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Original Research (Original Article) 


Shahad Mohammed Awad Alhazmi et al, 2019;3(10):806–812.

International Journal of Medicine in Developing Countries

Causes of hearing loss among adults in Hail region, Saudi Arabia

Shahad Mohammed Awad Alhazmi1*, Bayan Abdulkarim Abdullah Alsamaan1, Fatimah Saud Furaih Alshammari2, Abeer Hassan Elhaj3

Correspondence to: Shahad Mohammed Awad Alhazmi

*Hail University, Hail, Saudi Arabia.

Email: shahadalhazmi780 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 10 January 2019 | Accepted: 22 March 2019


ABSTRACT

Background:

Hearing loss, also known as hearing impairment, is a partial or total inability to hear. Hearing loss is the third most prevalent condition among older adults, and it strongly affects the physical and mental health of an individual. Despite these effects, a major part of the older patients remains not assessed or inefficiently treated for hearing loss. The aim of this study was to identify the types and major causes of hearing loss among adults in Hail, Saudi Arabia.


Methodology:

A cross-sectional survey study was carried out involving 100 individuals. Self-administered questioners were employed and completed by the study subjects. The questionnaire was divided into two sections: demographic information (name, age, gender, and occupation) and information regarding the hearing loss (type, site, and level of hearing loss, the effect on participant's life, symptoms, signs, and the most probable causes).


Results:

Approximately two-thirds (69%) of the participants had unilateral hearing loss, mainly on the right side (43%). The conductive type of hearing loss was identified in 46% of participants, while sensory neural and mixed disorders were detected in 45% and 9%, respectively. There was a significant association between age, sex, past history of ear infection, trauma, exposure to noise, the presence of hypertension, and rheumatoid arthritis and hearing loss. Most of the study subjects who had bilateral or mixed hearing loss reported adverse effects affecting their daily life.


Conclusion:

This study calls for the implementation of preventive and protective measures, such as educational campaigns, to enhance individuals’ health motivation addressing their hearing loss, avoiding exposure to risk factors, and seeking proper medical care.


Keywords:

Hearing loss, quality of life, Hail, Saudi Arabia.


Introduction

Hearing loss is one of the most common chronic health problems affecting elderly persons [1,2]. Nearly onethird of the adults over 60 years of age have a significant hearing impairment. The hearing loss is observed to be more prevalent among individuals with more than 85 years of age, where more than 80% of them have a significant decline in their hearing capacity. The ageassociated decline in hearing power has been reported to be about 1 decibel (dB) annually after 60 years of age, with earlier onset and a greater degree of affection among males compared to females [35]. Hearing loss in older adults progresses slowly and is usually considered as a part of the normal aging process, hence remains often unnoticed. In addition to the poor recognition, the problem of hearing loss remains usually undertreated, which could be due to the poor patient compliance and resistance to the use of hearing aids either due to high cost or social stigma [6]. Hearing loss is classified into two major categories, conductive and sensorineural, according to the site and type of the problem affecting hearing mechanisms. Problems involving sound transmission and conversion to mechanical vibrations result in conductive hearing loss, whereas problems influencing mechanical vibrations and their conversion to an electrical potential in the cochlea or impairing auditory nerve transmission end with the sensorineural hearing loss. Sometimes, both types of hearing loss are found in the same patient [7]. Genetic predisposition has been reported in nearly half of the cases of age-related hearing loss. The noise exposure is studied to increase the risk of hearing loss most probably through increasing cochlear hair cell damage [5,8]. Hearing loss could be graded as mild, moderate, and severe. Patients with mild-to-moderate hearing loss may not complain, especially in quiet environments, and the condition may pass unnoticed. Only a small percentage of individuals over 65 years with moderateto-severe hearing loss complain of hearing problems [9]. Although it is not a major complaint and may even pass unrecognized in most cases, hearing loss could have a profound impact on personal communication, cognitive ability and psychological well-being, and patient quality of life [7,10]. Diagnosis of hearing loss is based initially on the history of hearing difficulties, which could help in identifying the etiology and/or risk factors of the hearing loss, especially the exposure to noise and ototoxic drugs. However, the standard diagnostic testing is performed by audiometry in a sound-protected environment. Asking about the site and onset of the hearing loss is critical for the diagnosis. Unilateral, rapid onset hearing loss suggests local pathology or trauma, whereas agerelated hearing loss is usually bilateral and of gradual onset [2,6]. Successful management of hearing loss is usually associated with hearing optimization as well as social, emotional, and cognitive improvement. However, this is often at risk of non-adherence because of patient's perception of the significance of hearing loss, expectations for improvement, and cost and convenience regarding the use of hearing aid devices permanently [11,12]. Regarding age-related hearing loss, reducing noise exposure and avoiding risk factors are crucial to slow the onset of the disease, whereas intake of folic acid and omega-3 fatty acids could reduce the decline in hearing abilities [13,14]. The current study was conducted among adults in Hail region, Saudi Arabia, aiming at the following objectives: (1) to find out the most frequent type and the most important causes of hearing loss; (2) to describe the effects of hearing loss on the studied subjects and their personal life; and (3) to identify the instrument most frequently used for diagnosing the level of hearing loss.


