Sage Journals: Discover world-class research

Abstract

Objective:

Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its age at onset, reproductive lifespan, and hormone replacement therapy (HRT) with hearing loss in adult women in the US.

Methods:

Study cohort includes 1778 adult women (40-69 years), from the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016 who had complete data on audiometry and reproductive health. Hearing loss was defined based on speech-frequency pure-tone average (0.5, 1, 2, and 4 kHz) in better hearing ear. Menopause status was self-reported. Multivariable regression analyses were performed to explore the associations of menopause, age at onset, reproductive lifespan, and HRT with hearing loss.

Results:

After adjusting for age, demographics, medical comorbidities, and noise exposure, there was no significant association between binary postmenopausal status and hearing loss (β: 0.92 dB, [95% CI: −1.02 to 2.86]). When further considering age of menopause onset and reproductive lifespan, we found that late onset of menopause (vs early onset) was significantly associated with the better hearing (β: −4.60 dB, [95% CI: −8.42 to −0.79]) and longer reproductive lifespan was significantly associated with better hearing (β: −0.16 dB per year, [95% CI: −0.32 to −0.002]). Comparing reproductive lifespan quartiles, the fourth quartile was significantly associated with better hearing relative to the first quartile (β: −4.86 dB, [95% CI: −8.28 to −1.44]). Among post-menopausal women, there was no significant association between hearing loss and HRT (β: 0.45 dB, [95% CI: −1.69 to 2.58]).

Conclusion:

While menopausal status was not significantly associated with hearing loss, later onset of menopause and longer reproductive lifespan were associated with better hearing. Future studies should evaluate the clinical significance of the associations between hearing and reproductive health and potential causal relationships.

Level of evidence:

Keywords

hearing loss menopause hormone replacement therapy reproductive lifespan

Introduction

The burden of hearing loss is widespread amongst the American populace, affecting approximately 48 million Americans.¹ Hearing loss has significant negative effects on both health and the economy, posing a considerable burden on healthcare systems.² Hearing loss negatively contributes to various health conditions, including poorer quality of life, social isolation, and cognitive decline.^3-5 Investigating associated risk factors could lead to preventable measures, reducing these burdens.

Estrogen, a hormone vital for various physiological processes, is primarily produced in the ovaries of premenopausal women and in adipose tissue after menopause.⁶ It plays essential roles in vascular health, neural function, and bone maintenance through its interaction with 2 receptors: estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ).^6-8 Its protective effects on hearing are attributed to antioxidative, anti-inflammatory, and vasodilatory properties.^9-15 Estradiol, a potent form of estrogen, has been shown to affect hearing sensitivity in postmenopausal women, with lower serum estradiol levels significantly associated with reduced bone density and an increased risk of hearing loss.^16,17 Furthermore, studies highlight estrogen’s involvement in auditory function, as ERα and ERβ are expressed in inner ear tissues and neurons of the primary auditory cortex.^18,19

Menopause is the permanent cessation of menstruation resulting from the loss of ovarian function, either due to natural causes or bilateral oophorectomy.²⁰ The natural decline in sex hormones associated with menopause and the use of hormone replacement therapy (HRT) on a subgroup of postmenopausal women provide an opportunity to explore the effects of estrogen on auditory function based on the epidemiological data. Currently, the Food and Drug Administration approves the use of HRT for explicit menopausal symptoms which include vasomotor disturbances, bone density loss, and genitourinary issues.²¹ However, the relationship between otologic symptoms, menopause, and HRT remains unclear. Previous epidemiological studies on menopause and HRT have yielded mixed results. Some research suggests that menopause accelerates hearing decline,^22,23 while other studies indicate that a later onset of menopause may increase the risk of hearing loss.²⁴

In this study, we examined the associations of menopause, menarche, reproductive lifespan and HRT with hearing loss using objective measures of hearing in a nationally representative cohort of U.S. women.

Methods

Study Population

The study cohort consists of 1778 adult women aged 40 to 69 years from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 and 2015 to 2016 cycles, who had complete data on audiometry, reproductive health, and related demographic characteristics. NHANES, conducted by the Centers for Disease Control and Prevention (CDC), is a program designed to assess the health and nutritional status of adults and children in the United States. Each year, it employs a cross-sectional design with a complex, multistage probability sampling method, including the oversampling of underrepresented subgroups, to ensure a representative sample of the civilian, non-institutionalized U.S. population. Survey weights are applied to account for the complex sampling design, allowing analyses across the 2 cohorts to be generalizable to the U.S. population. The age range of the study cohort was chosen based on data availability and prior studies that have examined menopausal status in NHANES. All participants of the NHANES protocols were approved by the National Center for Health Statistics Research Ethics Review Board (Protocol #2011-17) and were provided with written informed consent. Additionally, the study protocol was reviewed and deemed exempt by the University of Southern California Institutional Review Board (UP-20-01447).

