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Review
. 2024 Jun;31(30):42970-42990.
doi: 10.1007/s11356-024-33943-1. Epub 2024 Jun 17.

Association of sudden sensorineural hearing loss with meteorological factors: a time series study in Hefei, China, and a literature review

Xiao-Bo Li #  1 , Yan-Xun Han #  2 , Zi-Yue Fu #  2   3 , Yu-Chen Zhang  2 , Min Fan  2 , Shu-Jia Sang  2 , Xi-Xi Chen  2 , Bing-Yu Liang  2 , Yu-Chen Liu  2 , Peng-Cheng Lu  1 , Hua-Wei Li  4 , Hai-Feng Pan  5 , Jian-Ming Yang  6
Affiliations
Review

Association of sudden sensorineural hearing loss with meteorological factors: a time series study in Hefei, China, and a literature review

Xiao-Bo Li et al. Environ Sci Pollut Res Int. 2024 Jun.

Erratum in

Abstract

Air pollution can cause disease and has become a major global environmental problem. It is currently believed that air pollution may be related to the progression of SSNHL. As a rapidly developing city in recent years, Hefei has serious air pollution. In order to explore the correlation between meteorological variables and SSNHL admissions, we conducted this study. This study investigated the short-term associations between SSNHL patients admitted to the hospital and Hefei climatic variables. The daily data on SSNHL-related hospital admissions and meteorological variables containing mean temperature (T-mean; °C), diurnal temperature range (DTR; °C), atmospheric pressure (AP; Hp), and relative humidity (RH; %), from 2014 to 2021 (2558 days), were collected. A time-series analysis integrating distributed lag non-linear models and generalized linear models was used. PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Literature published up to August 2023 was reviewed to explore the potential impact mechanisms of meteorological factors on SSNHL. The mechanisms were determined in detail, focusing on wind speed, air pressure, temperature, humidity, and air pollutants. Using a median of 50.00% as a baseline, the effect of exceedingly low T-mean in the single-day hysteresis effect model began at a lag of 8 days (RR = 1.032, 95% CI: 1.001 ~ 1.064). High DTR affected the admission rate for SSNHL on lag 0 day. The significance of the effect was the greatest on that day (RR = 1.054, 95% CI: 1.007 ~ 1.104) and then gradually decreased. High and exceedingly high RH affected the admission rate SSNHL on lag 0 day, and these effects lasted for 8 and 7 days, respectively. There were significant associations between all grades of AP and SSNHL. This is the first study to assess the effect of meteorological variables on SSNHL-related admissions in China using a time-series approach. Long-term exposures to high DTR, RH values, low T-mean values, and all AP grades enhance the incidence of SSNHL in residents. Limiting exposure to extremes of ambient temperature and humidity may reduce the number of SSNHL-related hospital visits in the region. It is advisable to maintain a suitable living environment temperature and avoid extreme temperature fluctuations and high humidity. During periods of high air pollution, it is recommended to stay indoors and refrain from outdoor exercise.

