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Changes in middle ear transmission characteristics secondary to altered bone remodelling

  • P. Kumar
  • N.K. Singh
  • A. Gargeshwari
  • R. S
  • R. JhaEmail author
Original Article

Abstract

Summary

Alteration in the process of bone remodelling results in conditions like osteopenia and osteoporosis in which the bones become susceptible to fracture. The functioning of middle ear bones in such individuals were assessed in this study and it was found that the middle ear bones are equally susceptible to micro-fractures and can cause reduction in the transmission of sound energy.

Introduction

Alteration in the process of bone remodelling or increase in the number of osteoclasts cells as it occurs in osteoporosis and osteopenia are likely to affect the middle ear bones in the same way it affects the skeletal bones. Whether these micro-structural changes occurring at the level of the middle ear secondary to altered bone remodelling cause any significant impairment in its functioning is not explored. Thus, the present study aimed at assessing the different aspects of middle ear functioning in individuals with reduced BMD.

Methods

The study included 25 normal, 39 osteopenic and 40 osteoporotic participants. The participants underwent pure-tone audiometry, otoscopic examination, conventional immittance evaluation using a 226 Hz probe tone, multi-component and multi-frequency tympanometry and acoustic reflex threshold testing. None of the participants had any current or previous history of middle ear effusion.

Results

A significantly higher proportion of participants in the clinical group had hearing loss compared to the normal group. The clinical group participants also had reduced middle ear resonance frequency, elevated static compliance values and elevated or absent acoustic reflexes compared to the normal participants. There was no difference among the three groups for the proportion of participants having conductive hearing loss.

Conclusions

There is a detrimental impact of reduction in bone mineral density on middle ear transmission characteristics which may go unnoticed initially. Treatment of osteoporosis may potentially mitigate hearing loss from middle ear fractures due to reduced bone mineral density. Absence of significant air-bone gap with the presence of reduced middle ear resonance frequency may be early signs of reduced BMD.

Keywords

Middle ear Osteopenia Osteoporosis 

Notes

Acknowledgements

We would also like to thank the Director and HOD Audiology, All India Institute of Speech and Hearing for permitting to carry out the research and providing the necessary infrastructure.

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

198_2019_4834_MOESM1_ESM.docx (13 kb)
Supplementary Table 1 (DOCX 12 kb)
198_2019_4834_MOESM2_ESM.docx (33 kb)
Supplementary Figure 1 (DOCX 33 kb)