Menopause and Hormone Replacement Therapy Variables

Variables related to menopause and HRT were collected from the Reproductive Health Questionnaire Interview. Participants were asked if they had at least 1 menstrual period in the past 12 months and the reason they have not had a period in the last 12 months. Postmenopausal status was defined as those who had no menstrual period in the past 12 months due to natural menopause or had a bilateral oophorectomy (surgical menopause) as in previous literature.²⁰ Participants were also asked the age of when they had their first and last menstrual cycle and whether or not they have ever used female hormones such as estrogen and progesterone of any form. Menarche was categorized by their first menstrual period at <12 (early) and ≥12 (not early) years.²⁵ Age at menopause was categorized into early, normal, and late with ages <45, 45-54, ≥55 years respectively.²⁶ Reproductive lifespan was defined as the difference between ages at menopause and menarche as a continuous variable and as quartiles (<30, 30-35, 36-39, >40).

Audiometric Assessment

Audiometry examinations were performed by mobile examination center (MEC) health technicians that were professionally trained by certified audiologists from the National Institute for Occupational Safety & Health.²⁷ Air conduction hearing thresholds were determined in both ears of participants in a sound-isolating room in the MEC. Testing was conducted according to a modified Hughson Westlake procedure using the automated testing mode of the audiometer (Model AD 226; Interacoustics). Quality assurance and control were maintained by daily calibrations and background noise checks using a sound level meter. As an additional measure of reliability, thresholds at 1 kHz were measured twice in each ear. Speech-frequency pure-tone averages were calculated for each ear with thresholds at 0.5, 1, 2, and 4 kHz. Hearing loss was defined based on speech-frequency pure-tone average in the better hearing ear as a continuous variable.²⁸

Other Variables

Demographics, medical history, and noise exposure history provided by interviews were used as covariates in multivariable analysis. Age was limited to the population that received a hearing test, 40 to 69 years. Race/ethnicity was sorted into Hispanic (Mexican-American or other Hispanic), Non-Hispanic white, Non-Hispanic black, Non-Hispanic Asian, and other. Education was categorized into 3 groups: Less than 12th grade, high school graduate, or some college or more. Household income was split into 5 categories (<$20 000, $20 000-$44 999, $45 000-$74 999, ≥$75 000, unknown). Insurance status had 4 categories (none, private insurance, Medicare, Medicaid). Smoking was divided into never, former, or current. Diabetes, strokes, hypertension, cardiovascular diseases (congestive heart failure, coronary heart disease, angina pectoris, or heart attack) were determined by self-reported diagnosis. Three different variables addressed noise exposure with yes or no questions. Occupational noise exposure (“Have you ever had a job where you were exposed to loud noise for five or more hours a week?”), recreational noise exposure (“Outside of a job, have you ever been exposed to very loud noise or music for five or more hours a week?”), and firearm exposure (Ever use firearms for any reason?). Heavy alcohol consumption was defined based on the response to the question: “Was there ever a time or times in your life when you drank 4 (if female) or 5 (if male) or more drinks of any kind of alcoholic beverage almost every day?”

Statistical Analyses

Survey weights were used to account for the analysis of 2 cycles in accordance with NHANES’ complex survey design.²⁹ Univariable and multivariable linear regression was used to evaluate menopause, age of menopause onset, age of menarche, reproductive lifespan, and HRT usage and their individualistic associations with audiometry-measured hearing as a continuous variable. Multivariate models adjusted for the covariates as aforementioned. The association analysis between hearing loss and reproductive variables, age of menopause onset, reproductive lifespan, and HRT usage was conducted on a subgroup consisting of only postmenopausal women (n = 1145). An additional supplemental model was conducted including heavy alcohol use as an additional covariate, limited to participants with complete data on alcohol use. Analysis involving menopause status was performed in a subgroup (n = 1366). Analysis involving HRT use and age of menopause onset was conducted in a further subgroup of postmenopausal women (n = 875). Statistical significance was set at P < .05, two-tailed. All statistical analyses were conducted using The R Project for Statistical Computing software version 4.4.1.

Results

Table 1 summarizes the characteristics of the study cohort. Among U.S. women aged 40 to 69 years, 65.9% (95% CI: 62.7-69.1) reported being postmenopausal, and 42.5% (95% CI: 38.1-46.7) of these postmenopausal women reported using HRT.

Table 1.

Characteristics of the Study Cohort, NHANES 2011 to 2012 and 2015 to 2016 (n = 1778).