Subjects and Methods

A cross-sectional survey was conducted, including the adult residents in the Hail region of the Kingdom of Saudi Arabia. Participants less than 18-year-old were included and the subjects with incomplete data were excluded from the study. Data collection was done during the period from May 2018 to September 2018. The study used a non-probability convenience sampling technique. A self-administrated questionnaire that consisted of multiple choice and fill-in-the-blank format questions were employed during the data collection procedure. The final questionnaire was divided into two sections: (1) demographic information, including name, age, gender, and occupation and (2) information about the type, site, and level of hearing loss, the effect on participant's life, symptoms and signs, and the most probable causes. An excel spreadsheet was established for the data entry. Data were represented and statistically analyzed using Statistical Package for the Social Sciences v 20.0. Chi-Square test was used to estimate the relationship between categorical variables. Fisher’s Exact test was used, when more than 20% of cells had expected count less than five. Significance was adopted at p < 0.05 for the interpretation of results.


Results

The present study assessed 100 adult subjects in Hail, Saudi Arabia. Most of the participants were males (95%), aged 15–40 years (72%). Students and policemen constituted 26% and 20%, respectively, while unemployed and retired subjects participated more frequently (28% and 21%, respectively) as shown in Table 1. Approximately two-thirds (69%) of the participants had unilateral hearing loss, mainly on the right side (43%). Those having unilateral hearing loss were significantly younger than their counterparts (97.1% vs. 16.1%). Additionally, there was a significant association between both sex and occupation and the unilateral or bilateral presence of hearing loss (p = 0.002 and <0.001, respectively). Tinnitus, the pressure in the ear, earache, and hearing loss were the most common symptoms among the study participants (29%, 26%, 17%, and 17%, respectively). The pressure in the ear was the most frequent cause reported among subjects with unilateral hearing loss, whereas hearing loss and tinnitus were found significantly associated with bilateral hearing loss (p < 0.001). More than two-thirds (67.7%) of the patients with bilateral hearing loss had a history of hypertension, while the significantly higher percentage of their counterparts had no medical illness (p = 0.001). Majority of the study participants reported a history of noise exposure (36%), trauma (28%), and ears, nose, and throat (ENT) infection (26%). The noise exposure was found significantly associated with bilateral hearing loss, while the affection of only one ear was more significantly associated with trauma and infection. Presence of a positive family history of hearing loss was only recorded by subjects with bilateral hearing loss (p = 0.002). Fourteen participants (14%) reported a history of rheumatoid arthritis, which was significantly associated with bilateral hearing loss (p < 0.001). Furthermore, hearing loss affected the lives of all the subjects with bilateral hearing loss and 40.6% of their corresponding ones with a significant difference between both the groups (p < 0.001) as illustrated in Table 1. Figure 1 shows the degree of hearing the loss in the right and left ears of the study participants. The right ear was reported with mild, moderate, and moderately severe degrees of hearing loss (21%, 22%, and 18%, respectively), whereas the leftsided hearing loss was moderate among the majority of the subjects (43%). Table 2 demonstrates the association of the type of hearing loss and socio-demographic data, medical illness, and effect on the patient's life. Patients with a conductive and mixed type of hearing loss had a significantly younger age than those with sensory neural type. All the participating females had sensory neural hearing loss (p = 0.035). Most of the conductive hearing loss was recognized among students (56.5%) and unemployed subjects (41.3%), while the mixed type was only found in unemployed with a significant difference (p < 0.001). Regarding the symptoms, the pressure in the ear was significantly higher in conductive hearing loss though tinnitus was highly recorded (64.4%) in sensory neural type. Hypertension was significantly associated with sensory neural hearing loss (p < 0.001).