Keywords: Air pollutants; Climatic variables; Mechanism; Outpatient; Sudden sensorineural hearing loss; Time-series analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The geographical location of Hefei city
Fig. 2
Fig. 2
A Spearman’s correlation coefficients for meteorological factors and atmospheric pollutants. B A three-dimensional plot of the relative risk of daily SSNHL vs. T-mean, diurnal temperature range, relative humidity, and atmospheric pressure. C The overall exposure–response association with SSNHL. SSNHL, sudden sensorineural hearing loss
Fig. 3
Fig. 3
Single-day lag effect estimates in SSNHL in T-mean stratified by age and sex. SSNHL, sudden sensorineural hearing loss
Fig. 4
Fig. 4
Single-day lag effect estimates in SSNHL in diurnal temperature range stratified by age and sex. SSNHL, sudden sensorineural hearing loss
Fig. 5
Fig. 5
Single-day lag effect estimates in SSNHL in relative humidity stratified by age and sex. SSNHL, sudden sensorineural hearing loss
Fig. 6
Fig. 6
Single-day lag effect estimates in SSNHL in atmospheric pressure stratified by age and sex. SSNHL, sudden sensorineural hearing loss
Fig. 7
Fig. 7
Potential mechanisms for linkage of wind speed and SSNHL. Strong wind speed can trigger SSNHL from three pathways: enhanced viral transmission, inflammatory immune response, and cross-reactivity. Enhanced viral transmission: In the case of strong wind speed, the virus can invade the spiral ganglion through respiratory transmission and blood transmission, infect the cochlear nerve, and cause hearing damage; inflammatory immune response: strong wind speed can cause elevated levels of IL-6 and TNF and promote the activation and differentiation of CD4T cells, CD8T cells, and B cells, thereby triggering inflammatory responses; cross-reactivity: strong wind speed can trigger cross-reactions and promote IgM production, which binds virus antigens and accidentally binds inner ear antigens and damaging the inner ear. SSNHL, sudden sensorineural hearing loss; IL-6, interleukin 6; TNF, tumor necrosis factor; NF-κB, nuclear factor kappa-B; SIP, steroid receptor coactivator, SRC, SRC-interacting protein; IgM, ImmunoglobulinM; Th17, T helper cell 17; CTL, cytotoxic T lymphocyte; CD4 + , cluster of differentiation 4 plus; CD8 + cluster of differentiation 8 plus
Fig. 8
Fig. 8
Potential mechanisms for linkage of atmospheric pressure and SSNHL. Under the conditions of low air pressure, the partial pressure of oxygen decreases, and hypoxia-induced ROS. ROS depresses levels of NO, induces monocyte invasion, elevates lipid peroxidation, promotes phenotype switching of VSMCs, induces EC dysfunction, precipitates inflammation as well as alters vascular responses and vasotone, which can cause vascular endothelial damage on the one hand, and on the other hand, it can promote Ca2+ inward flow, consume ATP, inhibit the guanylate cycle, reduce cGMP production, and cause vascular smooth muscle spasm, resulting in microcirculation disorders in the inner ear. SSNHL, sudden sensorineural hearing loss; ROS, reactive oxygen species; ATP, adenosine triphosphate; cGMP, cyclic guanosine monophosphate; O2, oxygen; NO, nitrogen; GTP, guanosine triphosphate; PKG, protein kinase G
Fig. 9
Fig. 9
Potential mechanisms for linkage of temperature and SSNHL. Under high temperatures or large temperature differences, on the one hand, norepinephrine is elevated, which promotes vascular smooth muscle contraction by binding to α1 receptors. Changes in blood flow within the inner ear lead to microcirculatory disorders, causing ischemia, decreased blood oxygen levels, and edema in local tissue cells of the inner ear. This ultimately results in damage to the nerves of the inner ear; on the other hand, high-temperature conditions cause microcirculatory disorders in the inner ear due to the diastole of erector spinae muscles and blood vessels, the increased secretion of sweat, and the increased viscosity of blood, which lead to microcirculatory disorders and damage of the inner ear. SSNHL, sudden sensorineural hearing loss; ATP, adenosine triphosphate; NE, noradrenaline
Fig. 10
Fig. 10
Potential mechanisms for linkage of air pollution and SSNHL. Air pollutants damage inner ear epithelial cells by inducing ROS and inflammatory responses, resulting in inner ear microcirculation disorders. ROS: when the concentration of air pollutants is high, ROS will be induced to increase. ROS depresses levels of NO, induces monocyte invasion, elevates lipid peroxidation, promotes phenotype switching of VSMCs, induces EC dysfunction, precipitates inflammation, and alters vascular responses and vasotone, which can cause vascular endothelial damage on the one hand, and on the other hand, it can promote Ca2+ inward flow, consume ATP, inhibit the guanylate cycle, reduce cGMP production, and cause vascular smooth muscle spasm, resulting in microcirculation disorders in the inner ear. Inflammatory immune response: Air pollutants can cause elevated levels of IL-6 and TNF and promote the activation and differentiation of CD4T cells, CD8T cells, and B cells, thereby triggering inflammatory responses. SSNHL, sudden sensorineural hearing loss; ROS, reactive oxygen species; ATP, adenosine triphosphate; cGMP, cyclic guanosine monophosphate; O2, oxygen; NO, nitrogen; GTP, guanosine triphosphate; PKG, protein kinase G; IL-6, interleukin 6; TNF, tumor necrosis factor; NF-κB, nuclear factor kappa-B; SIP, steroid receptor coactivator, Th17, T helper cell 17; CTL, cytotoxic T lymphocyte; CD4 + , cluster of differentiation 4 plus; CD8 + cluster of differentiation 8 plus
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