Characteristics	Overall	Menopause status
	Overall	No	Yes
	n = 1778	n = 610	n = 1168	P-value
Age, mean, years (SD)	54.2 (0.28)	46.0 (0.36)	58.4 (0.25)	<.001
Race/ethnicity, n (%)
White	570 (32.1)	177 (29.0)	393 (33.6)	<.001
Black	478 (26.9)	164 (26.9)	314 (26.9)	<.001
Hispanic	494 (27.8)	166 (27.2)	328 (28.1)	<.001
Asian	195 (11.0)	84 (13.8)	111 (9.5)	<.001
Other	41 (2.2)	19 (3.1)	22 (1.9)	<.001
Education, n (%)
Less than high school	161 (9.1)	42 (5.1)	119 (10.2)	<.001
High school graduate	234 (13.2)	78 (9.5)	156 (13.4)	<.001
Some college or more	1383 (77.8)	490 (85.4)	893 (76.5)	<.001
Income, n (%)
<$20 000	366 (20.6)	84 (13.8)	282 (24.1)	<.001
20 000-45 000	456 (25.6)	157 (25.7)	299 (25.6)	<.001
45 000-75 000	342 (19.2)	117 (19.2)	225 (19.3)	<.001
75 000	474 (26.7)	201 (33.0)	273 (23.4)	<.001
Unknown	140 (7.9)	51 (8.4)	89 (7.6)	<.001
Health insurance, n (%)
No	358 (20.1)	155 (25.4)	203 (17.4)	<.001
Private	1043 (58.7)	385 (63.1)	658 (56.3)	<.001
Medicare	228 (12.8)	17 (2.8)	211 (18.1)	<.001
Medicaid	149 (8.4)	53 (8.7)	96 (8.2)	<.001
Hypertension, n (%)	762 (42.9)	165 (27.0)	597(51.1)	<.001
Cardiovascular disease, n (%)	118 (6.6)	18 (3.0)	100 (8.6)	<.001
Diabetes, n (%)	312 (17.5)	67 (11.0)	245 (21.0)	<.001
Stroke, n (%)	56 (3.1)	5 (0.8)	51 (4.4)	<.001
Smoking, n (%)
Never	1143 (64.3)	442 (72.5)	701 (60.0)	<.001
Former	351 (19.7)	75 (12.3)	276 (23.6)	<.001
Current	284 (16.0)	93 (15.2)	191 (16.4)	<.001
Occupational noise exposure, n (%)	392 (22.0)	109 (17.9)	283 (24.2)	<.001
Recreational noise exposure, n (%)	118 (6.6)	37 (6.1)	81 (6.9)	.4
Firearm use, n (%)	354 (19.9)	119 (19.5)	235 (20.1)	.01

Table 2 summarizes the association of menopause status and menarche with audiometry-measured hearing. Sequential models incorporate additional adjustments for demographics, medical comorbidities, and noise exposure history. In a multivariable model adjusting for demographics, medical comorbidities, and noise exposure history, there was no significant association between postmenopausal status and hearing loss (β: 0.92 dB, [95% CI: −1.02 to 2.86]). Comparing early versus later menarche, no significant associations were found between menarche and hearing loss (β: 0.22 dB, [95% CI: −1.38 to 1.82]).

Table 2.

Linear Regression Analyses Examining the Association of Menopause Status and Menarche with Audiometry-Measured Hearing (Change in Speech-Frequency Pure-Tone Average (PTA)).

Menopause status
	Δ PTA (dB) [95% CI]	P-value
Crude model	5.78 [4.70-6.86]	<.001
Multivariable model
Model 1	1.07 [−0.63 to 2.77]	.20
Model 2	1.01 [−0.77 to 2.80]	.24
Model 3	0.92 [−1.02 to 2.86]	.31
Menarche
	Δ PTA (dB) [95% CI]	P-value
Crude model	−0.17 [−2.10 to 1.75]	.85
Multivariable model
Model 1	0.12 [−1.42 to 1.66]	.87
Model 2	0.24 [−1.33 to 1.81]	.74
Model 3	0.22 [−1.38 to 1.82]	.76

Note. N = 1788. Crude (unadjusted) model does not account for other covariates. Model 1 is adjusted for age + demographic factors (race, education, income, and insurance). Model 2 is adjusted for model 1 + traditional cigarette smoking + comorbidities (cardiovascular diseases, diabetes, hypertension, and stroke). Model 3 is adjusted for model 2 + noise exposure (occupational, recreational, and firearm); available in a subgroup n = 2979. PTA: speech-frequency pure tone average in better hearing ear at 0.5, 1, 2, and 4 kHz.