Table 1. Association of the side of hearing loss and socio-demographic data, medical illness, and effect on the patient’s life.

Hearing loss Chi-square test
Unilateral (right or left) (69%) Bilateral (31%) Total N = 100
N % N % N % p value
Age groups 15–40 67 97.1 5 16.1 72 72.0 <0.001*
>50 2 2.9 26 83.9 28 28.0
Sex Male 69 100.0 26 83.9 95 95.0 0.002*
Female 0 0.0 5 16.1 5 5.0
Occupation Did not attend school 0 0.0 5 16.1 5 5.0 <0.001*
Student 26 37.7 0 0.0 26 26.0
policeman 15 21.7 5 16.1 20 20.0
Unemployed 28 40.6 0 0.0 28 28.0
Retired 0 0.0 21 67.7 21 21.0
Symptoms Pain 17 24.6 0 0.0 17 17.0 <0.001*
Hearing loss 0 0.0 17 54.8 17 17.0
Tinnitus 15 21.7 14 45.2 29 29.0
Discharge 11 15.9 0 0.0 11 11.0
Pressure in ear 26 37.7 0 0.0 26 26.0
Medical illness Diabetes Mellitus 15 21.7 5 16.1 20 20.0 <0.001*
Hypertension 0 0.0 21 67.7 21 21.0
No 54 78.3 5 16.1 59 59.0
Past history ENT infection 26 37.7 0 0.0 26 26.0 <0.001*
Trauma 28 40.6 0 0.0 28 28.0
Noise exposure 15 21.7 21 67.7 36 36.0
No 0 0.0 10 32.3 10 10.0
Family history Yes 0 0.0 5 16.1 5 5.0 0.002*
No 69 100.0 26 83.9 95 95.0
Drug useNo 69 100.0 31 100.0 100 100.0 Not applicable
Autoimmune disease Rheumatoid 0 0.0 14 45.2 14 14.0 <0.001*
Don’t have 69 100.0 17 54.8 86 86.0
Does hearing loss affect your life? Yes 28 40.6 31 100.0 59 59.0 <0.001*
No 41 59.4 0 0.0 41 41.0

*Significant (p < 0.05).

Moreover, trauma and ENT infection were significantly associated with conductive and mixed types, whereas noise exposure was higher and significantly associated with sensory neural hearing loss. Likewise, positive family history and the presence of rheumatoid arthritis were significantly associated with sensory neural hearing loss (p = 0.035, <0.001, respectively). The impact of hearing loss on the personal life of the study subjects was significantly higher among mixed type than either conductive or sensory neural ones (100%, 66.7%, and 43.5%, respectively). Figure 2 demonstrates that audiometer was the only instrument that detected hearing loss in the participants having sensory neural or mixed types. Additionally, the conductive type was more detected by audiometer than tympanometry.

Figure 1. Degree of hearing the loss in the right and left ear.


