Tinnitus in Elderly Patients as an Indicator of Prognosis of Mild-To-Moderate Congestive Heart Failure -Study

Aim of Study

Claudio Borghi et al carried out a study to assess the prevalence of tinnitus in a large group of elderly patients with chronic heart failure (CHF) and to define the relationship between the occurrence of tinnitus and the severity and prognosis of CHF.

Tinnitus

Tinnitus is a head noise, which does not have an external source. It is usually perceived by the patient alone and cannot be heard by anyone outside. The noise may lasts for five or more minutes and may occur at least once a week.

Tinnitus is largely considered a nonspecific symptom of an unknown dysfunction of the hearing system and is associated with hearing loss of various degrees.

Various factors are associated with tinnitus ranging from genetic to iatrogenic, neurological to vascular. However a proper explanation is still not available.

Any clinical condition that causes a reduction in blood flow to the ear level can cause tinnitus or trigger a flare in those patients already affected by this disorder.

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Various clinical conditions are associated with tinnitus and they include middle ear diseases, vascular diseases, hypertension, diabetes, autoimmune disorders, and degenerative neural disorders.

Chronic heart failure (CHF)

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CHF could be considered as an ideal biological model to test the vascular disregulatory hypothesis of tinnitus since it is linked to reduced cardiac output.

Like tinnitus, CHF too is more prevalent in the elderly population.

Method Of Study

A cross–sectional study was carried out on 958 consecutive elderly patients (age >65 years) with a diagnosis of CHF to correlate the relationship between tinnitus and the clinical prognosis of mild-to-moderate chronic heart failure (CHF) in a large group of elderly patients.

Blood pressure, echocardiographic parameters, brain natriuretic peptide (BNP), hospitalization, and mortality for CHF were some of the parameters that were measured.

Multivariate logistic regression was used for analysis.

Patients who were excluded from the study include those with –

• Stage 3 to stage 5 chronic renal failure

• Hypoproteinemia

• Recent increase in diuretic dosage (less than 30 days)

• Diuretic dosage change during follow-up

• Use of other ototoxic drugs such as aminoglycosidics

• Continuous use of fully dosed non-steroidal anti-inflammatory drugs (NSAIDs).

Each patient was actively followed-up for a cumulative period of 12 months after enrolment in the study.

Conclusion

To date, this is the first large, cross-sectional, clinical study that has been carried out to link tinnitus and CHF in elderly patients.

The study suggests that in the elderly, presence of tinnitus is linked to a decline in LV function and that this could be the result of insufficient auto regulatory mechanism related to circulation of the inner ear.

The one-year hospitalization and mortality from CHF was significantly increased in patients with tinnitus.

 This may be considered as an indirect symptom of poor hemodynamic stability in elderly CHF patients and allows for the early identification of patients with CHF who need more aggressive management to improve their quality of life.

The data from this study indirectly supports the hypothesis that tinnitus is linked to poor CHF control in elderly patients and can have some important clinical implications in the early identification of CHF patients who need aggressive management.

Source: Tinnitus in elderly patients and prognosis of mild-to-moderate congestive heart failure: a cross-sectional study with a long-term extension of the clinical follow-up; Claudio Borghi et al; BMC Medicine 2011.

Source-Medindia