|Year : 2022 | Volume
| Issue : 7 | Page : 1046-1049
Hyperlipidemia and its relation with tinnitus: Cross-sectional approach
A Musleh1, S Alshehri1, A Qobty2
1 Department of Otorhinolaryngology, College of Medicine, King Khalid University, Kingdom of Saudi Arabia
2 Otorhinolaryngology Specialist, King Khalid University, Kingdom of Saudi Arabia
|Date of Submission||28-Apr-2021|
|Date of Acceptance||12-Apr-2022|
|Date of Web Publication||20-Jul-2022|
Dr. A Musleh
Department of Otorhinolaryngology, Colleague of Medicine King Khalid University, Abha City
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Tinnitus is a common auditory complaint among individuals characterized by ringing, buzzing, hissing, chirping, whistling, or other sounds in the ear. Following a low-fat/low-cholesterol diet can help reduce the blood cholesterol and triglyceride levels, which aids improvement in tinnitus symptoms. High cholesterol and triglyceride levels in the bloodstream play a significant role in the development of tinnitus, hearing loss, and vertigo. Aim: This paper aims to test the association between hyperlipidemia and tinnitus among outpatients in King Khalid University (KKU) ENT clinic. Patients and Methods: A retrospective review of the medical records of patients who attended the ENT clinic at KKU was performed. An otological examination including pure tone audiometry, personal habits, and lipid profile was conducted. Patients were contacted by phone if there were any missing data. Results: The study included 300 patients who were treated in the outpatient clinic during the study period. About 80% of the patients were of age >45 years and 60.3% were males. Half of the cases (150 cases) had tinnitus and 13% had hyperlipidemia. Patients with high lipid profile recorded doubled risk for tinnitus (P < 0.05). Other risk factors found to be significantly associated with tinnitus include vertigo, young age, and wearing an earpiece. Conclusions: In conclusion, there was a significant association between hyperlipidemia and the incidence of tinnitus even after adjusting for all other risk factors. More large-scale researches are needed to assess in detail the association between different lipid components such as low-density lipoprotein, high-density lipoprotein, triglycerides, and tinnitus epidemiology.
Keywords: Hearing loss, high cholesterol, hyperlipidemia, lipid profile, risk factors, tinnitus, hearing problem
|How to cite this article:|
Musleh A, Alshehri S, Qobty A. Hyperlipidemia and its relation with tinnitus: Cross-sectional approach. Niger J Clin Pract 2022;25:1046-9
| Background|| |
Tinnitus is the perception of noise or ringing in the ears., As a common problem, tinnitus affects about 15–20% of the population. Mostly, tinnitus is not a condition itself but a symptom of an underlying condition, such as age-related hearing loss, ear injury, or a circulatory system disorder. Although annoying, tinnitus usually is not a sign of a serious health condition. Tinnitus as a symptom worsens with age, but in many cases it can improve with treatment or even spontaneously. Treating an identified underlying cause may sometimes help. Other treatments reduce or mask the noise, making tinnitus less noticeable.,
Many factors may contribute to tinnitus, including age-related hearing loss. For many people, hearing worsens with age, usually starting around the age of 60 years. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis. Exposure to loud noise, such as those from heavy equipment, chain saws, and firearms, is a common source of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; both short- and long-term exposure to loud sound can cause permanent damage.,, Earwax blockage because of too much earwax accumulation becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can lead to tinnitus. There are other many risk factors including Meniere's disease, head and neck injuries, high blood pressure, and drugs such as antibiotics, diuretics, and aspirin.,
High cholesterol and triglyceride levels in the bloodstream have a significant role in the development of tinnitus, hearing loss, and vertigo. Insufficient perfusions of the cochlea due to increased blood viscosity, microthrombosis, or altered vasomotion are assumed., Low-fat/low-cholesterol diet can help reduce the blood cholesterol and triglyceride levels, which can result in improvement in tinnitus symptoms. The current study aimed to assess the relation between hyperlipidemia and tinnitus among patients attending the ear, nose, and throat (ENT) clinic at King Khalid University (KKU) and also to assess other risk factors of tinnitus.
| Methodology|| |
A retrospective record review of the medical records of patients who attended the ENT clinic at KKU during the period from January 2019 to April 2020 was done. Patients were contacted by phone if there were any missing data and to have more clinical data if needed. Data extracted were patients' demographics, medical history, drug history, tinnitus assessment, otological examination including pure tone audiometry (PTA), personal habits, and lipid profile. Patients with incomplete data or who refused to participate were excluded. Moreover, files with missing data and failed contact with the patient were excluded from the study.
After data were collected they were revised, coded, and fed to statistical software IBM SPSS version 22. All statistical analysis was done using two-tailed tests and an alpha error of 0.05. P value ≤ 0.05 was considered to be statistically significant. Frequency and percentage were used to describe the frequency distribution of patients' clinical data. Chi-square/Monte Carlo exact test and Fisher's exact test were used to test the association between patients' demographic data, clinical data, and lipid profile with tinnitus. The binary logistic regression model was used to detect the most significant predictors of tinnitus among patients.
| Results|| |
The study included 300 outpatients whose data were reviewed during the study period. About 80% of the patients were of age >45 years and 60.3% were males. Half of the cases (150 cases) had tinnitus and 13% had hyperlipidemia.
[Table 1 demonstrates that 66.7% of the patients with hyperlipidemia complained of tinnitus compared to 47.5% and those with high lipid profile recorded doubled risk for tinnitus with recorded statistical significance [odds ratio (OR) = 2.2; P = 0.024].
|Table 1: Distribution of tinnitus status according to patients' lipid profile|
Click here to view
As for other risk factors [Table 2], it was clear that 46.8% of patients above 45 years had tinnitus compared to 33.3% of those who were below the age of 20 years with recorded statistical significance (P = 0.035). Also, 76% of patients with vertigo had tinnitus compared to 41.2% of diabetic patients and 36.8% of hypertensive patients (P = 0.001). As for otological examination, all patients who had ear wax complained of tinnitus compared to 80% of those who had otitis media with effusion (OME) and 73.3% of patients with perforated eardrum, while 48% of the cases with free otological examination had tinnitus positive findings (P = 0.090). All other factors including gender, high altitude residency, noise work exposure, and using earpiece continuously were insignificantly associated with tinnitus.
PTA assessment revealed that 83.3% of the patients with tinnitus had normal PTA, while sensorineural hearing loss (SNHL) was recorded for 7.3% of those patients and conductive hearing loss (CHL) was diagnosed among 9.3% compared to 94.7% of cases with no tinnitus had PTA negative findings (P = 0.007). As for the severity of hearing loss, it was mild among 48% of the cases with tinnitus compared to 25% of those without (P = 0.132) [Table 3].
|Table 3: PTA findings and their relation with tinnitus among the study cases|
Click here to view
Finally, on adding all risk factors in one regression model, age, wearing an earpiece, having vertigo, and hyperlipidemia were the most important predictors for tinnitus. Patients at young age recorded 33% less risk for tinnitus after adjusting for all other factors (OR = 0.67), while those wearing an earpiece with music recorded 1.5 times more likelihood for tinnitus than others (OR = 1.47). Also, patients with vertigo had five times more likelihood for tinnitus (OR = 5.3) and those with hyperlipidemia recorded 72% more risk for developing tinnitus than patients with normal lipid profile (OR = 1.72) [Table 4].
|Table 4: Multiple stepwise logistic regression model for predictors of tinnitus among study cases|
Click here to view
| Discussion|| |
Tinnitus is a common auditory complaint among individuals characterized by ringing in the ears. It is the sensation of ringing, buzzing, hissing, chirping, whistling, or other sounds in the ear. The noise can be intermittent or continuous and can vary in loudness. It is often worse when background noise is low, so one may be most aware of it at night when trying to fall asleep in a quiet room. In rare cases, the sound beats in sync with your heart (pulsatile tinnitus)., In the last several years of researching tinnitus, it has become apparent that many basic health factors contribute to the intensity of tinnitus and a seed of thought has been growing. Whatever improvement in health in general also contributes to the management and reduction of tinnitus. Low-density lipoprotein (LDL) is known as bad cholesterol. When too much LDL circulates in the blood, it can build up in the inner walls of the arteries that feed the heart and the brain. It can form plaque, which is a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is called atherosclerosis. Once a clot is formed it blocks a narrowed artery, which results in a heart attack or stroke. One of the blockage sites is the inner ear vessels which are affected by the LDL, triglycerides, and cholesterol causing tinnitus.
The current study aimed to assess the relation between tinnitus and hyperlipidemia among the outpatients visiting the KKU ENT clinic. The study revealed that patients with hyperlipidemia recorded doubled risk for having tinnitus. Tinnitus was recorded among two-thirds of patients with high lipid profile compared to less than half of those with normal lipid profile. Other risk factors for tinnitus were young age, vertigo, diabetes, and ear wax. After controlling all risk factors, the same risk factors were identified besides wearing an earpiece.
A study was conducted by Kaźmierczak et al. to assess the occurrence of hyperinsulinemia, diabetes mellitus, and hyperlipidemia in patients suffering from vertigo, tinnitus, or hearing loss of unknown origin. Results of different tests of 48 patients were compared with those of 31 controls. Patients were found to be significantly more overweight (based on body mass index) than the control subjects.
In a clinical study published in 2007, researchers from the Gulhane Military Medical School, Ankara, Turkey studied the prevalence of hyperlipidemia (essentially high cholesterol) in patients who had high-frequency hearing loss and tinnitus due to noise exposure. In the study, 42 male patients with elevated cholesterol or triglyceride levels, or both, were selected. Researchers advised all the patients to a low-cholesterol diet or antihyperlipidemic therapy. Also, the patients were instructed to minimize the intake of cholesterol-containing food; all were followed up for 2 years. The researchers reported that 35% of the patients in the responsive group stated that their tinnitus has decreased and 20% of patients had no longer tinnitus. About 55% of the responsive group had either a significant decrease or complete resolution of their tinnitus.
A third study was conducted in 2015, in Korea based on data from the Korea National Health and Nutrition Examination Survey, with 19,290 participants of age 20–98 years, between 2009 and 2012. Researchers assessed the prevalence of tinnitus using a questionnaire and analyzed various possible factors associated with tinnitus. The researchers found that hyperlipidemia increased the risk for tinnitus by about 43% more than others with normal lipid profile.
| Conclusions and Recommendations|| |
In conclusion, there was a significant association between hyperlipidemia and the incidence of tinnitus even after adjusting for all other risk factors. Patients with tinnitus recorded some improvement if adhered to lipid-lowering medications besides adjusting lifestyle and eating behavior. More large-scale researches are needed to assess in detail the association between different lipid components such as LDL, high-density lipoprotein, triglycerides, and tinnitus epidemiology.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Papadakis MA, McPhee SJ. Current Medical Diagnosis and Treatment 2019. McGraw-Hill; 2019.
Makower J, Chang JY, Muni KP, Morriss JH, Ha HV, Kim IJ, inventors; Acclarent Inc, assignee. Methods and apparatus for treating disorders of the ear, nose and throat. United States patent US 8,961,398. 2015 Feb 24.
McCormack A, Edmondson-Jones M, Somerset S, Hall D. A systematic review of the reporting of tinnitus prevalence and severity. Hear Res 2016;337:70-9.
Lutman ME, editor. Hearing Science and Hearing Disorders. Academic Press; 2014.
Henry JA, Zaugg TL, Schechter MA. Clinical guide for audiologic tinnitus management I. Am J Audiol 2005;14:21-48.
Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Laryngoscope 2011;121:1555-64.
Sindhusake D, Golding M, Newall P, Rubin G, Jakobsen K, Mitchell P. Risk factors for tinnitus in a population of older adults: The blue mountains hearing study. Ear Hear 2003;24:501-7.
Hoffman HJ, Reed GW. Epidemiology of tinnitus. Tinnitus: Theory and management. 2004;16:16-41.
Axelsson A, Prasher D. Tinnitus induced by occupational and leisure noise. Noise Health 2000;2:47-54.
] [Full text]
Guest H, Munro KJ, Prendergast G, Howe S, Plack CJ. Tinnitus with a normal audiogram: Relation to noise exposure but no evidence for cochlear synaptopathy. Hear Res 2017;344:265-74.
El-Shunnar SK, Hoare DJ, Smith S, Gander PE, Kang S, Fackrell K, et al
. Primary care for tinnitus: Practice and opinion among GPs in England. J Eval Clin Pract 2011;17:684-92.
Gopinath B, McMahon CM, Rochtchina E, Karpa MJ, Mitchell P. Risk factors and impacts of incident tinnitus in older adults. Ann Epidemiol 2010;20:129-35.
Baguley D, McFerran D, Hall D. Tinnitus. Lancet 2013;382:1600-7.
Mohammed AA. Lipid profile among patients with sudden sensorineural hearing loss. Indian J Otolaryngol Head Neck Surg 2014;66:425-8.
Hameed MK, Sheikh ZA, Ahmed A, Najam A. Atorvastatin in the management of tinnitus with hyperlipidemias. J Coll Physicians Surg Pak 2014;24:927-30.
Weisz N, Hartmann T, Dohrmann K, Schlee W, Norena A. High-frequency tinnitus without hearing loss does not mean absence of deafferentation. Hear Res 2006;222:108-14.
Henry JA, Griest S, Zaugg TL, Thielman E, Kaelin C, Galvez G, et al
. Tinnitus and hearing survey: A screening tool to differentiate bothersome tinnitus from hearing difficulties. Am J Audiol 2015;24:66-77.
Seidman MD, Standring RT, Dornhoffer JL. Tinnitus: Current understanding and contemporary management. Curr Opin Otolaryngol Head Neck Surg 2010;18:363-8.
Itabe H. Oxidative modification of LDL: Its pathological role in atherosclerosis. Clin Rev Allergy Immunol 2009;37:4-11.
Kaźmierczak H, Doroszewska G. Metabolic disorders in vertigo, tinnitus, and hearing loss. Int Tinnitus J 2001;7:54-8.
Sutbas A, Yetiser S, Satar B, Akcam T, Karahatay S, Saglam K. Low-cholesterol diet and antilipid therapy in managing tinnitus and hearing loss in patients with noise-induced hearing loss and hyperlipidemia. Int Tinnitus J 2007;13:143-9.
Kim HJ, Lee HJ, An SY, Sim S, Park B, Kim SW, et al
. Analysis of the prevalence and associated risk factors of tinnitus in adults. PLoS One 2015;10:e0127578.
[Table 1], [Table 2], [Table 3], [Table 4]