Discussion

Hearing loss was reported as the third most prevalent chronic condition in older adults and has important effects on their physical and mental health. Despite these effects, a major part of the older patients remains not assessed or well-treated for the hearing loss [6]. In this survey, approximately, two-thirds (69%) of the study participants had unilateral hearing loss, mainly on the right side (43%). The conductive type of hearing loss was identified among 46% of these patients, while sensory neural and mixed disorders were detected in 45% and 9%, respectively. Conductive hearing loss is usually caused by problems in the external or middle ear that interfere with transmitting sound and its conversion to mechanical vibrations. Sensorineural hearing loss involves problems converting mechanical vibrations to an electrical potential in the cochlea and/ or in auditory nerve transmission to the brain. It is usually caused by permanent damage in the organ of Corti [7]. In this study, age was found associated with hearing loss, where bilateral and sensory neural types were significantly higher among the old-aged subjects. Age-related hearing impairment (ARHI) has been recognized by physicians and societies since ancient times. The environmental overload with damaging noise levels, beginning with the industrial revolution, and the introduction of ototoxic antibiotics and anticancer agents added to the spectrum of hazards to the auditory system and established the current triad of drug-induced, noise-induced, and age-related hearing losses. ARHI is the most prevalent form of hearing the loss in humans. It is characterized by decreased hearing sensitivity, decreased ability to understand speech in a noisy environment, slowed central processing of acoustic stimuli, and impaired sound localization [15]. ARHI is shaped by the interplay between genes that govern cochlear integrity and noxious environmental events on the inner ear [16]. Men usually experience greater hearing loss and have an earlier onset compared with women [6]. In agreement with this, this study revealed a significantly higher frequency of hearing loss among males. In the current study, noise exposure was associated with bilateral and sensory neural hearing loss. It is widely accepted that the excessive noise exposure either occupational or recreational can cause noise-induced hearing loss [17]. Prolonged exposure to noise at high intensity was reported to be associated with damage to the sensory hair cells of the inner ear and development of permanent hearing threshold shift, as well as poor speech in noise intelligibility [18]. Trauma to the ear or head may cause temporary or permanent hearing loss. Conductive hearing loss after trauma is caused by the disruption of the conductive chain, which may be due to ossicular luxation or fracture. However, post-traumatic sensory neural hearing loss potentially involves inner ear lesions, such as labyrinthine hemorrhage or perilymphatic fistulae [19]. In agreement with this, 28% of the study participants gave a history of trauma, which was associated with unilateral ear affection and conductive type of hearing loss.

Understanding the underlying pathological causes of hearing loss is prerequisite for a sensible design of protective therapies against hearing loss. In our study, ear infections, hypertension, and rheumatoid arthritis were associated with bilateral or sensory neural hearing loss. A prospective study relating hearing data in the seventh decade of life to infections in the first 5 years of life has shown associations with a number of childhood infections and hearing thresholds across the different frequencies at age 61–63 years. Individuals who had tonsillitis, otorrhea, two or more severe respiratory infections in their first year of life, or two or more episodes of bronchitis up to 5 years were reported more likely to have impaired hearing status in adulthood compared to those who did not have these infections [20]. Hypertension may increase the risk of hearing loss by decreasing vascular supply to the striavascularis, which is located in the lateral cochlear wall, and is responsible for sending auditory signals from the cochlea to the central nervous system [21]. Furthermore, a series of human studies support the hypothesis that patients with rheumatoid arthritis are more prone to hearing loss. This has been attributed to lesions in the middle ear and inner ear, including ossicular stiffness and discontinuity, immune complexes-mediated vasculitis, and destruction by antibody targeting the inner ear [22]. This survey explored that the hearing loss affects the life of these subjects, especially when it affects both ears or it is a mixed type disorder. It is well known that the disabling hearing impairment has a profound impact on interpersonal communication, psychosocial well-being, quality of life, and economic independence. In adulthood, disabling hearing impairment can lead to embarrassment, loneliness, social isolation and stigmatization, prejudice, abuse, psychiatric disturbance, depression, difficulties in relationships with partners and children, restricted career choices, occupational stress, and relatively low earnings [23].

Table 2. Association of the type of hearing loss and socio-demographic data, medical illness, and effect on the patient’s life.

