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"documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2024;162:425-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Value of the tumor inhibitor of cellular immunity PDL-1 in the incidence of venous thrombosis in patients with gastric cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "425" "paginaFinal" => "427" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor del inhibidor tumoral de la inmunidad celular PDL-1 en la incidencia de trombosis venosa en pacientes con cáncer gástrico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Margarita Lorente, Kevin Doello" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Margarita" "apellidos" => "Lorente" ] 1 => array:2 [ "nombre" => "Kevin" "apellidos" => "Doello" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062400161X?idApp=UINPBA00004N" "url" => "/23870206/0000016200000009/v2_202405200151/S238702062400161X/v2_202405200151/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Hearing loss" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "428" "paginaFinal" => "430" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Josep Maria Ibáñez Romaguera, Francesc Roca-Ribas Serdà" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Josep Maria" "apellidos" => "Ibáñez Romaguera" "email" => array:2 [ 0 => "jmibanezr.germanstrias@gencat.cat" 1 => "josepmariaibanez@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Francesc" "apellidos" => "Roca-Ribas Serdà" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Medicina, Vicedecanato de Audiología, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipoacusia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hearing loss (or hypoacusis), especially age-related hearing loss, is a major health problem due to the progressive ageing of the population.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Recognising the problem is the first step in developing an active policy aimed at minimising risk factors and establishing strategies to improve citizens’ quality of life.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The consequences of hearing loss vary depending on the degree of hearing impairment and the time of onset but can be disabling. In children, it causes a lack or delay in language development, decreasing academic performance, while in adults it often severely hinders social and professional development. In older people, hearing loss reduces the ability to communicate, which in turn leads to social isolation, low self-esteem due to the possible stigmatisation of the problem and depression. Hearing loss has been shown to be associated with increased cognitive impairment and faster progression of neurodegenerative diseases.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Of all known causes of cognitive problems in older adults, uncorrected hearing loss is found in 4% of cases and, in general, hearing loss carries a higher risk of age-related cognitive decline.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact, early treatment with hearing correction is the only intervention that has been shown to be effective in reversing this decline.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2021 the World Health Organisation published “<span class="elsevierStyleItalic">The World Report on Hearing</span>”,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> so far, the most recent and most comprehensive study published on hearing loss as a global health problem, its consequences, the challenges it poses and possible solutions and how to make ear and hearing care accessible to all. In his foreword, CEO Dr. Tedros Adhanom Ghebreyesus already underlines the fact that the number of people with hearing loss will grow significantly in the coming decades. Today, an estimated 1.5 billion people (20% of the world’s population) have some degree of hearing loss; of these, more than 300 million have sensorineural hearing loss and 6% of the population suffers from a disabling loss. By 2050, this number is expected to be around 2.5 billion. Of particular concern are hearing losses caused by noise at work (a classic risk factor), but also recreational noise exposure; with regard to the latter, it is estimated that more than a billion young people between 12 and 35 years of age are clearly at risk, which will undoubtedly be one of the elements to be taken into account in the medium term.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The same report estimates an annual loss of $1 trillion from the collective failure to adequately address hearing loss. While the economic burden is enormous, what is impossible to quantify is the suffering due to lack of communication, education and social interaction that accompanies untreated hearing loss. Scaling up hearing interventions to 90% of the population would require a global investment of $238.8 billion over 10 years, yielding a substantial gain of 130 million DALYs (disability-adjusted life years); $1.3 trillion translated into a monetary value plus productivity gains of over $2 trillion globally by 2030. In summary, the return for every dollar invested would be $15.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A person is considered to have a hearing loss, i.e. a decrease in hearing sensitivity, if he/she has an average tonal loss of more than 25 dB HL in the better hearing ear.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The WHO defines a permanent hearing loss in the better ear of 41 dB or more as disabling. However, this criterion does not take into account the degree of auditory discrimination; therefore, the prevalence of hearing impairment is much higher.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Hearing is a major component of human capacity; it is the sense most closely linked to interpersonal communication. Any impairment linked to it at any time in life can have a major impact. An individual’s hearing trajectory is determined by hearing ability at birth in conjunction with the presence of or exposure to a range of causal (genetic, biological, environmental or lifestyle) or protective factors throughout the different stages of life, from prenatal to adulthood. We will not go into detail in this paper on the different clinical forms of hearing loss, their classification or their aetiological factors, although we will mention age-related sensorineural hearing loss or presbycusis, of multifactorial aetiology, to which genetic factors, ageing itself, oxidative stress, vascular cochlear changes and various environmental factors such as exposure to noise, smoking, alcohol intake or other ototoxins contribute. Regarding genetic factors, the study by Wang et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> shows that the hearing impairment reported by the group of adults studied already shows evidence that hearing loss can begin in the first decade of life, adding evidence that polygenic hereditary factors may play a role in its pathogenesis, along with other environmental determinants.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sensorineural hearing loss has been attributed to degeneration or dysfunction of the cellular elements of the cochlea (inner hair cells, outer hair cells and/or spiral ganglion neurons).