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Year : 2017  |  Volume : 23  |  Issue : 3  |  Page : 151-154

Impact of smoking and tobacco addiction on sensorineural hearing loss among normal healthy participants: A cross-sectional cohort study

Department of ENT, Sir T Hospital, Bhavnagar, Gujarat, India

Date of Web Publication31-Aug-2017

Correspondence Address:
Balaji Sekher
Department of ENT, Goverment Medical College, Bhavnagar - 364 001, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_10_17

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Background: Cigarette smoking and tobacco addiction is one of the major health issues worldwide. Tobacco addiction is generally related to health issues such as chronic obstructive pulmonary disease and heart disease hypertension. It is also said that tobacco addiction causes sensorineural hearing loss (SNHL). Aim and Objective: The aim of this study was to show direct correlation between tobacco addiction and SNHL. Materials and Methods: In our study, sixty participants who are addicted to tobacco products at least minimum of 20 years were taken as subjects and matched with age-specific controls who do not have any tobacco addiction. They were asked to undergo basic history taking session, otoscopy, and pure tone audiometry, and results were analyzed. Results: SNHL is more common in tobacco users than the age-specific control group. Conclusion: TObacco addiction (both smoking and tobacco chewing) is associated with increased risk of developing SNHL.

Keywords: Sensorineural hearing loss, smoking and tobacco chewing, tobacco addiction

How to cite this article:
Sekher B, Sinha V, Jha SG. Impact of smoking and tobacco addiction on sensorineural hearing loss among normal healthy participants: A cross-sectional cohort study. Indian J Otol 2017;23:151-4

How to cite this URL:
Sekher B, Sinha V, Jha SG. Impact of smoking and tobacco addiction on sensorineural hearing loss among normal healthy participants: A cross-sectional cohort study. Indian J Otol [serial online] 2017 [cited 2021 Jul 30];23:151-4. Available from: https://www.indianjotol.org/text.asp?2017/23/3/151/213857

  Introduction Top

Cigarette and tobacco addiction is a common health problem. In general, 1.3 billion people are addicted to tobacco products worldwide.[1] It is one of the major causes of health issue in many countries, especially in India. In this study, we had selected people from Madhya Gujarat region where tobacco addiction is very common.

Tobacco products contain nicotine, toxins, and tar products which are deleterious to health in many ways.

Tobacco addiction is well linked to diseases such as lung cancers, oral malignancy, chronic obstructive pulmonary disease, and atherosclerosis.

However, in recent times, we also found that it is linked with sensorineural hearing loss (SNHL).

Hearing is one of the most important tools of social communication. Besides aging, a variety of environmental factors may also cause hearing impairment. Smoking is also considered as one of the risk factors for hearing loss.

The present study is designed to evaluate the association between tobacco addiction and SNHL in individuals who are addicted to tobacco-related products at least minimum of 20 years.


The aim of our study was to show a direct correlation between tobacco addiction and SNHL.

In this study, normal healthy participants who are addicted to tobacco products of any form including cigarette, bidi, and oral tobacco addiction for at least minimum of 20 years were asked to undergo basic history taking, otoscopic assessment, tuning fork test, and pure tone audiogram.

People who have chronic suppurative otitis media and other middle and internal ear pathology, history of ototoxic drug usage, working in a noisy environment congenital anomalies, and other systemic diseases such as diabetes and viral infection causing sudden SNHL and unilateral SNHL are excluded from the study.

  Materials and Method Top

After basic history taking, participants are asked to undergo routine ENT examination and if they have a intact drum, tuning fork test and pure tone audiometry are done.

In this study, people from the same locality are taken for the study and basic screening and audiometry is done by the same ENT surgeon and the audiologist in the same audiometry room setup.

People of between 20 and 60 years' of age without any tobacco addiction are taken as control group. Three subgroups are made, i.e., between 30 and 40 years, 40 and 50 years, and 50 and 60 years and compared with the same age group in the control as presbycusis is common with increasing in age.