Type of hearing loss Chi-square
Conductive (46%) Sensory neural (45%) Mixed (9%) Total N = 100 test
N % N % N % N % p value
Age groups 15–40 4393.52044.49100.07272.0<0.001*
>50 3 6.5 25 55.6 0 0.0 28 28.0
SexMale 46 100.0 40 88.9 9 100.0 95 95.0 0.035*
Female 0 0.0 5 11.1 0 0.0 5 5.0
Occupation Did not attend school 0 0.0 5 11.1 0 0.0 5 5.0 <0.001*
Student 26 56.5 0 0.0 0 0.0 26 26.0
policeman 1 2.2 19 42.2 0 0.0 20 20.0
Unemployed 19 41.3 0 0.0 9 100.0 28 28.0
Retired 0 0.0 21 46.7 0 0.0 21 21.0
Symptoms Pain 8 17.4 0 0.0 9 100.0 17 17.0 <0.001*
Hearing loss 1 2.2 16 35.6 0 0.0 17 17.0
Tinnitus 0 0.0 29 64.4 0 0.0 29 29.0
Discharge 11 23.9 0 0.0 0 0.0 11 11.0
Pressure in ear 26 56.5 0 0.0 0 0.0 26 26.0
Medical illness Diabetes Mellitus 1 2.2 19 42.2 0 0.0 20 20.0 <0.001*
Hypertension 0 0.0 21 46.7 0 0.0 21 21.0
No 45 97.8 5 11.1 9 100.0 59 59.0
Past history ENT infection 26 56.5 0 0.0 0 0.0 26 26.0 <0.001*
Trauma 19 41.3 0 0.0 9 100.0 28 28.0
Noise exposure 0 0.0 36 80.0 0 0.0 36 36.0
No 1 2.2 9 20.0 0 0.0 10 10.0
Family history Yes 0 0.0 5 11.1 0 0.0 5 5.0 0.035*
No 46 100.0 40 88.9 9 100.0 95 95.0
Drug use No 46 100.0 45 100.0 9 100.0 100 100.0 Not applicable
Autoimmune disease Rheumatoid 0 0.0 14 31.1 0 0.0 14 14.0 <0.001*
Don’t have 46 100.0 31 68.9 9 100.0 86 86.0
Does hearing loss affect your life? Yes 20 43.5 30 66.7 9 100.0 59 59.0 0.003*
No 26 56.5 15 33.3 0 0.0 41 41.0

*Significant (p < 0.05).

Figure 2. Measurement of hearing loss by audiometer and tympanometry.


Conclusion

In conclusion, approximately two-thirds (69%) of adults in Hail, Saudi Arabia had unilateral hearing loss, mainly on the right side (43%). Different types and grades of hearing loss were detected. There was a significant association between hearing loss and age, sex, past history of ear infections and trauma, noise exposure, the presence of hypertension, and rheumatoid arthritis. Most of the participants, especially who had bilateral or mixed hearing loss reported adverse effects during their daily life. The study results call for an action either on individual levels or at health administration systems to implement preventive and protective measures regarding hearing loss problem. In addition, educational campaigns could enhance individuals’ health motivation to address their hearing loss, avoid exposure to risk factors, and seek medical care.


List of Abbreviations

ARHI Age-Related Hearing Impairment

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The current study was approved from Hail University, Hail, Saudi Arabia (10 April 2019, reference number: EC-00068/ CM/UOH.04/19, approval of the study protocol: EC-00068).


Author details

Shahad Mohammed Awad Alhazmi1, Bayan Abdulkarim Abdullah Alsamaan1, Fatimah Saud Furaih Alshammari2, Abeer Hassan Elhaj3

  1. Hail University, Hail, Saudi Arabia
  2. Department of Internal Medicine, King Khalid Hospital, Hail, Saudi Arabia
  3. Department of Community Medicine, Sudan Board for Medical Specialties, Khartoum, Sudan

