Association of Skin Color, Race/Ethnicity, and Hearing Loss Among Adults in the USA

Abstract

Epidemiologic studies of hearing loss in adults have demonstrated that the odds of hearing loss are substantially lower in black than in white individuals. The basis of this association is unknown. We hypothesized that skin pigmentation as a marker of melanocytic functioning mediates this observed association and that skin pigmentation is associated with hearing loss independent of race/ethnicity. We analyzed cross-sectional data from 1,258 adults (20-59 years) in the 2003-2004 cycle of the National Health and Nutritional Examination Survey who had assessment of Fitzpatrick skin type and pure-tone audiometric testing. Audiometric thresholds in the worse hearing ear were used to calculate speech-(0.5-4 kHz) and high-frequency (3-8 kHz) pure-tone averages (PTA). Regression models were stratified by Fitzpatrick skin type or race/ethnicity to examine the association of each factor with hearing loss independent of the other. Models were adjusted for potential confounders (demographic, medical, and noise exposure covariates). Among all participants, race/ethnicity was associated with hearing thresholds (black participants with the best hearing followed by Hispanics and then white individuals), but these associations were not significant in analyses stratified by skin color. In contrast, in race-stratified analyses, darker-skinned Hispanics had better hearing than lighterskinned Hispanics by an average of −2.5 dB hearing level (HL; 95% CI, −4.8 to −0.2) and −3.1 dB HL (95% CI, −5.3 to −0.8) for speech and high-frequency PTA, respectively. Associations between skin color and hearing loss were not significant in white and black participants. Our results demonstrate that skin pigmentation is independently associated with hearing loss in Hispanics and suggest that skin pigmentation as a marker of melanocytic functioning may mediate the strong association observed between race/ethnicity and hearing loss.

Comparing behavioral and physiological measures of combination tones: Sex and race differences

“…Several lines of evidence suggest that skin pigmentation (and, by implication, intra-cochlear melanocytes) can affect auditory measures such as hearing sensitivity, number of SOAEs, susceptibility to noise-induced hearing loss, and even auditory brainstem responses (see McFadden and Wightman, 1983;Whitehead et al, 1993;McFadden and Loehlin, 1995;Lin et al, 2012;McFadden et al, 2012). Possible race differences in middle-ear characteristics also have been suggested (Shahnaz and Davies, 2006;Shahnaz and Bork, 2006).…”

Cellular Mechanisms of Age-Related Hearing Loss

“…and environmental/extrinsic (e.g., history of noise exposure, ototoxic drugs, etc.) factors that also contribute to the development of ARHL (Cruickshanks et al 1998a , b ;Agrawal et al 2008 ;Lin et al 2012 ;Marlenga et al 2012 ; for review, see Yamasoba et al 2013 ). In other words, systemic aging is a necessary but not suffi cient condition for the development of ARHL.…”

“…In other words, systemic aging is a necessary but not suffi cient condition for the development of ARHL. Along with contributions from sex and race, genetic risk factors (Lin et al 2012 ;Marlenga et al 2012 ) and predisposition to ARHL are reviewed in detail elsewhere (for reviews, see Yamasoba et al 2013 ; Chap. 14 by RD Frisina and DR Frisina).…”

Hearing Loss Health Care for Older Adults

“…It is ultimately up to the individual physician to determine whether screening is prudent for an asymptomatic patient. Epidemiologic risk factors associated with hearing loss include older age; paler skin (concentrations of melanin in the cochlea correlate with skin color, and cochlear melanin has a protective effect in the cochlea 39,40 ); male sex; less education; lower income; and a history of excess noise exposure, cardiovascular disease, or diabetes. 30 If a screening test is positive, patients should undergo a basic otoscopic examination and history to ensure none of the "red flag symptoms" discussed above are present.…”