1

Introduction

Presbyacousis is an age-related degeneration of the inner ear. Information about the initial process of presbyacousis is important for the interpretation of hearing problems in old age. It is the most common cause of sensorineural hearing loss (HL) in adults. Thirty percent of those 65 to 70 years old and 40% of those older than 75 years have presbyacousia. We all begin to lose our sense of hearing when we are in our 40s. This almost always starts in the very high-frequency areas above 8000 Hz, and as we approach our mid 50s, most everyone will have some mild HL in the speech range from 250 to 6000 Hz . The menopause seems to be a “starting point” for age-related HL, but very little is known about hearing in women during the period in life before, during, or after menopause .

In our study, we investigated HL between 250 and 8000 Hz in postmenopausal and premenopausal women. Coleman et al found that estrogen therapy in young adult rats shortened the latencies of electric responses in several auditory pathways. This suggests that lack of this hormone may play a role in the hearing disorder in postmenopausal women. The mean age of menopause women with sensorineural HL in our study was not suitable for the age range of presbyacousis that is commonly seen. In addition, we tried to find out the incidence and severity of HL especially between the young premenopausal and postmenopausal Turkish women, independently presbyacousis.

2

Materials and methods

This prospective study involved 28 premenopausal and 27 postmenopausal women who were referred to the otorhinolaryngology and gynecology departments of Dumlupinar University Faculty of Medicine. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years.

Postmenopausal status was defined as amenorrhea for at least 1 year, follicle-stimulating hormone (FSH) levels greater than 30 IU/L, and estradiol (E2) levels less than 20 IU/L. Subjects who had FSH levels more than 20 IU/l and E2 levels lower than 40 IU/L were considered as climacteric patients . The inclusion criteria for postmenopausal women were an intact uterus and a diagnostically valid negative Papanicolaou smear or, if inadequate tissue was available for analysis, an endometrial thickness of less than 5 mm, as determined by vaginal ultrasonography. Exclusion criteria included abnormal cervical smear result, undiagnosed genital bleeding, known or suspected malignant or premalignant disease, uncontrolled thyroid disorders, depression, stroke, diabetes mellitus, alcohol abuse, smoking, hypertension, idiopathic thrombophlebitis or thromboembolic disease, severe renal insufficiency, and adrenal insufficiency. Patients who had previously had otologic symptoms and those who had previously had any neurologic disease that can affect hearing were excluded. Women with medical histories that could have affected auditory functions were not included in this study. In addition, when we questioned the history of HL, an early-beginning familial presbyacousia history was not detected in our patients with sensorineural HL. The study was approved by the medical ethics committee of the Medical School of Dumlupinar University.

Otoscopic examination revealed normal tympanic membranes in all 55 subjects. All participants had normal middle ear function, as determined by conventional immittance audiometry. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000–8000 Hz) audiometry. The standard battery of hearing tests consisted of pure tone, speech, and impedance audiometry. The same audiometry technician performed all audiologic examinations in the same audiology laboratory. For each set of tests, mean values of air conduction at each frequency were calculated for the climacteric, and postmenopausal groups and graphs of decibels vs frequency were drawn to compare hearing between the 2 groups. Analysis of variance was used to analyze differences in baseline data among the 2 groups. Distribution of the continuous variables was checked by using the Kolmogorov-Smirnov test. After testing the normal distribution, comparisons between the groups were tested using the t test. P < .05 was considered to indicate statistical significance. Data were analyzed with the software SPSS for Windows version 9.05 (SPSS Inc, Chicago, IL). Results are expressed as mean ± SD.

2

Materials and methods

This prospective study involved 28 premenopausal and 27 postmenopausal women who were referred to the otorhinolaryngology and gynecology departments of Dumlupinar University Faculty of Medicine. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years.

Postmenopausal status was defined as amenorrhea for at least 1 year, follicle-stimulating hormone (FSH) levels greater than 30 IU/L, and estradiol (E2) levels less than 20 IU/L. Subjects who had FSH levels more than 20 IU/l and E2 levels lower than 40 IU/L were considered as climacteric patients . The inclusion criteria for postmenopausal women were an intact uterus and a diagnostically valid negative Papanicolaou smear or, if inadequate tissue was available for analysis, an endometrial thickness of less than 5 mm, as determined by vaginal ultrasonography. Exclusion criteria included abnormal cervical smear result, undiagnosed genital bleeding, known or suspected malignant or premalignant disease, uncontrolled thyroid disorders, depression, stroke, diabetes mellitus, alcohol abuse, smoking, hypertension, idiopathic thrombophlebitis or thromboembolic disease, severe renal insufficiency, and adrenal insufficiency. Patients who had previously had otologic symptoms and those who had previously had any neurologic disease that can affect hearing were excluded. Women with medical histories that could have affected auditory functions were not included in this study. In addition, when we questioned the history of HL, an early-beginning familial presbyacousia history was not detected in our patients with sensorineural HL. The study was approved by the medical ethics committee of the Medical School of Dumlupinar University.

Otoscopic examination revealed normal tympanic membranes in all 55 subjects. All participants had normal middle ear function, as determined by conventional immittance audiometry. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000–8000 Hz) audiometry. The standard battery of hearing tests consisted of pure tone, speech, and impedance audiometry. The same audiometry technician performed all audiologic examinations in the same audiology laboratory. For each set of tests, mean values of air conduction at each frequency were calculated for the climacteric, and postmenopausal groups and graphs of decibels vs frequency were drawn to compare hearing between the 2 groups. Analysis of variance was used to analyze differences in baseline data among the 2 groups. Distribution of the continuous variables was checked by using the Kolmogorov-Smirnov test. After testing the normal distribution, comparisons between the groups were tested using the t test. P < .05 was considered to indicate statistical significance. Data were analyzed with the software SPSS for Windows version 9.05 (SPSS Inc, Chicago, IL). Results are expressed as mean ± SD.