The present study sugggests that out of 120 healthy participants, including both control and study group 37 participants (30.8%) had SNHL. In this 25 (67.6%) people had mild SNHL,7 (18.9%) had moderate SNHL, and 5 (13.5%) had severe SNHL [Figure 1].
Figure 1: (a) Sensorineural hearing loss among tobacco users. (b) Sensorineural hearing loss in normal controls

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[Table 1] indicates that the prevalence of SNHL was found higher among smokers of all age groups compared to those of nonsmokers. In smokers, 35% participants are affected in 31–40 years' age group, 40% participants are affected in 41–50 years' age group, and 70% participants are affected in 51–60 years' age group. Whereas, in nonsmokers, 10.0% participants in 31–40 years' age group, 15.0% in 41–50 years' age group, and 40% participants in 51–60 years' age group are affected. In case of smokers, it was observed that mild form of SNHL was the most common, while severe type was the least common [Figure 2] and [Figure 3].
Figure 2: Sensorineural hearing loss among tobacco users

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Figure 3: Sensorineural hearing loss among control group

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Table 1: Association between tobacco addiction and age on hearing impairment

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As mentioned earlier, tobacco causes various health issues; at present, we come to know that there is a direct correlation between tobacco addiction and SNHL.

Nicotine causes SNHL by various mechanisms as follows:

  1. Direct ototoxic effect on cochlea [2],[3],[4],[5],[6]
  2. By increasing the carbon monoxide levels in blood, which converts hemoglobin to carboxyhemoglobin which causes reduction in availability of oxygen to cochlea and destroys the hair cells that are susceptible to hypoxia [7],[8],[9],[10],[11],[12]
  3. Toxic products in cigarette cause oxidative stress and cause oxidative damage to hair cells [13]
  4. It is also suggested that smoking causes atherosclerosis of vessels supplying cochlea similar to other vessels which results in reduced blood supply to cochlea [14],[15],[16]
  5. Direct vasospastic action of nicotine.[17]

Hence, cigarettes and tobacco products have direct effect on SNHL, and increase in age and increase in years of tobacco addiction directly correlate with the degree of hearing loss.

  Discussion Top

As discussed earlier, tobacco products cause SNHL by various above-mentioned mechanisms; quite interestingly, people who are addicted for oral tobacco products without cigarette addiction also suffer from SNHL.

In a Framingham population-based study, it was found that there is no correlation between smoking and SNHL.[18] However, in this study, mainly elderly people are taken into consideration who have many other associated risk factors.

In our study, subjects are matched with age specific control groups and people in 30-60 age group are only taken to study..people above 60 years of age are excluded from the study, as they may have physiological presbyacusis.

Similarly, in a Baltimore study, there is no association between smoking and hearing loss, however, in this study, we have only considered elderly patients and checked the risk factors associated with SNHL in the elderly but not taken smoking as a risk factor solely.[19]

There are several other studies which showed a definitive correlation between SNHL and tobacco addiction. In population-based study done by Cruickshanks et al., it was shown that smokers are at 1.7 times more risk of developing SNHL than the nonsmokers.[20]

It is proven that age and smoking have multiplicative effect in causing SNHL by Noorhassim and Rampal [21] Several other studies such as Itoh et al.,[22] Rosenhall et al.,[23] Helzner et al.,[24] and Fransen et al.[25] have shown that smoking is a major risk factor for SNHL. It is clearly shown that smoking causes high-frequency SNHL by Cunningham et al. study.[15]

An India-based study done by Kumar et al.[26] showed similar finding that there is a direct association between smoking and SNHL.

