性中， HL将使用适用于基于人群的自动测听方案进行测量 大样本听力评估，无需专业听力学家。VeD将是 通过新颖的视频头部脉冲测试进行评估，以捕获耳级前庭系统的完整性。PreD和T2 D 将根据第35年的空腹血糖以及历史上通过空腹血糖、口服葡萄糖 耐受性测试、药物使用和/或血红蛋白A1 c，并将记录 高血糖症 CARDIA队列在第35年临床访视时的年龄为53-65岁;因为听力敏感性 从60岁左右开始，每十年降低约10 dB，CARDIA现在处于理想状态 在年龄相关性下降之前捕获HL的年龄，同时具有足够的preD的患病率和发生率 和T2 D;虽然VeD本身不是一种临床疾病，但这项研究将为人群提供规范性数据- 基于研究。因此，这项辅助研究建议研究以下目标：1）评估 T2 D和preD与前庭功能障碍之间的关联;以及2）表征 preD和T2 D，具有整体、低/中和高频HL横截面，并使用轨迹分析， 纵向趋势。 CARDIA提供了一个独特的机会，可以将从青年期开始发展的preD和T2 D联系起来 患有HL和VeD将这项研究整合到现有的CARDIA诊所访视中是一种有效的方法， 这是一个成本效益高的方法，可以最大限度地在一个保持稳定的群体中招募人员。

Project Summary/Abstract Hearing loss (HL) and vestibular dysfunction (VeD) are common conditions resulting from inner ear dysfunction that often go undetected until the deficit is pronounced. Further, HL related to diabetes initially leads to high frequency HL, a communication deficit may lead to isolation, depression and low quality of life. Longer and more severe hyperglycemia may affect low/mid frequency HL, but the association is currently unclear. Physiologic damage is of the permanent, sensorineural type and therefore, prevention is accomplished by early detection and intervention. Vestibular dysfunction occurs through the same mechanisms as HL, and may lead to imbalance and dizziness, which are associated with falls and loss of independence. While the association between type 2 diabetes (T2D) and HL is well established, less is known about T2D and vestibular dysfunction. Data on prediabetes (preD) and inner ear dysfunction are also limited. The Year 35 Coronary Artery Risk Development in Young Adults (CARDIA) study clinic visit (2020- 2021) will be used to recruit participants for an ancillary study to examine the roles that cross-sectional and longitudinal measures of preD and T2D collected over 35 years from young adulthood play in HL and VeD in middle age among a well-characterized cohort of black and white men and women. HL will be measured using an automated audiometry protocol that is suitable for population-based hearing assessment in large samples without the requirement of specialized audiologists. VeD will be assessed with novel video head impulse testing to capture ear-level vestibular system integrity. PreD and T2D will be determined based on fasting glucose at Year 35, and historically via fasting glucose, oral glucose tolerance testing, medication use and/or hemoglobin A1c, and will capture both degree and duration of hyperglycemia. The CARDIA cohort will be ages 53-65 years at the Year 35 clinic visit; because hearing sensitivity decreases by approximately 10 dB per decade starting around the age of 60 years, CARDIA is now at the ideal age to capture HL prior to age-related declines while having sufficient prevalence and incidence of both preD and T2D; while VeD is not a clinical condition per se, this research will provide normative data for a population- based study. Therefore, this ancillary study proposes to examine the following aims: 1) to assess the association between both T2D and preD and vestibular dysfunction; and 2) to characterize the associations of preD and T2D with overall, low/mid, and high frequency HL cross-sectionally and using trajectory analysis for longitudinal glycemia trends. CARDIA provides a unique opportunity to connect preD and T2D developing from young adulthood with HL and VeD in middle age. Integration of this research into the existing CARDIA clinic visit is an efficient and cost-effective way to maximize recruitment in a cohort that has had stable retention.