Table 3 summarizes the associations of age of menopause onset, reproductive lifespan, and HRT with audiometry-measured hearing in postmenopausal women. Similarly, sequential models incorporate additional adjustments for demographics, medical comorbidities, and noise exposure history. In the multivariate model adjusting for all the covariates, older age at menopause onset was significantly associated with better hearing (β: −0.16 dB per year, [95% CI: −0.30 to −0.006]). When compared to early age of menopause onset, individuals with normal and late onset of menopause had significantly better hearing (β: −3.21 dB, [95% CI: −5.39 to −1.03], and β: −4.60 dB, [95% CI: −8.42 to −0.79] respectively). Longer reproductive lifespan was significantly associated with better hearing (β: −0.16 dB per year, [95% CI: −0.32 to −0.002]. Individuals in the highest quartile had significantly better hearing than those in the lowest quartile (β: −4.86 dB, [95% CI: −8.28 to −1.44]). No significant association was found between HRT use and hearing loss (β: 0.45 dB, [95% CI: −1.69 to 2.58]). An additional supplemental model including heavy alcohol use as an additional covariate among those with complete data on alcohol use (n = 1366) demonstrated similar results (Supplemental Table 1).

Table 3.

Linear Regression Analyses Examining the Association of Age of Menopause Onset, Reproductive Lifespan, and Hormone Replacement Therapy (HRT) with audiometry-Measured Hearing (Change in Speech-Frequency Pure-Tone Average (PTA)) in Postmenopausal Women.

Age of menopause onset (continuous)
	Δ PTA (dB) [95% CI]			P-value
Crude model	−0.10 [−0.22 to 0.010]			.072
Multivariable model
Model 1	−0.18 [−0.30 to −0.052]*			.007
Model 2	−0.15 [−0.29 to −0.008]*			.040
Model 3	−0.16 [−0.30 to −0.006]*			.043
Age of menopause onset (categorical)
	Normal (45-54)	Late (≥55)		Early (<45)
	Δ PTA (dB) [95% CI]	Δ PTA (dB) [95% CI]		Δ PTA (dB) [95% CI]
Crude model	−2.83 [−4.74 to −0.91]*	−2.59 [−6.04 to 0.85]		1.00 (reference)
Multivariable model
Model 1	−3.55 [−5.63 to −1.47]*	−4.73 [−8.04 to −1.47]*		1.00 (reference)
Model 2	−3.22 [−5.34 to −1.09]*	−4.48 [−8.07 to −0.89]*		1.00 (reference)
Model 3	−3.21 [−5.39 to −1.03]*	−4.60 [−8.42 to −0.79]*		1.00 (reference)
Reproductive lifespan (continuous)
	Δ PTA (dB) [95% CI]			P-value
Crude model	−0.11 [−0.22 to 0.013]			.080
Multivariable model
Model 1	−0.18 [−0.31 to −0.047]*			.011
Model 2	−0.16 [−0.31 to −0.003]*			.046
Model 3	−0.16 [−0.32 to −0.002]*			.048
Reproductive lifespan (quartiles)
	Q2	Q3	Q4	Q1
	Δ PTA (dB) [95% CI]	Δ PTA (dB) [95% CI]	Δ PTA (dB) [95% CI]	Δ PTA (dB) [95% CI]
Crude model	−1.64 [−4.68 to 1.39]	−2.27 [−4.83 to 0.28]	−3.12 [−5.74 to −0.51]*	1.00 (reference)
Multivariable model
Model 1	−2.30 [−5.11 to 0.52]	−3.17 [−6.04 to −0.30]*	−5.16 [−7.78 to −2.55]*	1.00 (reference)
Model 2	−2.09 [−5.13 to 0.95]	−2.85 [−5.97 to 0.27]	−4.79 [−7.99 to −1.59]*	1.00 (reference)
Model 3	−2.10 [−5.20 to 1.18]	−2.91 [−6.12 to 0.36]	−4.86 [−8.28 to −1.44]*	1.00 (reference)
HRT use
	Δ PTA (dB) [95% CI]	P-value
Crude model	0.60 [−1.03 to 2.23]	.46
Multivariable model
Model 1	0.45 [−1.60 to 2.50]	.65
Model 2	0.44 [−1.68 to 2.57]	.65
Model 3	0.45 [−1.69 to 2.58]	.64

Note. N = 1145. Subgroup analysis with only postmenopausal women. Crude (unadjusted) model does not account for other covariates. Model 1 is adjusted for age + demographic factors (race, education, income, and insurance). Model 2 is adjusted for model 1 + traditional cigarette smoking + comorbidities (cardiovascular diseases, diabetes, hypertension, and stroke). Model 3 is adjusted for model 2 + noise exposure (occupational, recreational, and firearm); available in a subgroup n = 1150. PTA: speech-frequency pure tone average in better hearing ear at 0.5, 1, 2, and 4 kHz.