  Conclusion Top

There are various studies that showed a direct correlation between SNHL and smoking; this study also concludes the same, but we additionally found that people who are addicted to tobacco chewing (without cigarette addiction) are also at higher risk of developing SNHL.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Hultcrantz E, Hillerdal M, Angelborg C. Effect of nicotinic acid on cochlear blood flow. Arch Otorhinolaryngol 1982;234:151-5.  Back to cited text no. 3
Wright MI. The Pathology of Deafness. Manchester: Manchester University Press; 1971.  Back to cited text no. 4
Evans MG. Acetylcholine activates two currents in guinea-pig outer hair cells. J Physiol 1996;491(Pt 2):563-78.  Back to cited text no. 5
Blanchet C, Eróstegui C, Sugasawa M, Dulon D. Acetylcholine-induced potassium current of guinea pig outer hair cells: Its dependence on a calcium influx through nicotinic-like receptors. J Neurosci 1996;16:2574-84.  Back to cited text no. 6
Miller GH. The smokers of cigarettes are constantly exposed to the levels of carbon monoxide in the range of 500 to 1,500 parts per million when they inhale the cigarette smoke. J Indiana State Med Assoc 1979;72:903-5.  Back to cited text no. 7
Stewart RD. Proceedings: The effect of carbon monoxide on humans. J Occup Med 1976;18:304-9.  Back to cited text no. 8
Chung DY, Willson GN, Gannon RP, Mason K. The individual susceptibility to noise. In: Hamernik RP, Henderson D, Salvi R, editors. New Perspectives on the Noise-Induced Hearing Loss. New York: Raven Press; 1982. p. 511-9.  Back to cited text no. 9
Fechter LD, Cheng GD, Rao D. Characterising conditions that favour potentiation of noise induced hearing loss by chemical asphyxiants. Noise Health 2000;3:11-21.  Back to cited text no. 10
[PUBMED]  [Full text]  
Rao DB, Fechter LD. Increased noise severity limits potentiation of noise induced hearing loss by carbon monoxide. Hear Res 2000;150:206-14.  Back to cited text no. 11
Shahbaz Hassan M, Ray J, Wilson F. Carbon monoxide poisoning and sensorineural hearing loss. J Laryngol Otol 2003;117:134-7.  Back to cited text no. 12
Maffei G, Miani P. Experimental tobacco poisoning: The resultant structural modification of the cochlea and the tuba acustica. Arch Otolaryngol 1962;75:386-96.  Back to cited text no. 13
Cruickshanks KJ, Tweed TS, Wiley TL, Klein BE, Klein R, Chappell R, et al. The 5-year incidence and progression of hearing loss: The epidemiology of hearing loss study. Arch Otolaryngol Head Neck Surg 2003;129:1041-6.  Back to cited text no. 14
Cunningham DR, Vise LK, Jones LA. Influence of cigarette smoking on extra-high-frequency auditory thresholds. Ear Hear 1983;4:162-5.  Back to cited text no. 15
Makishima K. Arteriolar sclerosis as a cause of presbycusis. Otolaryngology 1978;86:ORL322-6.  Back to cited text no. 16
Shapiro SL. Are you smoking more but hearing less? Eye Ear Nose Throat Mon 1964;43:96-100.  Back to cited text no. 17
Gates GA, Cobb JL, D'Agostino RB, Wolf PA. The relation of hearing in the elderly to the presence of cardiovascular disease and cardiovascular risk factors. Arch Otolaryngol Head Neck Surg 1993;119:156-61.  Back to cited text no. 18
Brant LJ, Gordon-Salant S, Pearson JD, Klein LL, Morrell CH, Metter EJ, et al. Risk factors related to age-associated hearing loss in the speech frequencies. J Am Acad Audiol 1996;7:152-60.  Back to cited text no. 19
Cruickshanks KJ, Klein R, Klein BE, Wiley TL, Nondahl DM, Tweed TS. Cigarette smoking and hearing loss: The epidemiology of hearing loss study. JAMA 1998;279:1715-9.  Back to cited text no. 20
Noorhassim I, Rampal KG. Multiplicative effect of smoking and age on hearing impairment. Am J Otolaryngol 1998;19:240-3.  Back to cited text no. 21
Itoh A, Nakashima T, Arao H, Wakai K, Tamakoshi A, Kawamura T, et al. Smoking and drinking habits as risk factors for hearing loss in the elderly: Epidemiological study of subjects undergoing routine health checks in Aichi, Japan. Public Health 2001;115:192-6.  Back to cited text no. 22
Rosenhall U, Sixt E, Sundh V, Svanborg A. Correlations between presbyacusis and extrinsic noxious factors. Audiology 1993;32:234-43.  Back to cited text no. 23
Helzner EP, Cauley JA, Pratt SR, Wisniewski SR, Talbott EO, Zmuda JM, et al. Hearing sensitivity and bone mineral density in older adults: The Health, Aging and Body Composition Study. Osteoporos Int 2005;16:1675-82.  Back to cited text no. 24
Fransen E, Topsakal V, Hendrickx JJ. Occupational noise, smoking, and a high body mass index are the risk factors for an agerelated hearing impairment and moderate alcohol consumption is protective: A European population-based multicenter study. J Assoc Res Otolaryngol 2008;9:264-76.  Back to cited text no. 25
Kumar A, Gulati R, Singhal S, Hasan A, Khan A. The effect of smoking on the hearing status-a hospital based study. J Clin Diagn Res 2013;7:210-4.  Back to cited text no. 26


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]

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