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The influence of systemic circulation on hearing: The reliability of a different impact of microcirculatory defects
Antonio Pirodda1, Cristina Brandolini1, Claudio Borghi2
1Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
Insights
Circulatory factors impact hearing, but the cause matters. Acute hearing loss may stem from inner ear blood flow issues, while progressive loss is less clearly linked to systemic atherosclerosis.
Area of Science:
- Otolaryngology
- Cardiology
- Vascular Biology
Background:
- The relationship between circulatory factors and hearing acuity is complex and debated.
- Existing literature lacks a definitive consensus on the impact of vascular health on hearing.
- Distinguishing between acute and progressive hearing loss is crucial for understanding circulatory influences.
Purpose of the Study:
- To investigate the differential impact of acute microcirculatory disturbances versus systemic atherosclerosis on hearing.
- To propose a framework for understanding the role of circulatory factors in various types of hearing impairment.
- To reconcile conflicting findings regarding cardiovascular risk and hearing preservation.
Main Methods:
- Literature review and analysis of existing research on circulatory factors and hearing.
- Clinical observation and case study analysis over several years.
- Consideration of cochlear autoregulation and vascular differences (microvasculature vs. large/middle vessels).
Main Results:
- Acute inner ear perfusion deficits are hypothesized to cause acute hearing damage.
- Systemic atherosclerosis can coexist with preserved hearing if local cochlear microcirculation is adequate.
- The proposed distinction explains cases of hearing loss in individuals with and without cardiovascular risk factors.
Conclusions:
- A clear distinction between acute/fluctuating hearing disorders and progressive hearing loss is essential for identifying circulatory causes.
- Inner ear microcirculation plays a critical role in acute hearing damage.
- Cochlear autoregulation and vascular differences help explain varied hearing outcomes in patients with circulatory conditions.
Abstract:
The extension of the dependence of hearing acuity from circulatory factors has been widely evaluated in the literature, without reaching an univocal conclusion. In our opinion, a precise distinction between acute/fluctuating disorders and progressive hearing loss must be made in order to identify the possible circulatory causes. Actually, it is conceivable to hypothesize that an acute lack of perfusion plays a major role in the inner ear microcirculation, and may be responsible for acute hearing damages; on the other hand, systemic atherosclerosis may coexist with good hearing provided that a sufficient local perfusion is maintained. This distinction, supported by our findings over the year, appears logical considering the autoregulatory properties of the cochlea and the differences between large/middle vessels and microvasculature; moreover, it can explain the finding of both people with no cardiovascular risk factors and (usually) unilateral inner ear affections and people with diffuse atherosclerosis and well preserved hearing, not exceptionally occurring in daily practice.
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