In this recent case control report by Kandemir and colleagues, we are asked to consider the association between hypertensive disease and hearing impairment, tinnitus and dizziness. A 200-strong cohort of normotensive and newly-diagnosed hypertensive patients underwent pure tone audiometry, Tinnitus Handicap Inventory assessment and Dizziness Handicap Inventory assessment at initial and follow-up consultations. Hypertension was newly diagnosed and treated at the initial appointment for case patients. Hypertensive patients had significantly worse baseline hearing (p<0.001), tinnitus (p=0.025) and dizziness burdens (p=0.021). At follow-up, hypertensive patients showed significant improvements in systolic (SBP) and diastolic blood pressure (DBP). Interestingly, a decrease in SBP was significantly associated with improvements in hearing status and symptoms. Disappointingly, we are not provided with data on time to follow-up consultation, or any information on hypertension treatment plans. The authors remind us that the link between hypertension and these symptoms remains controversial. They do well to rattle through the corroborating and challenging literature and, quite importantly, emphasise the uniqueness of their data, particularly their exclusion of patients with coexisting, and likely confounding, cardiovascular and metabolic disease. We are also treated to a wonderfully reflective limitations section to inform future research. They acknowledge their study cohort is mostly young and otherwise well, limiting generalisability. Furthermore, they even question the clinical relevance of measured changes in hearing quality/symptomatology in a population unlikely to have ever sought medical attention for these issues. This is a fabulous piece of reflective, hypothesis generating research that should inspire bigger and better studies in this field and beyond.
A dizzying response to the silent killer
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