P ≤ .05.

Discussion

In this nationally representative sample of U.S. women, there was no significant association between menopausal status and hearing loss. Yet, amongst postmenopausal women, later onset of menopause and longer reproductive lifespans were significantly associated with better hearing. Use of HRT was not independently associated with hearing among postmenopausal women.

A few prior studies investigating the relationship between menopause and hearing loss reported mixed findings.^22-24,30,31 For example, several population-based studies have suggested that postmenopausal status may accelerate hearing decline, aligning with our findings.^22,23,30 In contrast, a large cross-sectional study reported that postmenopausal status was not an independent risk factor for self-reported hearing loss, though a later onset of menopause was associated with an increased risk of self-reported hearing loss.²⁴ Similarly, a smaller cross-sectional study conducted in Turkey found no significant differences in hearing thresholds based on menopausal status.³¹ Our study, which utilized a large sample size and audiometry-measured hearing thresholds, demonstrated that menopausal status itself was not significantly associated with hearing loss.

Upon further consideration of the onset of menopause and reproductive lifespans among postmenopausal women, our study found that a later onset of menopause and longer reproductive lifespans were significantly associated with better hearing. These results suggest that the duration of physiological estrogen exposure may have a greater impact on hearing than the occurrence of menopause itself. This finding is consistent with a cross-sectional population-based study from Korea, which reported that longer reproductive lifespan and older age of menopause were associated with better hearing thresholds at speech frequencies (0.5, 1, 2, and 4 kHz).³² However, given the relatively small effect sizes of these associations, the clinical significance of the findings remains uncertain.

Estrogen has been well established to play an integral role in auditory function. Cross-sectional correlation analyses between serum estradiol levels and hearing loss revealed that lower estradiol levels corresponded with declining hearing sensitivities, indicating that higher estradiol levels may help protect against hearing loss.^16,17 Evidence shows that estrogen plays an active role in auditory function through its effects on the primary auditory cortex and inner ear structures via estrogen receptors ERα and ERβ.^18,19 Experimental studies using ERβ−/− mice further support this protective role; these mice develop deafness by 12 months, whereas wild-type mice exhibit no hearing deficits.³³ Similarly, a study using a rat model to examine the effects of ovariectomy on auditory brainstem responses (ABR) found that estrogen deficiency due to the loss of ovaries impaired auditory processing at the brainstem level. However, estrogen replacement therapy following ovariectomy reversed some of these ABR deficits, underscoring estrogen’s critical role in maintaining auditory function.³⁴

The influence of sex hormones on auditory function is complex, and the exact mechanisms remain unclear. However, several effects have been proposed. Estrogen exhibits protective properties, particularly in the bone, cardiovascular system, and central nervous system, by mitigating oxidative stress.^9,35-37 It has also been shown to counteract the ototoxic effects of aminoglycosides by inhibiting the JNK pro-apoptotic pathway in hair cells.³⁸ Additionally, estrogen demonstrates anti-inflammatory effects by inhibiting NLRP3 inflammasomes, thereby reducing neuroinflammation.^10,11 Emerging research indicates that estrogen improves auditory function by increasing blood flow to the stria vascularis via upregulation of vascular endothelial growth factor through the PI3K/Akt pathway.¹⁵ The impact of menopause on bone integrity has also been suggested as a potential mechanism influencing hearing health. Menopause is a major risk factor for osteoporosis due to estrogen’s direct role in regulating osteoclast and osteoblast activity.³⁹ A large-scale cross-sectional study of U.S. female nurses found that women with osteoporosis had a higher likelihood of experiencing hearing loss.⁴⁰ These findings suggest that bone density loss may underlie the connection between declining estrogen levels and hearing impairment.⁴¹

In this study, there was no significant association between the use of HRT and hearing thresholds. While some studies also found no association between HRT use and hearing outcomes,^42-44 others reported contrasting findings, with HRT use being linked to both improved hearing^44-47 and worse hearing.^24,48 For example, a large nationwide population study in Taiwan showed that the risk of developing sensorineural hearing loss after a 10 year time span did not differ across postmenopausal women that were on HRT compared to those that were not on HRT.⁴² Alternatively, a study examining a cohort of 83 women of the same age found that postmenopausal women treated with tibolone had a significant lower hearing threshold in the right ear at 4000 to 6000 Hz relative to postmenopausal women that were not on any form of HRT.⁴⁴ Hederstierna et al⁴⁵ similarly implicates the potential protective role HRT has on hearing in postmenopausal women; postmenopausal women without HRT demonstrated worse hearing in selective frequencies, 2000, 3000, and 8000 Hz, relative to postmenopausal women on HRT and premenopausal women. Conversely, a large population study following over 80 000 women in the United States reported an association opposing HRT’s potential benefit on hearing. Among these postmenopausal women, longer duration of HRT use was associated with self-reported hearing loss.²⁴ The variability in these studies may have been influenced by factors such as the type of HRT administered, its dosage, onset, and the treatment regimen.^49,50