References

  1. Cruickshanks KJ, Wiley TL, Tweed TS, Klein BE, Klein R, Mares-Perlman JA, et al. Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study. Am J Epidemiol. 1998;148(9):879–86. https://doi.org/10.1093/oxfordjournals.aje.a009713
  2. Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, et al. Long-term effectiveness of screening for hearing loss: the screening for auditory impairment--which hearing assessment test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 2010;58(3):427–34. https://doi.org/10.1111/j.1532-5415.2010.02738.x
  3. Gates GA, Cooper JC, Jr., Kannel WB, Miller NJ. Hearing in the elderly: the Framingham cohort, 1983–1985. Part I. Basic audiometric test results. Ear Hear. 1990;11(4):247–56. https://doi.org/10.1097/00003446-199008000-00001
  4. Lee FS, Matthews LJ, Dubno JR, Mills JH. Longitudinal study of pure-tone thresholds in older persons. Ear Hear. 2005;26(1):1–11. https://doi.org/10.1097/00003446-200502000-00001
  5. Van Eyken E, Van Camp G, Van Laer L. The complexity of age-related hearing impairment: contributing environmental and genetic factors. Audiol Neurootol. 2007;12(6):345–58. https://doi.org/10.1159/000106478
  6. Walling AD, Dickson GM. Hearing loss in older adults. Am Family Phys. 2012;85(12):1150–6.
  7. Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care: scientific review. JAMA. 2003;289(15):1976–85. https://doi.org/10.1001/jama.289.15.1976
  8. Cruickshanks KJ, Nondahl DM, Tweed TS, Wiley TL, Klein BE, Klein R, et al. Education, occupation, noise exposure history and the 10-yr cumulative incidence of hearing impairment in older adults. Hear Res. 2010;264(1–2):3–9. https://doi.org/10.1016/j.heares.2009.10.008
  9. Chou R, Dana T, Bougatsos C, Fleming C, Beil T. Screening adults aged 50 years or older for hearing loss: a review of the evidence for the U.S. preventive services task force. Ann Intern Med. 2011;154(5):347–55. https://doi.org/10.7326/0003-4819-154-5-201103010-00009
  10. Gates GA, Cobb JL, Linn RT, Rees T, Wolf PA, D'Agostino RB. Central auditory dysfunction, cognitive dysfunction, and dementia in older people. Arch Otolaryngol Head Neck Surg. 1996;122(2):161–7. https://doi.org/10.1001/archotol.1996.01890140047010
  11. Mulrow CD, Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, et al. Quality-of-life changes and hearing impairment. A randomized trial. Ann Intern Med. 1990;113(3):188–94. https://doi.org/10.7326/0003-4819-113-3-188
  12. Pacala JT, Yueh B. Hearing deficits in the older patient: “I didn't notice anything”. JAMA. 2012;307(11):1185–94. https://doi.org/10.1001/jama.2012.305
  13. Durga J, Verhoef P, Anteunis LJ, Schouten E, Kok FJ. Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial. Ann Intern Med. 2007;146(1):1–9. https://doi.org/10.7326/0003-4819-146-1-200701020-00003
  14. Gopinath B, Flood VM, Rochtchina E, McMahon CM, Mitchell P. Consumption of omega-3 fatty acids and fish and risk of age-related hearing loss. Am J Clin Nutr. 2010;92(2):416–21. https://doi.org/10.3945/ajcn.2010.29370
  15. Gates GA, Mills JH. Presbycusis. Lancet (London, England). 2005;366(9491):1111–20. https://doi.org/10.1016/S0140-6736(05)67423-5
  16. Yang C-H, Schrepfer T, Schacht J. Age-related hearing impairment and the triad of acquired hearing loss. Front Cell Neurosci. 2015;9:276. https://doi.org/10.3389/fncel.2015.00276
  17. Keppler H, Dhooge I, Vinck B. Hearing in young adults. Part I: the effects of attitudes and beliefs toward noise, hearing loss, and hearing protector devices. Noise Health. 2015;17(78):237–44. https://doi.org/10.4103/1463-1741.165024
  18. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise Health. 2012;14(61):274–80. https://doi.org/10.4103/1463-1741.104893
  19. Maillot O, Attye A, Boyer E, Heck O, Kastler A, Grand S, et al. Post traumatic deafness: a pictorial review of CT and MRI findings. Insights Imaging. 2016;7(3):341–50. https://doi.org/10.1007/s13244-016-0490-9
  20. Pearson F, Mann KD, Rees A, Davis A, Pearce MS. The effect of childhood infection on hearing function at age 61 to 63 years in the Newcastle Thousand Families Study. Ear Hear. 2015;36(2):185–90. https://doi.org/10.1097/AUD.0000000000000094
  21. Lin BM, Curhan SG, Wang M, Eavey R, Stankovic KM, Curhan GC. Hypertension, Diuretic Use, and Risk of Hearing Loss. Am J Med. 2016;129(4):416–22. https://doi.org/10.1016/j.amjmed.2015.11.014
  22. Chen R, Schwander M, Barbe MF, Chan MM. Ossicular bone damage and hearing loss in rheumatoid arthritis: a correlated functional and high resolution morphometric study in collagen-induced arthritic mice. PLoS ONE. 2016;11(9):e0164078. https://doi.org/10.1371/journal.pone.0164078
  23. Olusanya BO, Neumann KJ, Saunders JE. The global burden of disabling hearing impairment: a call to action. Bull World Health Organ. 2014;92(5):367–73. https://doi.org/10.2471/BLT.13.128728