</p><p id="par0040" class="elsevierStylePara elsevierViewall">However, many individuals with normal hearing thresholds on tone audiometry have significant difficulties in auditory discrimination and therefore in understanding what they hear, especially in noisy environments.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This type of hearing loss has been termed <span class="elsevierStyleItalic">hidden hearing loss</span> (HHL) and can affect 12%–15% of individuals.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Unlike disorders of central origin, HHL is due to cochlear involvement and although research has focused on animal models, several studies have begun to shed light on the aetiology and prevalence of this cochlear disorder in humans.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There is pathophysiological evidence for changes in the cochlea caused by noise, certain drugs or ageing, independent of any loss of hair cells. Among the mechanisms responsible for HHL, although demyelination of Schwann cells or dysfunction of the hair cells themselves have been postulated,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> the best documented pathophysiological mechanism for HHL is degeneration of cochlear synapses without loss of hair cells or spiral ganglion neurons, described as early as 2009 by Kujawa and Liberman.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These synapses are located at the basal end of the inner hair cells and consist of a presynaptic specialisation containing neurotransmitters that are released and a postsynaptic area at the nerve terminals with AMPA receptors for glutamate (a type of receptor that is activated on contact with the synthetic analogue of glutamate).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Noise exposure, in particular, damages cochlear synapses in the first instance and when the number of affected synapses increases, hair cells are subsequently affected and hearing impairment occurs.</p><p id="par0060" class="elsevierStylePara elsevierViewall">On the other hand, proper development and maintenance of auditory nerve myelination by Schwann cells is essential for proper auditory processing, as demyelination has been shown to be involved in hearing loss in both animal and human models.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Recent studies also suggest that outer hair cell loss in turn leads to a decrease in cochlear amplification and consequently to decreased hearing acuity and struggling to hear conversation in environments with a lot of background noise,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> although further studies are needed to know exactly the contribution of hair cell loss to HHL.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This may open the door to potential treatments in the future. There is already evidence that new treatments can improve hearing loss caused by cochlear dysfunction due to ageing, noise or ototoxic drugs.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis of hearing loss is usually made through history-taking and is verified by pure-tone threshold audiometry. In the case of hidden hearing loss, we are dealing with patients who report hearing loss, but with evidence of normal hearing thresholds in tonal audiometry. In these cases, the complementary diagnostic role of auditory brainstem evoked potentials or the presence and measurement of the stapedial reflex is being investigated, although they are not performed in routine clinical practice.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Therefore, in order to minimise the impact on language or cognitive development, it is imperative that hearing loss is detected and addressed as early as possible. The introduction of universal newborn hearing screening programmes and genetic counselling has meant that many people who would have ended up deaf and hard of hearing have been able to recover through early hearing aid fitting or cochlear implantation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Prevention aspects are also beyond the scope of this work, but we must insist on early diagnosis adapted to different age groups, from systematic screening of newborns to regular audiological check-ups. Systematic screening in adults deserves a separate chapter; at the moment there are no established and universal programmes for prevention and early detection in adults, only a few published experiences in the US,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Canada or Australia. On the other hand, the lack of available evidence makes it difficult to implement screening programmes, which is why more research is needed in this field.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The same WHO report<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> shows that evidence-based, cost-effective public health interventions can prevent many causes of hearing loss. The overall focus of the report is to make hearing care a global goal within the framework of the United Nations Sustainable Development Goals (SDGs). Thus, health systems face a significant challenge for which there are potential solutions despite significant gaps in their capacity to act.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, hearing loss is a major health problem due to the progressive ageing of the world’s population and its direct association with cognitive impairment due to the lack of sensory input that hearing loss entails, and therefore requires a multi-systemic approach. On the other hand, the growing interest in the study of hearing loss, and in particular of hidden hearing loss and its pathogenic factors, should lead to the development of diagnostic tools to distinguish which of the cochlear components are involved and should be treated. Multidisciplinary research and the development of treatments that prevent or improve degenerative alterations in the inner ear is therefore essential, as well as technological innovation that provides new solutions to already established hearing loss. Nor should we forget solid training in Audiology, a pending subject in our educational system.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Finally, it is of vital importance to inform and raise collective awareness among citizens and health administrations for an effective prevention and early detection of the problem. All this will undoubtedly open a new perspective of hope for the population suffering from hearing loss.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hearing loss in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.L. 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Journal Information
Vol. 162. Issue 9.
Pages 428-430 (May 2024)
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Vol. 162. Issue 9.
Pages 428-430 (May 2024)
Editorial
Hearing loss
Hipoacusia
a Servicio de Otorrinolaringología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
b Facultad de Medicina, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, Spain
c Facultad de Medicina, Vicedecanato de Audiología, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, Spain
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