This study has limitations. This is a cross-sectional study, and the temporal and causal relationships are unable to be established. Menopausal status and HRT use were determined based on self-reported data, which lacks objective measurements and may be prone to misreporting and recall bias. Furthermore, the data on HRT did not include information on the type, dosage, or duration, limiting the ability to comprehensively assess its effectiveness. The audiometry data were based on pure-tone air-conduction testing, which did not allow for the determination of the type of hearing loss. Additionally, residual confounders or potential mediators (eg, genetic predisposition, nutritional status, depression, etc) that were not available in this dataset could not be fully accounted for. Lastly, although our findings regarding hearing loss were statistically significant, their clinical relevance may be limited due to the small effect size. Future research should aim to evaluate the complex relationship between reproductive health and hearing health, as well as investigate the potential role of therapeutic options, such as HRT, and the underlying mechanisms involved.

Conclusion

In a nationally representative sample of U.S. women, menopausal status and HRT use were not significantly associated with hearing loss. However, later menopause and longer reproductive lifespan were significantly associated with better hearing among post-menopausal women. These results indicate a possible relationship between reproductive health and auditory function that requires further study to clarify clinical relevance and causal mechanism.

Supplemental Material

sj-docx-1-aor-10.1177_00034894261435259 – Supplemental material for Association of Menopause and Hormone Replacement Therapy with Hearing Loss

Supplemental material, sj-docx-1-aor-10.1177_00034894261435259 for Association of Menopause and Hormone Replacement Therapy with Hearing Loss by Jonathan Z. Hsu, Kaiqi Gu, Breana Nguyen and Janet S. Choi in Annals of Otology, Rhinology & Laryngology

Footnotes

ORCID iDs

Jonathan Z. Hsu

Breana Nguyen

Janet S. Choi

Author Contributions

Jonathan Z. Hsu: Study conception, data collection, data analysis, and manuscript writing. Kaiqi Gu: Data collection, Data analysis, and manuscript revision. Breana Nguyen: Data collection and manuscript writing. Janet S. Choi: Study conception, data analysis, data interpretation, and critical revision of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

References

Lin

Niparko

Ferrucci

Hearing loss prevalence in the United States. Arch Intern Med. 2011;171(20):1851-1852. doi:10.1001/archinternmed.2011.506

Reed

Altan

Deal

, et al. Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngol Head Neck Surg. 2019;145(1):27-34. doi:10.1001/jamaoto.2018.2875

Lin

Metter

O’Brien

Resnick

Zonderman

Ferrucci

Hearing loss and incident dementia. Arch Neurol. 2011;68(2):214-220. doi:10.1001/archneurol.2010.362

Zhang

Hoffman

Cotch

Themann

Wilson

MR.

Hearing impairment associated with depression in US adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngol Head Neck Surg. 2014;140(4):293-302. doi:10.1001/jamaoto.2014.42

Lin

Yaffe

Xia

, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013;173(4):293-299. doi:10.1001/jamainternmed.2013.1868

Simpson

ER.

Sources of estrogen and their importance. J Steroid Biochem Mol Biol. 2003;86(3-5):225-230. doi:10.1016/S0960-0760(03)00360-1

Hamilton

Hewitt

Arao

Korach

. Chapter Four - Estrogen Hormone Biology. In: Forrest

Tsai

, eds. Current Topics in Developmental Biology, Vol. 125. Nuclear Receptors in Development and Disease. Academic Press; 2017:109-146.

Horner

KC.

The effect of sex hormones on bone metabolism of the otic capsule – an overview. Hear Res. 2009;252(1-2):56-60. doi:10.1016/j.heares.2008.12.004

Lagranha

Silva

TLA

Silva

SCA

, et al. Protective effects of estrogen against cardiovascular disease mediated via oxidative stress in the brain. Life Sci. 2018;192:190-198. doi:10.1016/j.lfs.2017.11.043

10.

Thakkar

Wang

Sareddy

, et al. NLRP3 inflammasome activation in the brain after global cerebral ischemia and regulation by 17β-estradiol. Oxid Med Cell Longev. 2016;2016(1):8309031. doi:10.1155/2016/8309031

11.

Sheng

Bao

Wang

NLRP3 inflammasome activation mediates estrogen deficiency-induced depression- and anxiety-like behavior and hippocampal inflammation in mice. Brain Behav Immun. 2016;56:175-186. doi:10.1016/j.bbi.2016.02.022

12.