References

  1. 1.
    Clarke B (2008) Normal bone anatomy and physiology. Clin J Am SocNephrol 3(Supplement 3):S131–S139.  https://doi.org/10.2215/CJN.04151206 CrossRefGoogle Scholar
  2. 2.
    De Vernejoul MC (1989) Bone remodelling in osteoporosis. Clin Rheumatol 8(Suppl 2):13–15 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2758777 CrossRefGoogle Scholar
  3. 3.
    World Health Organization (2004, May) WHO scientific group on the assessment of osteoporosis at primary health care level. In Summary meeting report:5–7Google Scholar
  4. 4.
    Raisz LG, Martin T, Garrett I et al (2005) Pathogenesis of osteoporosis: concepts, conflicts, and prospects J Clin Invest. 115(12):3318–3325.  https://doi.org/10.1172/JCI27071
  5. 5.
    Kanzaki S, Ito M, Takada Y, Ogawa K, Matsuo K (2006) Resorption of auditory ossicles and hearing loss in mice lacking osteoprotegerin. Bone 39(2):414–419.  https://doi.org/10.1016/j.bone.2006.01.155 CrossRefGoogle Scholar
  6. 6.
    Wang TC, Lin CC, Lin CD, Chung HK, Wang CY, Tsai MH, Kao CH (2015) Increased acquired cholesteatoma risk in patients with osteoporosis: a retrospective cohort study. PLoS One 10(7):e0132447.  https://doi.org/10.1371/journal.pone.0132447 CrossRefGoogle Scholar
  7. 7.
    Aydogan LB, Uguz A, Surmelioglu O, Soylu L, Yildiz A (2007) The effect of osteoporosis on rabbit middle ear ossicles. Otolaryngology-Head & Neck Surgery 137(2):P174CrossRefGoogle Scholar
  8. 8.
    Gallagher JC, Riggs BL, Eisman J, Hamstra A, Arnaud SB, Deluca HF (1979) Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium. J Clin Invest 64(3):729–736.  https://doi.org/10.1172/JCI109516 CrossRefGoogle Scholar
  9. 9.
    Chan DK, Hudspeth AJ (2005) Ca2+ current-driven nonlinear amplification by the mammalian cochlea in vitro. Nat Neurosci 8(2):149–155.  https://doi.org/10.1038/nn1385 CrossRefGoogle Scholar
  10. 10.
    Clark K, Sowers MR, Wallace RB, Jannausch ML, Lemke J, Anderson CV (1995) Age-related hearing loss and bone mass in a population of rural women aged 60 to 85 years. Ann Epidemiol 5(1):8–14.  https://doi.org/10.1016/1047-2797(94)00035-R CrossRefGoogle Scholar
  11. 11.
    Ozkiriş M, Karaçavuş S, Kapusuz Z, et al. (2013). Does bone mineral density have an effect on hearing loss in postmenopausal patients? Ann Otol Rhinol Laryngol, 122(10), 648–652. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24294688
  12. 12.
    Kahveci OK, Demirdal US, Yücedag F, Cerci U (2014) Patients with osteoporosis have higher incidence of sensorineural hearing loss. ClinOtolaryngol 39(3):145–149.  https://doi.org/10.1111/coa.12242 Google Scholar
  13. 13.
    Yeh MC, Weng SF, Shen YC, Chou CW, Yang CY, Wang JJ, Tien KJ (2015) Increased risk of sudden sensorineural hearing loss in patients with osteoporosis: a population-based, propensity score-matched, longitudinal follow-up study. J ClinEndocrinolMetab 100(6):2413–2419.  https://doi.org/10.1210/jc.2014-4316 CrossRefGoogle Scholar
  14. 14.
    Gargeshwari A, Singh NK, Kumar P, Jha RH (2017) Effect of lowered bone mineral density on the outcomes of audiological tests: a preliminary study. Journal of Indian Speech Language & Hearing Association 31(1):29CrossRefGoogle Scholar
  15. 15.
    Singh NK, Jha RH, Gargeshwari A, Kumar P (2017) Altered auditory and vestibular functioning in individuals with low bone mineral density: a systematic review. Eur Arch Otorhinolaryngol:1–10Google Scholar
  16. 16.
    Arabi A, Baddoura R, Awada H, Khoury N, Haddad S, Ayoub G, Fuleihan GEH (2007) Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures. Bone 40(4):1060–1065.17CrossRefGoogle Scholar
  17. 17.
    El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. QJM: An International Journal of Medicine 101(8):605–617CrossRefGoogle Scholar
  18. 18.
    Blake GM, Fogelman I (2007) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 83(982):509–517CrossRefGoogle Scholar
  19. 19.
    Carhart R, & Jerger J. (1959). Preferred method for clinical determination of pure-tone thresholds. Journal of Speech & Hearing DisordersGoogle Scholar
  20. 20.
    Clark JG (1981) Uses and abuses of hearing loss classification. Asha 23(7):493–500Google Scholar
  21. 21.
    Monzani D, Galeazzi GM, Genovese E, Marrara A, Martini A (2008) Psychological profile and social behaviour of working adults with mild or moderate hearing loss. ActaOtorhinolaryngologicaItalica 28(2):61Google Scholar
  22. 22.
    Blood J, Greenberg HJ (1977) Acoustic admittance of the ear in the geriatric person. Ear Hear 2(5):185–187Google Scholar
  23. 23.
    Wiley TL, Cruickshanks KJ, Nondahl DM, Tweed TS (1999) Aging and middle ear resonance. J Am Acad Audiol 10(4):173–179Google Scholar
  24. 24.
    Khetarpal U, Schuknecht HF (1990) In search of pathologic correlates for hearing loss and Vertigo in Pagets disease. Ann OtolaryngolSupplement 99(3_suppl):1–16.  https://doi.org/10.1177/00034894900990S301 Google Scholar
  25. 25.
    Applebaum E L, & Clemis J D. (1977). Temporal bone histopathology of Paget’s diseasewith sensorineural hearing loss and narrowing of the internal auditory canal. Laryngoscope, 87(10), 1753-1759.  https://doi.org/10.1288/00005537-197710000-00022
  26. 26.
    Nager GT (1975) Paget’s disease of the temporal bone. Ann OtolRhinolLaryngol 84(4_suppl2):1–32.  https://doi.org/10.1177/00034894750844S201 Google Scholar
  27. 27.
    Gallagher JC, Riggs BL, Deluca HF (1980) Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis. The Journal of Clinical Endocrinology & Metabolism 51(6):1359–1364CrossRefGoogle Scholar
  28. 28.
    Atan D, Atan T, Özcan KM, Ensari S, Dere H (2016) Relation of otosclerosis and osteoporosis: a bone mineral density study. AurisNasus Larynx 43(4):400–403CrossRefGoogle Scholar
  29. 29.
    Clayton AE, Mikulec AA, Mikulec KH, Merchant SN, McKenna MJ (2004) Association between osteoporosis and otosclerosis in women. The Journal of Laryngology & Otology 118(8):617–621CrossRefGoogle Scholar
  30. 30.
    Tonuk SB, Koybasi S, Bicer YO, AlkanTemel S (2016) Bone mineral density measurements in otosclerosis using dual-energy X-ray absorptiometry. Clin Otolaryngol 41(2):149–153CrossRefGoogle Scholar
  31. 31.
    Swinnen FKR, De Leenheer EMR, Goemaere S et al (2012) Association between bone mineral density and hearing loss in osteogenesis imperfecta. Laryngoscope 122(2):401–408.  https://doi.org/10.1002/lary.22408 CrossRefGoogle Scholar
  32. 32.
    Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Fang M (2007) Effectiveness and safety of vitamin D in relation to bone health. Evidence report/technology assessment 158:1Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of AudiologyAll India Institute of Speech and HearingMysoreIndia
  2. 2.Manasa Orthopaedic CentreMysoreIndia

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