The fragility of the hemodynamic balance in the elderly: possible influences on the inner ear

The possible occurrence of labyrinthine disorders linked to hemodynamic imbalances has been widely outlined [1-4] and well demonstrated by clinical observations concerning both young and healthy people [4] and subjects suffering from cardiovascular affections as hypertension the prevalence of tinnitus was studied in patients under antihypertensive [5] or heart failure of variable severity [6]. In all cases, a possible influence of a sharp decrease in the values of blood pressure followed by an abnormal vasomotor reaction was postulated to have some role in the genesis of the disorder, mostly when considering that blood supply of the inner ear is of terminal type. In the elderly, the problem is even more complicated by the frequent presence of isolated systolic hypertension, which is characterized by the lowered compliance of the vascular tree, presenting with an increase of the arterial stiffness and reported to be due both to age-related loss of distensibilty in the major central arteries and to endothelial dysfunction [7]: this increases, in general terms, the risk of transient hypoperfusion to an organ with a terminal circulation as the labyrinth and represents a crucial factor to deal with when treating hypertension in elderly. Moreover, the possibility of the so-called "hypertension-hypotension syndrome" [8], i.e. the coexistence of supine hypertension and orthostatic hypotension as a result of dysautonomia [7] represents a further complication in this sense. Hence the necessity of choosing, when possible, an antihypertensive therapy able to protect the endothelial wall and to avoid brusque falls of peripheral oxygenation which could damage the inner ear. Author details Department of Specialist Surgical and Anesthesiological Sciences, University of Bologna, Italy. Posgraduate School of Audiology and Phoniatrics, University of Bologna, Italy

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

<p>Abstract</p> <p>Background</p> <p>The complex mechanism responsible for tinnitus, a symptom highly prevalent in elderly patients, could involve an impaired control of the microcirculation of the inner ear, particularly in patients with poor blood pressure control and impaired left ventricular (LV) function.</p> <p>Methods</p> <p>In order to define the relationship between the presence of tinnitus and the severity and clinical prognosis of mild-to-moderate chronic heart failure (CHF) in a large population of elderly patients (N = 958), a cross-sectional study was conducted with a long-term extension of the clinical follow-up. Blood pressure, echocardiographic parameters, brain natriuretic peptide (BNP), hospitalization, and mortality for CHF were measured. Multivariate logistic regression analysis was used to assess the association between the presence of tinnitus and some of the prognostic determinants of heart failure.</p> <p>Results</p> <p>The presence of tinnitus was ascertained in 233 patients (24.3%; mean age 74.9 ± 6 years) and was associated with reduced systolic and diastolic blood pressure (123.1 ± 16/67.8 ± 9 vs 125.9 ± 15/69.7 ± 9; <it>P </it>= .027/<it>P </it>= .006), reduced LV ejection fraction (LVEF%; 43.6 ± 15 vs 47.9 ± 14%, <it>P </it>= .001), and increased BNP plasma levels (413.1 ± 480 vs 286.2 ± 357, <it>P </it>= .013) in comparison to patients without symptoms. The distribution of CHF functional class was shifted toward a greater severity of the disease in patients with tinnitus. Combined one-year mortality and hospitalization for CHF (events/year) was 1.43 ± 0.2 in patients with tinnitus and 0.83 ± 0.1 in patients without tinnitus, with an adjusted hazard ratio (HR) of 0.61 (95% confidence interval (CI): 0.37 to 0.93, <it>P </it><.002).</p> <p>Conclusions</p> <p>Our preliminary data indirectly support the hypothesis that tinnitus is associated with a worse CHF control in elderly patients and can have some important clinical implications for the early identification of patients who deserve a more aggressive management of CHF.</p

Meniere's disease and the use of proton pump inhibitors.

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Systemic haemodynamic profile and labyrinthine disorders

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