Guo

Razandi

Pedram

Kassab

Levin

ER.

Estrogen induces vascular wall dilation: mediation through kinase signaling to nitric oxide and estrogen receptors alpha and beta. J Biol Chem. 2005;280(20):19704-19710. doi:10.1074/jbc.M501244200

13.

Yamane

Takayama

Konishi

, et al. Nitric oxide synthase and contractile protein in the rat cochlear lateral wall: possible role of nitric oxide in regulation of strial blood flow. Hear Res. 1997;108(1-2):65-73. doi:10.1016/S0378-5955(97)00041-5

14.

Brechtelsbauer

Nuttall

Miller

JM.

Basal nitric oxide production in regulation of cochlear blood flow. Hear Res. 1994;77(1-2):38-42. doi:10.1016/0378-5955(94)90251-8

15.

Feng

Huang

, et al. 17β-Estradiol promotes angiogenesis of stria vascular in cochlea of C57BL/6J mice. Eur J Pharmacol. 2021;913:174642. doi:10.1016/j.ejphar.2021.174642

16.

Kim

Kang

Chae

Kim

CH.

The association between serum estradiol level and hearing sensitivity in postmenopausal women. Obstet Gynecol. 2002;99(5 Pt 1):726-730. doi:10.1016/s0029-7844(02)01963-4

17.

Yang

Sun

Wang

Huang

The association of sex steroid hormone concentrations with hearing loss: a cross-sectional study. Acta Otolaryngol. 2023;143(7):582-588. doi:10.1080/00016489.2023.2224398

18.

Stenberg

Wang

Sahlin

Hultcrantz

Mapping of estrogen receptors alpha and beta in the inner ear of mouse and rat. Hear Res. 1999;136(1-2):29-34. doi:10.1016/S0378-5955(99)00098-2

19.

Tremere

Burrows

Jeong

Pinaud

Organization of estrogen-associated circuits in the mouse primary auditory cortex. J Exp Neurosci. 2011;2011:45-60. doi:10.4137/JEN.S7744

20.

World Health Organization. Research on the menopause : report of a WHO scientific group [meeting held in Geneva from 8 to 12 December 1980]. World Health Organization; 1981. Accessed January 12, 2025. https://iris.who.int/handle/10665/41526

21.

Cameron

Cohen

Sewell

Lee

The Art of Hormone Replacement Therapy (HRT) in Menopause Management. J Pharm Pract. 2024;37(3):736-740. doi:10.1177/08971900231167925

22.

Svedbrant

Bark

Hultcrantz

Hederstierna

Hearing decline in menopausal women–a 10-year follow-up. Acta Otolaryngol. 2015;135(8):807-813. doi:10.3109/00016489.2015.1023354

23.

Hederstierna

Hultcrantz

Collins

Rosenhall

The menopause triggers hearing decline in healthy women. Hear Res. 2010;259(1-2):31-35. doi:10.1016/j.heares.2009.09.009

24.

Curhan

Eliassen

Eavey

Wang

Lin

Curhan

GC.

Menopause and postmenopausal hormone therapy and risk of hearing loss. Menopause. 2017;24(9):1049-1056. doi:10.1097/GME.0000000000000878

25.

Shadyab

Macera

Shaffer

, et al. Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the women’s health initiative. Menopause. 2017;24(1):35-44. doi:10.1097/GME.0000000000000710

26.

Jiao

Hao

Hou

, et al. Age at natural menopause and associated factors with early and late menopause among Chinese women in Zhejiang province: a cross-sectional study. PLoS One. 2024;19(7):e0307402. doi:10.1371/journal.pone.0307402

27.

Centers for Disease Control. Audiometry/tympanometry procedures manual. 2003. Accessed January 12, 2025. https://wwwn.cdc.gov/nchs/data/nhanes/public/2003/manuals/AU.pdf

28.

Informal Working Group on Prevention of Deafness and Hearing Impairment Programme Planning & World Health Organization. Programme for the Prevention of Deafness and Hearing Impairment. Report of the Informal Working Group on Prevention of Deafness and Hearing Impairment Programme Planning, Geneva, 18-21 June 1991. 1991. Accessed January 12, 2025. https://iris.who.int/handle/10665/58839

29.

Analytic and Reporting Guidelines. The National Health and Nutrition Examination Survey (NHANES). Published 2005. Updated 2006. Accessed January 12, 2025. https://wwwn.cdc.gov/nchs/data/nhanes/analyticguidelines/05-06-analytic-guidelines.pdf

30.

Özgedik

Kirbaç

Belgin

Is there any difference in hearing function between surgical and natural menopause?

