Characterizing the Effects of Chronic Substance Misuse on Auditory and Vestibular Function

越来越多的报告表明，物质使用障碍(SODS)和过量使用会导致听力损失(HL)和前庭损失(VL)。这是有问题的，因为听力和平衡对沟通、就业、心理健康、身体独立和整体生活质量都很重要。HL和VL将对肥胖症患者产生更大的负面影响，因为这一人群已经在与更高的精神健康问题、失业和较差的生活质量作斗争。由于听力保健方面的社会经济和/或文化障碍，少数族裔的HL/VL患者进一步被边缘化。不幸的是，关于物质滥用相关的HL的文献是零星的，主要由描述由非法药物或处方阿片类药物滥用引起的不同程度的临时性或永久性HL的病例报告组成。肥皂水对前庭系统的影响更是知之甚少。一些研究表明，酒精滥用会损害平衡，阿片类药物和酒精会破坏外周和中枢前庭功能。现有的研究表明，根据物质类型和使用模式的不同，对内耳的影响也不同。目前严重缺乏使用客观方法来确定肥胖症对听力和前庭功能的外周和中枢影响的严格研究。同样，在SUD人群中，健康共病、人口统计学、社会经济地位和药物使用模式对HL/VL的影响也没有被调查。我们的项目目标是提高我们对肥皂泡对听力和前庭功能影响的了解，并确定谁是HL/VL的最大风险者。为了实现这些目标，我们将首先调查在三个地区独特的研究地点招募的患有肥皂症的不同人群的外周和中枢听力(目标1)和前庭(目标2)功能。数据将与没有肥皂水的年龄、性别、种族或种族匹配的对照组进行比较。最后，我们将确定可预测的健康、人口、社会经济和物质使用因素，这些因素会增加因物质滥用而继发HL/VL的风险(目标3)。我们假设，慢性物质滥用将影响听觉和/或前庭系统，就像耳毒性药物的潜在机制一样。基于文献，我们假设，更多的健康合并症、高龄、非西班牙裔白人背景、较低的社会经济地位和更高风险的药物使用模式将预测HL或VL的严重程度。在现有的HL/VL文献中，生物学性别差异尚不清楚；然而，我们的结果将有助于阐明HL/VL和SODS的性别差异。自冠状病毒大流行以来，肥皂和过量使用显着增加，在少数群体中更是如此。因此，这项工作是及时和重要的，因为早期HL/VL干预是将健康和社会负担降至最低的关键，但在南德和少数族裔人群中，护理受到阻碍。我们的发现将提高为肥皂水患者提供服务的专业人员的意识，以便他们能够做出适当的诊断和建议。这一结果将指导我们未来的工作，为患有肥胖症和健康差距的人开发可获得的、公平的干预措施。

Accumulating reports indicate that substance use disorders (SUDs) and overdoses result in hearing loss (HL) and vestibular loss (VL). This is problematic because hearing and balance are important for communication, employment, mental health, physical independence, and overall quality of life. HL and VL would have a greater negative impact on people with SUDs, as this population already struggles with a higher incidence of mental health issues, unemployment, and poorer quality of life. People of minority status with HL/VL are further marginalized because of socioeconomic and/or cultural barriers to audiological healthcare. Unfortunately, the literature on substance-misuse-related HL is sporadic and primarily consists of case reports describing various degrees of either temporary or permanent HL from illicit drugs or prescribed opioid misuse. Even less is known about the effects of SUDs on the vestibular system. A few studies indicate alcohol misuse impairs balance, and opioids and alcohol disrupt peripheral and central vestibular function. The existing studies suggest differential effects on the inner ear based on substance type and use patterns. There is a critical lack of rigorous research using objective measures to identify the peripheral and central effects of SUDs on hearing and vestibular function. Likewise, the influence of health comorbidity, demographics, socioeconomic position, and substance-use patterns on HL/VL in the SUD population has not been investigated. Our project goals are to improve our knowledge of the impact of SUDs on hearing and vestibular function and to identify who is most at risk for HL/VL. To accomplish these goals, we will be the first to investigate peripheral and central hearing (Aim 1) and vestibular (Aim 2) function in a large cohort of diverse people who have SUDs, recruited across three regionally unique study sites. Data will be compared to an age-sex-race or ethnicity-matched control group without SUDs. Last, we will determine the predictive health, demographic, socioeconomic, and substance-use factors that increase the risk of developing HL/VL secondary to substance misuse (Aim 3). We hypothesize that chronic substance misuse will affect the auditory and/or vestibular systems like mechanisms underlying oto- vestibulotoxic medications. Based on the literature, we hypothesize that more health comorbidities, older age, being of non-Hispanic White background, lower socioeconomic position, and riskier substance-use patterns will predict the severity of HL or VL. Biological sex differences are unclear in the existing HL/VL literature; however, our results will help elucidate sex differences in HL/VL and SUDs. SUDs and overdoses have significantly increased since the coronavirus pandemic and disproportionately so among minority populations. Thus, this work is timely and important because early HL/VL intervention is key to minimizing health and social burdens, but care is impeded in SUD and minority populations. Our findings will enhance awareness among professionals who serve people with SUDs so they can make appropriate diagnoses and recommendations. The results will inform our future work to develop accessible, equitable interventions for people with SUDs and health disparities.