How to Cite this Article
Pubmed Style

Alhazmi SMA, Alsamaan BAA, Alshammari FSF, Elhaj AH. Causes of hearing loss among adults in Hail region, Saudi Arabia. IJMDC. 2019; 3(10): 806-812. doi:10.24911/IJMDC.51-1547118000


Web Style

Alhazmi SMA, Alsamaan BAA, Alshammari FSF, Elhaj AH. Causes of hearing loss among adults in Hail region, Saudi Arabia. https://www.ijmdc.com/?mno=25506 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1547118000


AMA (American Medical Association) Style

Alhazmi SMA, Alsamaan BAA, Alshammari FSF, Elhaj AH. Causes of hearing loss among adults in Hail region, Saudi Arabia. IJMDC. 2019; 3(10): 806-812. doi:10.24911/IJMDC.51-1547118000



Vancouver/ICMJE Style

Alhazmi SMA, Alsamaan BAA, Alshammari FSF, Elhaj AH. Causes of hearing loss among adults in Hail region, Saudi Arabia. IJMDC. (2019), [cited October 15, 2021]; 3(10): 806-812. doi:10.24911/IJMDC.51-1547118000



Harvard Style

Alhazmi, S. M. A., Alsamaan, . B. A. A., Alshammari, . F. S. F. & Elhaj, . A. H. (2019) Causes of hearing loss among adults in Hail region, Saudi Arabia. IJMDC, 3 (10), 806-812. doi:10.24911/IJMDC.51-1547118000



Turabian Style

Alhazmi, Shahad Mohammed Awad, Bayan Abdulkarim Abdullah Alsamaan, Fatimah Saud Furaih Alshammari, and Abeer Hassan Elhaj. 2019. Causes of hearing loss among adults in Hail region, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 806-812. doi:10.24911/IJMDC.51-1547118000



Chicago Style

Alhazmi, Shahad Mohammed Awad, Bayan Abdulkarim Abdullah Alsamaan, Fatimah Saud Furaih Alshammari, and Abeer Hassan Elhaj. "Causes of hearing loss among adults in Hail region, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 806-812. doi:10.24911/IJMDC.51-1547118000



MLA (The Modern Language Association) Style

Alhazmi, Shahad Mohammed Awad, Bayan Abdulkarim Abdullah Alsamaan, Fatimah Saud Furaih Alshammari, and Abeer Hassan Elhaj. "Causes of hearing loss among adults in Hail region, Saudi Arabia." International Journal of Medicine in Developing Countries 3.10 (2019), 806-812. Print. doi:10.24911/IJMDC.51-1547118000



APA (American Psychological Association) Style

Alhazmi, S. M. A., Alsamaan, . B. A. A., Alshammari, . F. S. F. & Elhaj, . A. H. (2019) Causes of hearing loss among adults in Hail region, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 806-812. doi:10.24911/IJMDC.51-1547118000