Women Health. 2022;62(2):135-143. doi:10.1080/03630242.2022.2029801

31.

Oghan

Coksuer

Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women. Am J Otolaryngol. 2012;33(3):322-325. doi:10.1016/j.amjoto.2011.10.003

32.

Suh

Lee

Kim

SH.

Effects of endogenous and exogenous oestrogen exposure on hearing level in postmenopausal women: a cross-sectional study. Clin Otolaryngol. 2021;46(3):508-514. doi:10.1111/coa.13685

33.

Simonoska

Stenberg

Duan

, et al. Inner ear pathology and loss of hearing in estrogen receptor-β deficient mice. Published online June 1, 2009. doi:10.1677/JOE-09-0060

34.

Coleman

Campbell

Cooper

Welsh

Moyer

Auditory brainstem responses after ovariectomy and estrogen replacement in rat. Hear Res. 1994;80(2):209-215. doi:10.1016/0378-5955(94)90112-0

35.

Fiocchetti

Ascenzi

Marino

Neuroprotective effects of 17β-estradiol rely on estrogen receptor membrane initiated signals. Front Physiol. 2012;3:73. doi:10.3389/fphys.2012.00073

36.

Iorga

Cunningham

Moazeni

Ruffenach

Umar

Eghbali

The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biol Sex Differ. 2017;8(1):33. doi:10.1186/s13293-017-0152-8

37.

Lean

Davies

Fuller

, et al. A crucial role for thiol antioxidants in estrogen-deficiency bone loss. J Clin Investig. 2003;112(6):915-923. doi:10.1172/JCI18859

38.

Nakamagoe

Tabuchi

Uemaetomari

Nishimura

Hara

Estradiol protects the cochlea against gentamicin ototoxicity through inhibition of the JNK pathway. Hear Res. 2010;261(1-2):67-74. doi:10.1016/j.heares.2010.01.004

39.

Väänänen

Härkönen

PL.

Estrogen and bone metabolism. Maturitas. 1996;23 Suppl:S65-S69. doi:10.1016/0378-5122(96)01015-8

40.

Curhan

Stankovic

Halpin

, et al. Osteoporosis, bisphosphonate use, and risk of moderate or worse hearing loss in women. J Am Geriatr Soc. 2021;69(11):3103-3113. doi:10.1111/jgs.17275

41.

Kahveci

O. K

Demirdal

U. S

Yücedag

Cerci

Patients with osteoporosis have higher incidence of sensorineural hearing loss. Clin Otolaryngol. 2014;39(3):145-149. doi:10.1111/coa.12242

42.

Chen

Chung

Chien

Chen

HC.

Hormone therapy is not associated with the risk of sudden sensorineural hearing loss in postmenopausal women: a 10-year nationwide population-based study. Menopause. 2019;26(8):892-898. doi:10.1097/GME.0000000000001323

43.

Zhang

, et al. Effects of ovarian reserve and hormone therapy on hearing in premenopausal and postmenopausal women: a cross-sectional study. Maturitas. 2018;111:77-81. doi:10.1016/j.maturitas.2018.01.019

44.

Köşüş

Turhan

NÖ

Kurtaran

Hearing levels in menopausal women and the effect of tibolone on audiological functions. J Obstet Gynaecol. 2012;32(3):294-297. doi:10.3109/01443615.2011.649316

45.

Hederstierna

Hultcrantz

Collins

Rosenhall

Hearing in women at menopause. Prevalence of hearing loss, audiometric configuration and relation to hormone replacement therapy. Acta Otolaryngol. 2007;127(2):149-155. doi:10.1080/00016480600794446

46.

Khaliq

Tandon

Goel

Auditory evoked responses in postmenopausal women on hormone replacement therapy. Indian J Physiol Pharmacol. 2003;47(4):393-399.

47.

Kilicdag

Yavuz

Bagis

Tarim

Erkan

Kazanci

Effects of estrogen therapy on hearing in postmenopausal women. Am J Obstet Gynecol. 2004;190(1):77-82. doi:10.1016/j.ajog.2003.06.001

48.

Strachan

Sudden sensorineural deafness and hormone replacement therapy. J Laryngol Otol. 1996;110(12):1148-1150. doi:10.1017/S0022215100135984

49.

Shuster

Depireux

Mong

Hertzano

Sex differences in hearing: probing the role of estrogen signaling. J Acoust Soc Am. 2019;145(6):3656-3663. doi:10.1121/1.5111870

50.

Delhez

Lefebvre

Péqueux

Malgrange

Delacroix

Auditory function and dysfunction: estrogen makes a difference. Cell Mol Life Sci. 2020;77(4):619-635. doi:10.1007/s00018-019-03295-y

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB