IntroductionMucormycosis is a rare opportunistic fungal infection caused by fungi belonging to the Mucorales order and Mucoraceae family. It ranks as the third most prevalent angioinvasive fungal infection, following aspergillosis and candidiasis. This severe infection typically affects individuals with compromised immune systems, including those with hematological malignancies like leukemia and lymphoma, individuals who have undergone stem cell transplants, and people with diabetes mellitus. Individuals in good health are rarely affected, making immunocompromised individuals particularly vulnerable to this potentially fatal fungal disease. The aim of this study was to perform a comparative analysis of survivors versus non-survivors among diabetes patients admitted with mucormycosis.MethodologyThis was a descriptive observational study. A total of 338 patients were enrolled in the study. The study variables included demographics, COVID-19 infection, diabetes mellitus history, steroid use, use of oxygen support, and steam inhalation.ResultsOf the total 338 patients enrolled in the study, 253 (74.9%) were male and 85 (25.01%) were female. The number of survivors were 305 (90.2%) and non-survivors were 33(9.8%). The mean age of survivors was 52.50 ± 11.31 and non-survivors was 54.06 ± 8.54 years. Patients who underwent steam inhalation had a higher chance of survival compared to those who did not undergo steam inhalation and this association was statistically significant (p=0.01). Males showed a higher chance of survival (93.7%) as compared to females (80.0%). The associations between oxygen support, steroid use, and COVID-19 infection with the survival status were statistically non-significant.ConclusionThere was a strong association between the history of steam inhalation and the outcome of mucormycosis among diabetes patients admitted with mucormycosis. Female patients demonstrated a higher fatality rate than males indicating a significant gender disparity observed in cases. Our findings may help to better identify and treat patients who are at higher risk for severe forms of mucormycosis. Mucormycosis, a rare yet formidable fungal infection caused by mucormycetes molds, has gained increasing attention due to its severity and association with various risk factors. This paper tells the critical relationship between diabetes and mucormycosis, focusing on the high mortality rates associated with this infection, particularly in diabetic individuals. As we navigate the complexities of this fungal disease, it becomes evident that understanding the factors distinguishing survivors from non-survivors among diabetic patients is paramount for improving patient outcomes.Mucormycosis can affect virtually any part of the body, with the sinuses, lungs, and brain being common sites of infection . People Mucormycosis poses varying levels of severity depending on the affected body part, with infections in diabetic individuals often proving more severe and challenging to treat due to the vascular damage caused by high blood sugar levels ,6. AntifThe high mortality rates associated with mucormycosis, especially in diabetic individuals, raise alarms within the medical community. While the overall mortality rate stands at approximately 40-50%, diabetic patients face a staggering 70-80% mortality rate , primariStudy design and settingThis observational study was actively conducted at Rajiv Gandhi Government General Hospital, Chennai, India, following ethical approval from the Institutional Review Board. The research spanned from April to June 2021 allowing for a comprehensive exploration of mucormycosis cases within this period. This specific timeframe was chosen to capture the mucormycosis cases during the peak of the COVID-19 pandemic, allowing for a focused investigation into the interplay of mucormycosis, diabetes, and COVID-19. The choice of this hospital and timeframe ensured a robust dataset for our investigation.Study participants and selection criteriaOur study has included all the patients who presented with meeting certain inclusion and exclusion criteria. Patients with established diabetes mellitus and a confirmed diagnosis of mucormycosis via potassium hydroxide (KOH) mount examination were considered confirmed study subjects. To ensure the rigor and relevance of our study, a strong set of selection criteria was employed for the inclusion of participants. These criteria were carefully designed to identify patients who met the specific characteristics and conditions necessary for our investigation while minimizing potential confounding factors. The following criteria were applied to select study participants.Confirmed Diagnosis of MucormycosisOnly patients with a confirmed diagnosis of mucormycosis, established through KOH mount examination, were considered for inclusion. These criteria ensured that the study focused exclusively on individuals with documented mucormycosis infections.Diabetes MellitusPatients with a documented history of diabetes mellitus were eligible for inclusion. Diabetes is a known risk factor for mucormycosis, and its presence was a key criterion for establishing a relevant patient population.Exclusion of Immunocompromised ConditionsIndividuals with known immunocompromised conditions, such as HIV/AIDS or chemotherapy-induced immunosuppression, were excluded from the study. This exclusion was necessary to isolate the impact of diabetes and other factors on mucormycosis risk without the interference of additional immunological variables.Exclusion of Other Confounding FactorsPatients with conditions or factors that could potentially confound the analysis, such as organ transplantation or long-term corticosteroid use, were excluded from the study to maintain the clarity and specificity of the research focus. These criteria ensured that the study population was representative of the research objectives and minimized the potential for bias in the findings. Exclusions were made to account for immunocompromised conditions, minimizing external variables that could influence the study's outcomes.Data sources and measurement of variablesIn our quest to provide a comprehensive understanding of the complex landscape of mucormycosis, we diligently gathered data from 338 eligible patients, meticulously documenting the information using Microsoft Excel . Key variables, such as age, gender, recent COVID-19 infection history, documented diabetes, steroid use during COVID-19 treatment, oxygen support requirements, and the practice of steam inhalation within a month before admission, were systematically recorded. By sourcing this data, we aimed to provide a comprehensive overview of mucormycosis cases in relation to these critical variables, facilitating a refined analysis.This methodology can be delineated as follows, data collection and categorization, encompassing a multitude of demographic and clinical variables. These variables, including age, gender, COVID-19 status, steroid use, oxygen support, steam inhalation practices, comorbidities, infection site, and clinical symptoms, were thoughtfully categorized, rendering the extensive dataset manageable. For instance, age groups were carefully defined, and gender was distinctly partitioned into "male" and "female." Likewise, the COVID-19 status was systematically categorized as "positive" or "negative" through a proper history-taking process. Our dedication to detail extended to the application of the KOH method, a critical facet of the study, which was used to determine the presence or absence of mucormycosis. By employing KOH to process patient samples, this method selectively dissolved non-fungal components while preserving fungal structures, notably hyphae. The presence of these fungal elements under microscopic examination indicated a positive diagnosis of mucormycosis, whereas their absence denoted a negative result.Demographic variables, which included age and gender, not only provided valuable insights into the patient population's distribution across different age groups and gender ratios but also acted as crucial determinants for subsequent analyses. Moreover, clinical history and treatment variables, encompassing COVID-19 status, steroid use, oxygen support, and steam inhalation practices, collectively contributed to a comprehensive understanding of the patient's experiences and the intricate landscape of treatment interventions, particularly in the context of mucormycosis and concurrent COVID-19 infections. Our comprehensive data collection also encompassed comorbidity variables, including conditions such as hypertension, asthma, cardiac disease, and others. These variables signified the presence or absence of concurrent health issues within the patient cohort and played a vital role in the holistic assessment of overall health status. Additionally, variables associated with the site of mucormycosis infection were systematically categorized, providing critical insights into the diverse anatomical locations affected by the disease, with data thoughtfully presented as percentages for each specific infection site. The comprehensive array of clinical symptoms captured in our study, ranging from nasal blockage and facial pain to headaches, contributed to a nuanced and sophisticated understanding of the multifaceted clinical presentation of mucormycosis. Our study ultimately shifted its focus to the analysis of survival outcomes among the patients, venturing into the intricate relationships between variables and the ultimate survival status.Statistical analysisOur analysis applied Statistical Package for the Social Sciences , a robust statistical tool. This rigorous analytical approach ensured that our findings were statistically sound and clinically relevant. The study involved a comprehensive statistical analysis of data collected from mucormycosis patients. The initial phase focused on describing the demographic characteristics, comorbidities, infection sites, and clinical symptoms of the participants. For the demographic data, frequencies and percentages were calculated, offering a clear picture of the age and gender distribution of the patient, as well as the prevalence of comorbidities and the anatomical locations of the infections. Subsequently, a logistic regression analysis was conducted to assess the relationship between selected variables and the survival status of the patients.The age distribution of the 338 patients included in the study varied significantly. Most patients fell within the age range of 41-60 years, with 97 patients (28.7%) aged between 41 and 50, and 105 patients (31.1%) falling within the 51-60 age group as shown in Table In this study, the treatment and clinical history of mucormycosis patients in relation to their COVID-19 status, steroid use, oxygen support, and steam inhalation practices were examined. Most of the patients, representing 78.1% as shown in Table Table The infection distribution of mucormycosis infections within the study population exhibited a diverse pattern. The most affected site was the rhino-orbital region, accounting for 158 cases 47%), followed by rhino-sinusal involvement in 71 cases (21%). Rhino-orbito-cerebral presentation was observed in 51 cases (15%) as seen in Table 7%, folloThe clinical presentation of mucormycosis patients encompassed a spectrum of symptoms showing the nature of the disease. The most reported symptom was nasal blockage or congestion, affecting 60% of patients (203 cases). Facial pain was also prevalent, with 64% (216 cases) of patients experiencing this discomfort. Headache was another prominent symptom, reported by 69% of patients (233 cases). A foul smell was noted in 28% of cases 95), while orbital pain was observed in 44% (149 cases). Numbness was documented in 34% of patients (115 cases), and redness around the eyes, nose, and sinus tract on the face was seen in 12% of cases (41). Paresthesia, blurred or double vision, toothache, and swollen, infected gums were relatively less common but still present, affecting 8% (27 cases), 4% (14 cases), 6% (20 cases), and 6% (20 cases) of patients, respectively. Discoloration of the skin was observed in 2% of cases (7), while respiratory symptoms such as cough , shortness of breath , and hemoptysis  were also documented. These diverse clinical symptoms highlight the varied and often complex clinical presentation of mucormycosis. The detail of the same has been depicted in tabular form in Table , while oAgain, several factors were examined in relation to the survival outcomes of mucormycosis patients as shown in Table Conversely, the provision of oxygen support, steroid use, and the presence of COVID-19 infection did not exhibit statistically significant associations with survival status. The odds ratios for oxygen support (1.594), steroid use (1.44), and COVID-19 infection (1.291) suggested that these factors did not significantly impact survival outcomes, as reflected by their respective p-values (0.325 for both oxygen support and steroid use and 0.588 for COVID-19 infection).These findings provide valuable insights into the factors influencing survival among mucormycosis patients and underscore the potential benefits of steam inhalation and gender-specific considerations in clinical management.The age distribution observed in our study of diabetic patients with mucormycosis tells that the patients fell within the 41-60 age range, with the age group of 51-60 being the most heavily affected. Conversely, patients aged 60 and above represented a smaller proportion of the study population, accounting for 20.4%. The mean age of survivors and non-survivors did not exhibit a substantial difference. Both groups displayed similar average ages. This finding suggests that age may not be a critical determinant of survivorship in mucormycosis cases, but these findings raise questions about the potential influence of external factors, particularly the COVID-19 vaccination rollout in India , on the In our observation we can also see that corticosteroids were commonly administered in managing mucormycosis aligns with the findings reported by Sen M et al.  and SharOur study revealed that COVID-19 infection and mucormycosis have a positive correlation, with 78.1% of patients having a history of positive COVID-19 and 27 subjects did not survive. COVID-19's immunosuppressive effects create a favorable environment for opportunistic infections like mucormycosis, particularly in those with compromised immune systems which is very similar to the study done by Rudrabhatla PK et al. . AdditioA significant limitation of this study is the potential for selection bias due to the exclusion criteria, which excluded individuals with hematological illnesses, other immunocompromised conditions, and new-onset diabetes mellitus, which is a serious drawback of this study. This exclusion criterion may create a bias that limits the study's findings to a narrower diabetic group, perhaps missing substantial differences in mucormycosis outcomes among a broader spectrum of diabetes individuals, and also the study's lack of long-term follow-up prevents our understanding of the long-term impacts and recurrence of mucormycosis among survivors. Furthermore, while the sample size of 338 individuals is large, it may lack the ability to discover more subtle relationships or risk factors, especially for rare outcomes such as mucormycosis. Lastly, the fact that this study was conducted at a single hospital is a limitation because it may limit the generalizability of the results to a larger population of diabetic patients with mucormycosis, potentially removing the full diversity of cases that may arise in different healthcare settings.Our comparative study has explained several critical facts of mucormycosis in diabetic patients. Notably, we found that age diversity within our study population did not hold significant influence over survival outcomes, prompting further investigation into gender-based survival disparities. Interestingly, the use of corticosteroids, a common practice in managing COVID-19, did not substantially impact patient survival, highlighting the multifactorial nature of these outcomes. The intricate infection distribution of mucormycosis infections underscores the complexity of its presentation, while our study also found steam inhalation as a potential factor associated with improved survival, especially in conjunction with COVID-19, invites further exploration of this simple yet promising intervention. Overall, our study underscores the pressing need for a comprehensive approach to patient care, encompassing heightened awareness, timely diagnosis, swift treatment, and the integration of innovative strategies. This holistic approach is essential for mitigating the significant mortality rates linked to this severe fungal infection in diabetic individuals.


Approximately 1 in 10 children with hearing loss is affected by auditory neuropathy spectrum disorder (ANSD). People who have ANSD usually have great difficulty understanding speech or communicating. However, it is possible for these patients to have audiograms that may indicate profound hearing loss up to normal hearing. This disorder is prognosed with positive, intact or present otoacoustic emissions (OAE) and/or cochlear microphonics (CM) as well as abnormal or absent auditory brainstem responses (ABR). Treatment methods include conventional hearing aids as well as cochlear implants. Cochlear implants (CI) usually promise better speech understanding for ANSD patients. We performed a systematic literature review aiming to show what improvements can effectively be achieved with cochlear implants in children with ANSD and compare this with our experience with two cases of ANSD implanted at our clinic. The retrospective review of two young CI patients diagnosed with ANSD during infancy demonstrated improvements over time in speech development communicated by their parents. Globally, more than 1.5 billion people experience some degree of hearing loss (HL). Of these, an estimated 466 million adults and 34 million children have hearing loss of moderate or higher severity in the better hearing ear , with thAuditory neuropathy spectrum disorder (ANSD) occurs when the inner ear can perceive sound, but there is trouble transmitting that information to the brain. People of all ages, from infants to adults, are receptive ,6,7,8.ANSD is identified via present otoacoustic emissions (OAE) and/or cochlear microphonic (CM), and absent or grossly abnormal auditory brainstem response (ABR) . The maiGenerally, it is well accepted that untreated hearing loss leads to delayed development of speech, language and cognitive skills, which may result in slow learning and difficulty progressing in school . TherefoCochlear implants (CI) usually promise better speech understanding for ANSD patients than hearing aids ,6,7. FurSeveral reports showed that cochlear implantation in children with ANSD resulted in open-set speech perception abilities and progressive improvements in communication skills even up to being able to have telephone conversations ,22,23,24Based on the identified PICOS, presented in To identify all publications for cochlear implantation in ANSD, the PubMed database was consulted. The search terms and the filters applied in the process of the search are shown in When necessary, mean values and standard deviations were evaluated from tables or approximated from figures. If this was not possible, these publications were excluded due to lacking sufficient information for the evaluation.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence (accessed on 1 July 2022)) was applied to rate the identified publications. Additionally, any conflicts of interest were reported considering that there could have been bias in the results. Furthermore, it was also indicated whether the studies were supported financially.The Oxford Level of Evidence Chart (An excerpt of the assessments applied in the publications is described here.PTA (Pure-Tone-Audiometry): It is possible to test a person’s hearing sensitivity to calibrated pure tones utilizing pure-tone threshold audiometry [diometry . The headiometry .SRT (Speech Recognition Threshold): The SRT is the minimum level at which a person can recognize 50% of two-syllable words from a closed list. The person should repeat or in some other way indicate recognition of the speech material 50% of the time. The words are presented from the front to the respondent. In the cases presented in this review, the child’s realistic index of the Speech Perception Jr. (CRISP Jr.) test was utilized for the SRT evaluation [aluation ,23.CAEP : P1 latency is given in milliseconds and examines the state of the central auditory pathway’s development; furthermore, it has been applied to assess how the maturation of the auditory pathway has changed in congenitally deaf children after they have been treated with hearing aids or cochlear implants [implants .PBK  word list: Word recognition assessed with the PBK word list. This test consists of a list of 50 monosyllabic words. Therefore, the test items must be repeated by the subject. The responses are evaluated by the percentage of words and phonemes correctly identified [entified .NU-CHIPS (Northwestern University—Children’s Perception of Speech): It is applicable for kids younger than three years. It is a closed-set picture-pointing word recognition exam; 50 words that should be known to three-year-olds are spread across the test [the test .HSM (Hochmair–Schulz–Moser) sentence tests: The HSM sentence exam is made up of 30 lists, each comprising a total of 106 words in 20 common sentences of three to eight words. The test was created with the intention to assess cochlear implant users’ speech understanding. Adding noise makes the task more difficult. Users are able to achieve 0% to 100% understanding of the words by repeating them [ing them .This review also presents the results of other assessments for speech recognition, which are similar in principle to the tests already explained. The following scales and word or sentence tests have been performed:Scales: The speech perception category score is based on achievements in other speech perception assessments such as the MLNT  or closed-set speech perception test . The MSPWord/sentence tests: CID  test ; MWT : It is a systematic interview for the parents, created to evaluate the child’s spontaneous reactions to sounds in their daily environment. The major areas are vocalization habits, sound detection and sound interpretation. Performance is evaluated based on the overall sum of points earned out of a maximum score of 40 points. Each question has a possible score ranging from 0 (lowest) to 4 (highest) [highest) .MUSS : This is a parent-reported scale that assesses children’s language use in everyday situations. The MUSS scale estimates verbal skills categorized into five categories: vocal behaviour, family conversations, social situations, language comprehension, and verbal description skills. This assessment was developed to determine how cochlear implants can help improve speech skills in children with severe hearing impairments [airments .LittlEARS hearing questionnaire: The LittleEARS questionnaire was developed to help professionals and caregivers monitor the hearing abilities of young children with hearing loss. It is based on parents’ observations of their children’s listening behaviour in everyday life. It contains 35 age-dependent questions that must be answered with yes, one point, or no, zero points. Therefore, in total, there are 35 points that can be achieved, which are given either in absolute or percentage terms. The questions reflect important milestones in hearing development up to two years of age [s of age .Other questionnaires such as the parental and salt (speech and language therapist) benefit score  as well CAP (Categories of Auditory Performance): In order to provide a usable measurement for non-specialists, the CAP is a global outcome measure of the development of auditory skills in deaf children. It involves the use of established criteria and observation to evaluate how well the children perform in normal scenarios at home and at school. It covers a wide variety of abilities, including understanding common phrases and conversations without lip-reading and using a phone with a known speaker. The scale ranges from 0, no awareness of ambient noise, to 7, where even the use of a phone with a known listener is possible [possible ,41.SIR (Speech Intelligibility Rating): The Speech Intelligibility Rating classifies the intelligibility of the children’s speech while using cochlear implants or hearing aids. SIR is a five-point hierarchical scale that describes different levels of speech intelligibility, from level 1, speech that is incomprehensible, to level 5, speech that is understood by every listener [listener ,41.In Austria, a nationwide universal newborn hearing screening is in place. Most ANSD cases, such as the two cases described here, arise from this screening program, based on OAE for low-risk and ABR measures for high-risk infants. When in the subsequent diagnostic assessment, the evaluation of ABR waveforms showed inconsistent ABR, OAE and/or CM data are categorized as possible ANSD. Following identification as ANSD, children are referred to auditory verbal therapy and will have regular audiological assessments.The two patients were referred from the newborn hearing screening program for diagnostic audiologic evaluation and the clinical finding of ANSD was initially confirmed by (1) abnormal ABRs, (2) preserved CM responses, and (3) recordable distortion product otoacoustic emissions (DPOAEs). Both patients received a low or insufficient benefit from hearing aids and were thus considered for cochlear implantation.The patients underwent pre-operative acoustic steady-state response testing (ASSR) and pure tone measurements post-operatively every 3 months up to 27 months (+/−2 months depending on availability). The Auditory Performance and Speech Intelligibility rating was given by the parents and evaluated by the speech therapists one year after switch-on.A total of 222 publications were identified and taken into consideration for the first screening process. The title and abstract screening excluded 34 publications. In this stage, most publications were excluded because the treatment in demand was not included, or it was not about the intended population. All reasons are presented in the flow diagram of the study selection in In most publications, it was stated that there was a trial period with a conventional hearing aid before cochlear implantation, because this was part of the indications to be considered for a CI in the first place ,59,60,61A total of 919 children who were diagnosed with auditory neuropathy spectrum disorder and subsequently received a cochlear implant were examined in the publications. Implants from the following manufacturers were applied: Advanced Bionics, Cochlear, MED-EL and Nurotron. As already mentioned, the patients discussed are children, but in the study by Gibson et al., 2007 , no age Most of the extracted publications were case reports or consisted of small study cohorts. However, the studies ,45,62,63In the studies ,38, riboThe quality classification and statement on conflicts of interest or financial support are shown in Two ANSD cases reported to our clinic, one female and one male aged 8 months and 25 months at the time of diagnosis, respectively. An MRI of the cerebrum and a CT of the petrous bones were performed for both cases, indicating no abnormal anatomical condition.Both children also underwent genetic testing, which revealed a mutation in the OTOF gene, indicating the possibility of an autosomal recessive hearing loss type 9/auditory neuropathy type 1. These results pointed towards the diagnosis of auditory neuropathy.Case 1 was a male boy who trialed other options for 7 months before opting for an implant. Case 2 was a girl who had an implant fitted 2 months after presenting to our clinic as no other rehabilitation option would be tolerated by the child.A male infant presented to our clinic with a diagnosis of ANSD, following abnormal ABR testing with preserved CM responses, and recordable distortion product otoacoustic emissions (DPOAEs). The parents reported no benefit from hearing aid trials and thus considered cochlear implantation for their child. At the age of 15 months, the boy was implanted with a Synchrony 2 implant and a Flex Soft array (MED-EL) on both sides simultaneously. Surgery was uneventful and activation/first fitting of the Sonnet 2 Audio Processor (MED-EL) was performed 24 days after surgery.The subject underwent pre-operative acoustic steady-state response testing (ASSR) and pure tone measurements post-operatively every 3 months up to 27 months (+/−2 months depending on availability) . The AudTwenty-seven months after implantation, the child uses the implant for about 11.94 ± 1.34 h per day (as extracted from manufacturer data logging). Free field threshold with CI improved from 2 months after surgery with a mean of 77.5 dB to 41.67 dB at the latest visit (pure tone audiometry between 0.5 and 1–2–4 KHz). Despite still being averse to loud noises, the parents are very satisfied with the development of the child. The child is able to detect voices, tries to copy environmental sounds such as animals, and produces various vocalizations and a few onomatopoeias. Speech audiometry was conducted but did not result in useful outcomes due to a lack of concentration; nonetheless, the speech understanding as reported by the mother is very good.A 25-month-old female infant presented to our clinic with a diagnosis of ANSD, following abnormal ABR testing with preserved CM responses and recordable DPOAEs. The parents reported no acceptance of hearing aids and thus considered cochlear implantation for their child within 2 months of diagnosis. At the age of 27 months, the girl was bilaterally provided with a Synchrony 2 implant and a Flex Soft array (MED-EL). Surgery was uneventful; neither intra- nor post-op complications were reported. The activation/first fitting of the Sonnet 2 Audio Processor (MED-EL) was performed 23 days after surgery.The subject underwent pre-operative acoustic steady-state response testing (ASSR) and pure tone measurements post-operatively every 3 months up to 25 months (+/−2 months depending on availability) . The AudTwenty-five months after implantation, the child uses the implant for about 9.08 ± 1.01 h per day .Free field threshold with CI improved from 2 months after surgery with a mean of 70.0 dB to 38.33 and 40.0 dB  25 months after the intervention (pure tone audiometry between 0.5 and 1–2–4 KHz). Despite not tolerating the right-side audio processor as much as the left side, the parents are very satisfied with the development of the girl . InteresThe latest fitting session was performed 25 months after surgery and the child was able to answer whispered questions and understand commands, and she was very chatty, but her speech was difficult to understand. The vocabulary of the girl was 50+ words, which is roughly expected for a two-year-old. The parents are very satisfied with the steady and fast development of their child, which they did not expect after counselling regarding the relatively late implantation age (27 months) and when the diagnosis of ANSD and rehabilitation prospects were given.The outcomes of the performed systematic review are in line with our experiences in the two presented cases. Except for one study, all publications where the pure tone average was assessed achieved a hearing threshold of mild hearing loss to normal hearing conditions. In Some studies argued for considering hearing aids because a CI is not useful for everyone, but most of the time, these are special cases with comorbidities such as BVVL or Friedrichs ataxia. However, the study by Miyamoto et al., 1999 , presentn = 10) than the unilaterally implanted children with an additional hearing aid  on the open-set word perception score. However, since the data collected after surgery are far apart, 20 and 29 months, this comparison is not meaningful and could yield the same outcomes over time.The P1 latency of cortical auditory evoked potential is usually delayed in the presence of hearing loss. In the study by Alvarenga et al., 2012 , not onlAs already mentioned in the results, there were no uniform scores among the publications. A variety of language comprehension evaluations were utilised as well as questionnaires, making it difficult to interpret the results in a consistent manner. However, it was seen that in all assessments there were improvements for the children with ANSD who received a cochlear implant. However, it is repeatedly stated in the literature that CIs should only be applied to ANSD patients when conventional hearing aids do not provide any auditory improvement ,68,69,71n = 40) while the ANSD group provided a score of 5.6 ± 2.0 (n = 18). Furthermore, the SIR score after one year of the implantation was 3.4 ± 1.2 (n = 40) for SNHL patients and 2.9 ± 1.1 (n = 18) for the ANSD group. Comparative values for the pure-tone average were also provided by Attias et al., 2017 [n = 16) than the SNHL control group with a value of 28.1 dB ± 1.4 dB (n = 16). The similarity of results between ANSD and SNHL groups receiving CIs is also confirmed by the study by Fulmer et al., 2011 [n = 10) in quiet and 64.6 dB ± 5.5 dB (n = 10) in noise while the SNHL group achieved 41.6 dB ± 6.4 dB (n = 10) in quiet and 61.9 dB ± 5.8 dB (n = 10) in noise.Some comparative studies ,46,71,81In general, it can be said that in the included studies of this systematic review, children with ANSD benefited from cochlear implants, which is coherent with our experience. The use of cochlea implants in ANSD patients can lead to a clear increase in quality of life, speech comprehension and speech development.We presented two young children diagnosed with ANSD that successfully received and benefited from CI. After careful and detailed evaluations, audiological training follow-ups and tailored rehabilitation plans, patients should be considered as beneficial candidates for the implantation of cochlear implants, especially with the diagnosis of auditory neuropathy. The use of cochlea implants in ANSD patients can lead to a clear increase in quality of life, speech comprehension and speech development.


Colonoscopy is considered the most effective screening method for colorectal polyps. However, the longevity and complexity of the procedure makes it less desirable to screen for colorectal polyps in the general population. Therefore, it is essential to identify other independent risk factors. In this study, we explored the link between Hp infection, atrophic gastritis, and colorectal polyps to identify a new potential risk factors of colorectal polyps.In this study, atrophic gastritis and intestinal polyps were diagnosed by endoscopy and pathology. All the 792 patients in this retrospective study were divided into sub-groups based on the presence of colorectal polyps. The correlation between polyps and atrophic gastritis was analyzed using the chi-square test and Kruskal-Wallis test. The receiver operating characteristic (ROC) curve was used to compare the predictive value for colorectal polyps between Hp infection and atrophic gastritis. Binary logistic regression was utilized to identify independent risk factors for colorectal polyps.Patients with colorectal polyps were primarily male with advanced age, and the number of patients with colorectal polyps had a higher association with smoking, alcohol drinking, and Hp infection than the control group. A positive correlation between the number of colorectal polyps and the severity of atrophic gastritis was observed. ROC analysis showed that atrophic gastritis was a better risk factors for colorectal polyps. Multivariate analysis identified atrophic gastritis as an independent risk factor for colorectal polyps .Atrophic gastritis confirmed could be an independent risk factors for colorectal polyps. Colorectal cancer is the third most common cancer and the fifth leading cause of cancer-related deaths worldwide . ColorecHelicobacter pylori (Hp) is recognized as a type I carcinogen by World Health Organization , 5 and pPatients who underwent their first gastroscopy combined with colonoscopy at the Affiliated Hospital of Qingdao University from January 2021 to March 2022 were enrolled for the study. Patients diagnosed with gastric cancer, colon cancer, ulcerative colitis, Crohn’s disease, MALT lymphoma, gastric submucosal masses, and familial adenomatous polyposis were excluded from the study. Further patients who underwent previous gastrointestinal resection were also excluded from the study.Patients with colorectal polyps were categorized as the polyp group, while patients with no detectable colorectal polyps were classified as the control group.Gastroscopy biopsy specimens and carbon 13 urea breath test was used to detect Hp infection in the patients. Patients confirmed positive for either of these tests were considered positive for Hp infection. Information on previous Hp infection and treatment plans was obtained from all the patients through inquiry and medical records. Two experienced physicians graded the degree of gastric atrophy in patients using the Kimura-Takemoto classification [Quantitative data were expressed as mean value ± standard deviation (X ± S), while qualitative data was represented as n (%). Differences between the two sets of qualitative data were compared using the Chi-square test or Fisher’s exact test. The quantitative data were calculated using the parametric test like student’s t-test, and non-parametric tests like Kruskal-Wallis test. The univariate analysis compared the clinicopathological features between the two groups and was calculated using the Chi-square test, Fisher’s exact test, student’s t-test, and Kruskal-Wallis test. Multivariate regression analysis was performed on variables with P < 0.05 and was calculated using the odds ratio (OR) and a 95% confidence interval (95% CI). A binary logistic regression analysis was used to identify independent risk factors for colorectal polyps. Receiver operating characteristic (ROC) curve was used to compare the predictability of colorectal polyps by Hp infection and atrophic gastritis. P < 0 0.05 was considered as statistically significant. The data analysis was performed using SPSS version 26 .A total of 792 patients were included in the study. The mean age of patients was 54.34 ± 10.92 years, of whom 381 (48.1%) were males, and 411 (51.9%) were females. Colorectal polyps were diagnosed in 385 (48.7%) patients, while a total of 332 patients (41.9%) were diagnosed with atrophic gastritis. Table The incidence of colorectal polyps in patients with atrophic and non-atrophic gastritis was analyzed. The number of colorectal polyps in patients with atrophic gastritis was significantly higher than in non-atrophic gastritis patients (P < 0.05) and significant difference was observed in the diagnosis of adenoma and the polyp diameter between the two groups Table .To understand the association between atrophic gastritis and colorectal polyps, the atrophic gastritis patients were further classified based on the severity of atrophy, and Kruskal-Wallis test was performed Table . O-2 andPrevious studies have shown an association between Hp infection and colorectal polyps. This association focused on current Hp infections, whereas patients with the previous infection mainly were neglected. To further investigate the association between Hp infection and colorectal polyps, the patients were divided into three groups: patients with current Hp infection, patients with previous Hp infection, and Hp negative patients Table .Logistic regression analysis showed that gender, mean age, body mass index (BMI), alcohol drinking habits, smoking habits, diabetes, atrophic gastritis, and current Hp infection were associated with colorectal polyps. Multivariate analysis Table  revealedThe area under the curve (AUC) for the ROC curve analysis was performed to check the predictive value of atrophic gastritis and Hp infection for colorectal polyps. AUC for atrophic gastritis was 0.62 (P < 0.001) and for Hp infections was 0.57 (P < 0.001).Although the value is low and should be combined with other indicators for a more accurate diagnosis, these results still reveal that atrophic gastritis was better than Hp infection in finding colorectal polyps in patients.Previous studies have established that colorectal polyps, especially adenomatous polyps, are risk factors for colon cancer , 15. ColSeveral studies have shown that Hp infection is a risk factor for colorectal polyps , 17. Hp Hp infection leads to chronic inflammation, which causes damage to the gastric mucosa.Previous studies have also demonstrated that atrophic gastritis with Hp infection is a risk factor for colorectal polyps . HoweverThe mechanism of atrophic gastritis leading to colorectal polyps is not yet fully understood . SeveralHowever, the study has some limitations. This was a single-center and retrospective study with relatively small sample size, leading to biased results. Although atrophic gastritis was an independent risk factor of colorectal polyps and was better than Hp infection in hinting colorectal polyps, the sensitivity and specificity of atrophic gastritis were low, indicating that additional studies are needed to validate the results.Previous studies focus on the association between Hp infections and colorectal polyps , 17. How


Purpose: To assess sound-level exposure during vitrectomy using 3 of the most common commercially available machines. Methods: This noninterventional cross-sectional study examined sound emission from the Constellation, Stellaris, and EVA vitrector systems. For each machine, a noise dosimeter was used to measure the sound-level exposure of the surgeon during 3 surgical cases in which vitrectomy was performed. Sound levels associated with progressively increasing cut rates and vacuum pressures were also measured. Finally, sound measurements were taken during the use of various additional functions of each machine, including diathermy, laser, and extrusion. Sound levels were compared with occupational health guidelines in Canada and the United States. Results: The maximum sound level recorded during vitrectomy surgery was 88.2 dBA. The mean sound level during vitrectomy surgical cases ranged from 58.5 to 66.8 dBA. A strong positive linear correlation was found between the cut rate and sound level (r = 0.88-0.98) and the vacuum pressure and sound level (r = 0.83-0.97). This relationship was consistent across the 3 vitrector systems (P < .001). Conclusions: Noise exposure during vitrectomy procedures was acceptable but may be sufficient for surgical team activity interference, as described by World Health Organization recommendations. A strong correlation was found between the cut rate and noise exposure. If cut rates continue to increase, attention should be given to ensure that the resulting noise exposure does not threaten the hearing of vitreoretinal surgeons and the operating room staff. The modern vitrector uses a pneumatic guillotine, which operates with an outer needle and an inner needle. This pneumatic-driven system cuts the vitreous while simultaneously aspirating severed strands. A separate infusion line is used to maintain intraocular pressure during the procedure.Vitrectomy is the most common surgical procedure performed by the vitreoretinal specialist. The vitreous cutter has evolved significantly since Robert Machemer’s first designs in the 1970s. This increase in the cut rate may be associated with increasing sound levels produced by the vitrector and cutter apparatus. Furthermore, whether this level of noise risks hearing damage has thus far not been investigated to our knowledge.Cut rates have increased progressively over the past 2 decades. Whereas 1500 cuts per minute (cpm) was standard in the early 1990s, modern technology allows for upward of 10 000 cpm, with 20 000 cpm cutters beginning to enter practice. A common etiology of sensorineural hearing loss is noise-induced hearing loss, which is prevalent in North America. A study found that approximately 28 million people in the US have impaired hearing, and around half of these cases were attributed to noise exposure. Levels of occupational noise exposure are of particular concern because exposure often occurs frequently and for long durations. Devastating, noise-induced hearing loss is often preventable. A better understanding of potential exposure settings may contribute to a reduction in occupational hearing loss.Hearing loss is the fourth leading contributor to disability worldwide. However, to our knowledge there are no studies in the existing literature that have evaluated the risk for hearing loss during any ophthalmology surgery. This study sought to determine whether vitrectomy surgery with a guillotine cutter produces sound levels significant enough to be associated with long-term hearing loss in surgical staff.Existing research has shown potentially damaging sound levels in other surgical settings.This multicenter study was performed at the following 3 major centers in North America: Victoria General Hospital, Halifax, Nova Scotia, Canada; Burlington Laser Eye Centre, Toronto, Ontario, Canada; and Dell Medical Center, Austin, Texas, USA. The study received approval from the respective institutional ethics review boards and was conducted in accordance with the Declaration of Helsinki.The Constellation , Stellaris (Bausch + Lomb), and EVA  vitrector systems were used at the Halifax, Toronto, and Austin sites, respectively. The Extech SL400 noise dosimeter and calibrator (ITM) was used to record the sound-level exposure at each site. The same dosimeter was used at each site and was recalibrated in each operating room (OR) to ensure consistency among measurements.For each vitrector system, sound levels from the cutter during 3 in vivo 25-gauge vitrectomies were recorded. Procedures included were vitrectomy for vitreous hemorrhage, epiretinal membrane peeling, retinal detachment, or macular hole repair. The cut rates used during these procedures were adjusted at the preference of the surgeon to be reflective of a routine case. The primary surgeon of the case was equipped with the noise dosimeter. The dosimeter was attached under the surgeons’ gown and the microphone attached to the surgeons’ mask, approximately 2.5 cm from the ear .To accurately portray the human hearing response curve, sound levels were recorded by the dosimeter on an A-weighted (dBA) scale. The baseline OR sound level was measured and recorded before each surgical case. The distance from the surgeon to the vitrector was measured before each case and was consistent between sites.9To evaluate the relationship between the cut rate and the sound level, sound emitted from the vitrector systems with 23-gauge, 25-gauge, and 27-gauge cutters at progressively increasing cut rates was also measured and plotted. These measurements were taken with ambient noise minimized in the OR setting . At each cut rate, 10 sound level recordings taken with the cutter inside the eye were obtained and the average sound level was plotted. Sound produced by the vitrector during vacuum function at increasing vacuum pressures was similarly measured and recorded. Sound levels produced artificially from the vitrector machine itself were measured during various functions, including reflux, viscous fluid control (VFC) extract, VFC inject laser, diathermy, and voice naming procedure. Sound levels were compared with current Canadian Centre for Occupational Health and Safety (CCOHS) guidelines and US National Institute for Occupational Safety and Health (NIOSH) guidelines.P < .05 for all analyses.Statistical analysis was performed using SPSS Statistics for Macintosh  and Prism software . Simple linear regression was used to model the relationship between sound levels and ascending cut rates or vacuum pressures. Statistical significance was defined as The duration of vitrector use during surgical cases ranged from 5 to 15 minutes per case. The average sound level during vitrectomy ranged from 59.5 to 66.8 dBA. The maximum sound level recorded during vitrectomy was 88.2 dBA. P < .001). All were strong positive linear correlations, with correlation coefficients (r) ranging from 0.88 to 0.98. With vacuum function in use, increasing vacuum pressures also had a strong positive linear correlation with sound level across systems . No difference was found between the various cutter gauges and associated sound levels (P > .05). An increasing cut rate was found to have a correlation with the sound level across the 3 vitrector systems  and the Environmental Protection Agency have suggested limits of 35 dBA and 45 dBA for hospitals and ORs, taking into account the impact of sound on surgical team activity interference. Moreover, in a study examining noise levels in total knee and hip arthroplasty, the peak noise level during surgery measured more than 140 dB. Although noise exposure throughout these surgeries remained within occupational standards, the mean percentage of allowed daily noise reached 40% in the surgeons performing these cases. The authors ultimately recommended hearing protection during loud surgical steps or working toward quieter tools.In the field of otolaryngology, a systematic review of noise exposure in the OR found an overall mean noise level of 84.9 dBA. This level was deemed to be in excess of safety thresholds.Based on the findings of the present study, the sound levels currently produced during vitrectomy likely do not warrant immediate intervention. However, the association we found between the cut rate and the sound level suggests that increasing cut rates could produce noise that threatens hearing. Should sound levels reach hazardous levels, hearing protection may be warranted during vitrector use, as has been the case in other surgical specialties.This study has several limitations. Given that each center operated using a single vitrector system, it was necessary to transport the dosimeter to the various sites to obtain data from multiple vitrectors. Device calibration was performed to mitigate changes that could have been induced by shipping. As expected, the baseline OR sound levels were similar but not identical, making comparison between vitrector systems difficult. The lack of data on the 27-gauge cutter for the Stellaris system is acknowledged. Unfortunately, 27-gauge packs were not readily available at the trial site at the time of the study.In conclusion, given the emerging data on occupational noise safety in other surgical fields, this study sought to describe the risk for hearing loss during vitrectomy surgery. Current vitrector sound levels were not significant enough to cause noise-induced hearing loss. However, current sound levels may be sufficient for surgical team activity interference and therefore affect communication and performance as described by WHO recommendations. Furthermore, we found a strong positive correlation between the cut rate and the sound level, both from the vitrector tower during use of vacuum and from the pneumatic guillotine itself during the core and shave functions. This may threaten hearing should vitrector cut rates continue to increase and may be worthy of consideration in future development of surgical instruments.


Pint <0.05), and such relationships were more evident in high PRS. Similarly, the above relationships were also observed for age-related hearing loss and noise-induced hearing loss, particularly the latter. In addition, age-modified effects of sleep patterns on hearing loss were likewise observed, with stronger estimation among those aged <65 years. Accordingly, longer sleep duration, early bedtime, and high PRS were independently and jointly related to increased risk of hearing loss, suggesting the importance of considering both genetics and sleep pattern for risk assessment of hearing loss.Evidence available on the independent and combined associations of sleep duration, bedtime, and genetic predisposition with hearing loss was lacking. The present study included 15,827 participants from the Dongfeng–Tongji cohort study. Genetic risk was characterized by polygenic risk score (PRS) based on 37 genetic loci related to hearing loss. We conducted multivariate logistic regression models to assess the odds ratio (OR) for hearing loss with sleep duration and bedtime, as well as the joint association and interaction with PRS. Results showed that hearing loss was independently associated with sleeping ≥9 h/night compared to the recommended 7 to <8 h/night, and with bedtime ≤9:00 p.m. and >9:00 p.m. to 10:00 p.m. compared to those with bedtime >10:00 p.m. to 11:00 p.m., with estimated ORs of 1.25, 1.27, and 1.16, respectively. Meanwhile, the risk of hearing loss increased by 29% for each 5-risk allele increment of PRS. More importantly, joint analyses showed that the risk of hearing loss was 2-fold in sleep duration ≥9 h/night and high PRS, and 2.18-fold in bedtime ≤9:00 p.m. and high PRS. With significant joint effects of sleep duration and bedtime on hearing loss, we found an interaction of sleep duration with PRS in those with early bedtime and an interaction of bedtime with PRS in those with long sleep duration on hearing loss ( Hearing loss as the third largest cause of years lived with disability globally has affected 1.57 billion people by 2019, and is estimated to grow to 2.45 billion by 2050 . The comIt is generally recommended that a sleep duration of 7 to 8 h/night and a bedtime of 10:00 p.m. to 11:00 p.m. would be the best for adults, while shorter or longer sleep duration and earlier or later bedtime might be harmful to human health ,7. HowevAlthough environmental risk factors contribute the most to hearing loss risk, it is reported that heritability of up to 36% variation could account for hearing loss . Hence, As aging and noise are the most important risk factors of hearing loss, it is also necessary to separately evaluate the impact of sleep duration and bedtime on age-related hearing loss (ARHL) and noise-induced hearing loss (NIHL), which have different pathological processes ,15. The 2; 12.3%, 6.0%, and 23.7% of the total subjects were current smokers, current drinkers, and taking ototoxic drugs, respectively. Those with hearing loss in the overall population, the ARHL subgroup, and the NIHL subgroup accounted for 47.8%, 46.1%, and 49.5%, respectively. Sleep duration of at least 9 h/night accounted for 26.5% and those who went to sleep before 9:00 p.m. or 10:00 p.m. accounted for 8.6% and 35.6%, respectively. Compared to those in the NIHL subgroup, participants in the ARHL subgroup were more likely to be older, be female, have a higher education level, have never smoked, have never drank, have an earlier bedtime, or have hypertension or hyperlipidemia. There was no significant difference in sleep duration between the 2 subgroups. We also present the baseline characteristics of sleep duration, bedtime, and PRS between hearing loss and normal hearing in Table P < 0.001).We listed the characteristics of the study subjects in Table P for overall = 0.003, P for nonlinearity = 0.230), while the dose–response relationships of sleep duration and hearing loss in the overall population and the ARHL subgroup were nonlinear , with a sharp increase when sleep duration is around 9 h/night . For high PRS, sleeping 8 to <9 h/night and ≥9 h/night were associated with hearing loss, compared with sleeping 7 to <8 h/night (Table Pint = 0.017), and risk of hearing loss was related to bedtime ≤10:00 p.m. when compared with >10:00 p.m. to 11:00 p.m. ; such relationships were more evident in participants aged <65 years than in those aged ≥65 years among the overall population and the NIHL group  and early bedtime (≤10:00 p.m.) were associated with nearly 16% to 27% elevated risk of hearing loss compared to recommended sleeping patterns. Meanwhile, PRS was dose–responsively linked to hearing loss. The combination of sleep duration and bedtime with PRS conferred increased risk of hearing loss. Also, a significant interaction of PRS and sleep duration in those within bedtime ≤10:00 p.m. and an interaction of PRS and bedtime in those within sleeping ≥9 h/night were observed, indicating that those with greater genetic risks might be more susceptible to the impact of sleep duration and bedtime on hearing loss. Similarly, the above relationships were also observed in the ARHL and NIHL subgroups. Taken together, our results add to important knowledge of population-based prevention strategies for hearing loss.Previous studies available on the relationship between sleep and hearing loss were quite limited and inconsistent –10. A stMeanwhile, time of sleep onset also yielded a significant influence on circadian rhythm, which could increase the risk of multiple diseases, including cardiovascular and nervous system disorders ,17. A prFurthermore, hereditary susceptibility was also an important factor in the development of hearing loss. Several studies devoted efforts to exploring the relationships of hearing loss with single SNPs based on GWAS results ,19,20 orBoth genetic risk and lifestyles were regarded as contributing to the etiology of complex diseases, while the effect of lifestyles might be different depending on inherited genetic susceptibility ,25. A crIt is acknowledged that aging and noise are the most important risk factors for hearing loss, resulting in ARHL and NIHL separately , which hThe underlying mechanisms behind associations of sleep duration and bedtime with hearing loss have not been documented. The development of hearing loss attributed to inner ear homeostasis was relevant to microvascular damage , which w2, diabetes, or hyperlipidemia, although there was no interaction. Previous studies reported that obesity  × [37/sum of Ln (OR)] . Based oAeq, 8h ≥ 80 dB [A]) for no less than 1 year [Semi-structured questionnaires were designed to obtain the basic information of retirees by trained interviewers, including sociodemographic characteristics , lifestyle , and personal and family medical histories. According to the workplace and the monitoring records for each participant, occupational noise exposure refers to those who were exposed to normalized continuous A-weighted sound pressure level equivalent to 8 h per day of 80 dB (A) or above , or numbers (percentages) according to their distributions. We compared the differences between the ARHL subgroup and the NIHL subgroup by Student’s  studies ,7. Based studies , models Further, we explored the joint associations or interactions of sleep duration and PRS, and bedtime and PRS with hearing loss. The joint association of sleep duration and PRS, and bedtime and PRS on hearing loss was conducted based on the following reference: the low level of PRS and sleeping 7 to <8 h/night, and the low level of PRS and bedtime >10:00 p.m. to 11:00 p.m., respectively. Given the significant joint effect of sleep duration and bedtime on hearing loss  and calculated weighted PRSs. We assessed the association of hearing loss with PRSs calculated by 8 SNPs as well as its joint and interactions with sleep patterns.In addition, we carried out stratification analyses by the major characteristics, including age, gender, BMI, hypertension, diabetes, and hyperlipidemia, and derived their modification effects on the relationships of sleep duration and bedtime with hearing loss by adding the multiplied interaction terms to the above primary models. We also assessed the associations of sleep quality and midday napping with hearing loss. Finally, we conducted sensitivity analyses for associations of sleep duration and bedtime with hearing loss after excluding those who had cancer, cardiovascular disease, and stroke. Given the impact of sleep medicine, we further carried out the primary model after excluding those who took hypnotics in the recent 2 weeks. Due to the possible influence of stroke on hearing loss, we conducted the primary model with adjustment added stroke. Considering that some SNPs in PRS showed no significance in our GWAS, we further included only 8 SNPs with a significant effect on hearing loss according to Table P < 0.05 (2-sided) was regarded as statistically significant.The SAS program , R software , or PLINK was applied for analyses, and


Partial differential equations are common models in biology for predicting and explaining complex behaviors. Nevertheless, deriving the equations and estimating the corresponding parameters remains challenging from data. In particular, the fine description of the interactions between species requires care for taking into account various regimes such as saturation effects. We apply a method based on neural networks to discover the underlying PDE systems, which involve fractional terms and may also contain integration terms based on observed data. Our proposed framework, called Frac-PDE-Net, adapts the PDE-Net 2.0 by adding layers that are designed to learn fractional and integration terms. The key technical challenge of this task is the identifiability issue. More precisely, one needs to identify the main terms and combine similar terms among a huge number of candidates in fractional form generated by the neural network scheme due to the division operation. In order to overcome this barrier, we set up certain assumptions according to realistic biological behavior. Additionally, we use an  The functions Two-component reaction–diffusion systems often model the interaction of two chemicals, leading to the formation of non-uniform spatial patterns of chemical concentration or morphogenesis under certain conditions due to chemical reactions and spreading. Since Turing’s groundbreaking work , reactioenomenon ,4.t or to the spatial variable x. Moreover, the non-linear function Cell polarity plays a vital role in cell growth and function for many cell types, affecting cell migration, proliferation, and differentiation. A classic example of polar growth is pollen tube growth, which is controlled by the Rho GTPase ROP1) molecular switch. Recent studies have revealed that the localization of active ROP1 is regulated by both positive and negative feedback loops, and calcium ions play a role in ROP1’s negative feedback mechanism. Initially, ROP1 is inside the membrane. During positive feedback , an The paper is organized as follows. In t. Its architecture is a feed-forward network that combines the forward Euler method in time with the second-order finite difference method in space through the implementation of special filters in the CNN that imitate differential operators. The network is trained to approximate the solution to the above PDEs and then the network is used to make predictions for the subsequent time steps. The authors of [The main idea of the PDE-Net method, as described in , is to uthors of  show thaThe feed-forward network consists of several u at time F. Here, the operators Denote the space variable z in  to be z=q can be performed through the training of M (or q) must be carefully constrained to match differential operators.For a general nd order accuracy. More precisely, if we plug For example, to approximate y chooseM1(q10)=0 M1 into  with Δx= M2 into , then 1ΔF. It takes a m-dimensional vector as input and consists of k layers. As depicted in The n is the number of N is the total number of samples, and j indicates the jth solution path with a certain initial condition of the unknown dynamics, and the index i represents the solution at time s, recall the Huber’s loss function The loss function for this method has three components and is defined as follows:fined asℓ1(s)(x)=L=Ldata+λu and v, as these interactions are not commonly present in biological phenomena. Additionally, to handle interactions in fractional or integral forms, such as those in Equation  as the average testing loss obtained from mPDE-Net, implemented using PyTorch;3:Set the optimization algorithm, specify the number of trials, and initialize the results list.4:for do5:      Sample a set of hyperparameters from the search spaces, evaluate the objective function with the sampled hyperparameters, and set a list called the Validation loss.6:for do      7:        Train model of mPDE-Net on 8:end for      9:      Get an average validation loss from the Validation loss, append the hyperparameters and the average validation loss to the results list, and then update the search space based on the results so far.10:end for11:return the hyperparameters with the minimum objective function value.The selection procedure is described in Algorithm 2.We have noted that mPDE-Net accurately fits data and recovers terms, but it may not always simplify the learned PDE, making it challenging to interpret. To address this, we implement sparsity-encouraging methods such as the Lasso approach. However, even with Lasso and hyperparameters chosen from the validation sets, the predicted equation still had redundant terms. This is likely due to correlated data and linear dependencies in the data, which prevent Lasso from fully shrinking the extra coefficients to zero. To overcome this, we employ two approaches. The first, called the  Consider the underlying PDE in the form ofTo address the issue of excessive terms in the learned PDE, we apply the By removing the terms in Sparse regression: STRidge. After using the DE model . Here, aAlgorithm 3: STRidgeHypothesis 2.The two sets (Alternative)Let onerroni , Holm [3onerroni  and Benjonerroni  methods In this section, we showcase numerical examples to demonstrate the efficacy of Frac-PDE-Net, our proposed method. The training, validation, and testing data are generated based on the underlying governing equation. Our aim is to use Frac-PDE-Net on these data to obtain a concise and interpretable model for the PDE. The governing PDEs under consideration in this paper are of the following form:Our first example is taken from (Equation 2.8) in Section 2.2 in [.8 in SecEquation  is reducquation =0quation  are selIn the following, we outline the notation used and summarize the key steps of our framework.1.2.Next, we utilize the 3.Subsequently, we fix the terms in 4.Finally, to verify that no further terms can be eliminated after Frac-PDE-Net, we compare two models: Model 1, generated by Frac-PDE-Net; and Model 2, which is identical to Model 1 but removes the term with the smallest For this case, we added 5% noise to the generated data to form the observational data. The results are displayed in To test whether Model 1 u,v).In , the nonq are of size M is 32. To optimize the parameters, we again use the BFGS algorithm.The filters For this case, we added 1% noise to the generated data to form the observational data. The results are displayed in Similar to the post hoc selection procedure we performed in Example 1, we also need to compare Model 1 u0 and v0In The results of the comparison between Frac-PDE-Net and PDE-Net 2.0 are presented in both graphical and quantitative form. The model discovered by PDE-Net 2.0 is shown in In this section, we validate the robustness of the model discovered by Frac-PDE-Net in Example 2 in terms in  and 21)u0 and v0The results of the comparison between Frac-PDE-Net and PDE-Net 2.0 are presented in both graphical and quantitative form. The model discovered by PDE-Net 2.0 is shown in Our approach, Frac-PDE-Net, builds on the symbolic approach developed in PDE-Net for addressing the discovery of realistic and interpretable PDE from data. While the neural network remains very efficient for generating and learning dictionaries of functions, typically polynomials, we have shown that if we enrich the dictionaries with large families of functions , an extra-care is needed for selecting the important terms by penalization and by evaluating and testing the impact of a reaction term in the predicted solution. Quite remarkably, we can extract a sparse equation with readable terms and with good estimates of the associated parameters.The introduction of rich families of functions, such as fractions  is often necessary because they are well used by modelers, but also they can avoid the limitations of the approximation capacity of polynomials. Indeed, it might be necessary to have numerous terms in the expansion in order to have a correct approximation of the unknown reaction terms. As a matter of fact, we have introduced a very flexible family of fractions that avoid truncation based on powers u and v, say Our work is originally motivated by the discovery and estimation of reaction–diffusion PDEs, with possibly complex terms such as fractions, non-integer powers, or non-local terms , as it has been introduced for the pollen tube growth problem . Neverth


Diabetes mellitus (DM) is a major disease threatening human health and its incidence is increasing year on year. As a chronic complication of DM, hearing loss mostly occurs undetectably. However, the mechanism of this diabetes-related hearing loss (DRHL) remains unclear and there is no effective clinical treatment. Studies of animal or human pathology show that DM causes damage to the blood vessels, spiral ganglion neurons, afferent nerve fibers, the organ of Corti, and the stria vascularis of the inner ear. In recent years, more advances in pathological research have revealed the possible mechanism of DRHL. In addition, a large number of clinical studies suggest that the duration and severity of DM are closely related to the incidence and severity of DRHL. This review focuses on the relationship between DM and hearing loss. The clinical audiological characteristics of diabetic patients, risk factors for DRHL, typical pathology, and potential interventions of DRHL are summarized. This will help reveal the pathogenesis and intervention approaches for DRHL. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. It can cause dysfunction of multiple target organs, including the eyes, kidneys, and heart, leading to diabetic retinopathy, diabetic nephropathy, and diabetic cardiomyopathy (Kollias and Ulbig Hearing loss caused by DM can be referred to as diabetes-related hearing loss (DRHL), a term first proposed by Axelsson et al. . This tyDue to differences between subjects and research methods, there are still contradictions between the characteristics of DRHL reported in different studies. Accordingly, the conclusions of these studies have not been consistent. Moreover, due to the inability to perform a biopsy in the human inner ear, the specific pathogenesis of DRHL remains unknown. Early pathological studies were mainly based on animal studies or autopsies, and the pathological manifestations mainly included degeneration of spiral ganglion neurons (SGNs), atrophy of the stria vascularis (SV), and degeneration of auditory hair cells. Recently, new advances have been made in the pathological study of DRHL . When further stratified by age, it was found that the prevalence of deafness was also significantly higher in subjects with DM than in those without DM in almost all age groups. For example, the prevalence of mild deafness in the diabetic and non-diabetic groups was 4.95% and 1.28%, respectively (30–39 years age-group), 5.87% and 3.21% (40–49 years age-group), and 12.69% and 9.21% (50–59 years age-group) , Oh et al. showed that the prevalence of hearing loss was 17.3% and 6.5% in diabetic and non-diabetic patients, respectively . This kind of hearing loss refers to a loss of 30 dB or more in three contiguous frequencies over less than three days. In a large sample cohort study , Lin et al. . HoweverDM can also aggravate hearing loss in adults. Mitchell et al. define “aggravate” as the progression of hearing loss greater than 5 dB over 5 years. The results showed that patients with T2DM had significantly higher rates of deafness progression than normal people, especially in newly-diagnosed diabetic patients, with an OR = 2.71 (95%CI 1.07–6.86)  level on SSNHL, and grouped deafness according to the mean hearing threshold. A mean hearing threshold greater than 80 dB HL was defined as total SSNHL. Their results showed that diabetic patients with SSNHL had a higher rate of total SSNHL, while the mean hearing threshold of patients without DM was mostly less than 80 dB HL , Kurien et al. . A similP = 0.0001)  , moderate (41 dB HL to 55 dB HL), moderately severe (56 dB HL to 70 dB HL), severe (71 dB HL to 90 dB HL) or profound (> 91 dB HL). The results of a study by Mishra et al. showed that when the course of DM ranged from 1 to 3 years, only mild hearing loss occurred. When the duration of DM was 4–12 years, severe hearing loss began to occur among patients. And when the course exceeded 12 years, some patients developed severe and profound hearing loss   is clinically recognized as a better reflection of plasma glycemic status over the preceding 2 to 3 months and is a reliable diagnostic biomarker for DM.HbA1c levels were found to be positively correlated with the incidence of hearing loss in both T1DM and T2DM patients. In a study on T1DM, Schade et al. . In anotOther researchers have found that the HbA1c level was associated with SNHL in the non-diabetic population   and DRHL remains unclear. Some researchers believe that there is an association between high FBG levels and the development of SNHL  , followed by the 35–49 age group . However, there was no significant difference in the incidence of SSNHL between the diabetic and non-diabetic populations in the age groups under 35 years and over 65 years     are the most effective acid-suppressing agents used to treat and prevent various gastrointestinal diseases. However, recent studies have found that PPI use can cause adverse effects on the nervous system, including hearing loss , a branch of the anterior inferior cerebellar artery, is the primary source of blood supply to the cochlea.P < 0.001). Compared with T1DM patients, T2DM patients receiving insulin therapy exhibited thicker vessel walls and a higher vessel wall ratio    is another vulnerable area for hyperglycemia. It is located in the outer wall of the cochlear duct and is composed of three types of cells: marginal cells (MCs), intermediate cells (ICs), and basal cells (BCs). They are surrounded by a dense plexus of intraepithelial capillaries, also known as vessels of the stria vascularis (VSV). They play a key role in maintaining endocochlear potential, ion transport, and endolymphatic balance.P < 0.0001). Among them, in patients with T1DM, the mean area of the SV in the apical turn was found to be half that of non-diabetic patients   and non-obese diabetic (NOD) mice as animal models of T2DM and T1DM, respectively. At three months of age, the MCs of KK mice protruded into the endolymphatic space. With aging, there was marked swelling of the ICs and widening of the intercellular spaces. By the age of 8 months, MCs had atrophied and were replaced by swollen ICs and intercellular spaces. However, in age-matched nondiabetic animals, no gross pathological changes were observed in the SV (Tachibana and Nakae P < 0.01)  rests on the basilar membrane of the scala media and is composed of hair cells and supporting cells (SCs). Hair cells are the sensor of the hearing organ, which can convert mechanical energy into electrochemical potential signals. They are divided into one row of inner hair cells (IHCs) and three rows of outer hair cells (OHCs). Each hair cell contains about 100 stereocilia. When external sound waves cause the basement membrane of the cochlea to vibrate, hair cells and cilia move relative to the tectorial membrane. This movement generates electrical signals that are sensed by the hair cells and transmitted to axons and eventually to the brain. Mammalian hair cells are non-regenerative and damage to the hair cells can cause permanent hearing loss.P < 0.01). Meanwhile in patients with T2DM, loss of OHCs was observed in both the lower and upper basal turns  are the primary afferent neurons of the auditory system, which transmit sound information from hair cells to the cochlear nucleus of the brainstem to produce hearing. Neurons can be divided into two types, type-I and type-II neurons. Type-I neurons account for 95% of the total. Each of these bipolar and myelinated fibers innervates only one IHC. Afferent Type-II neurons account for only 5% of the total number of spiral ganglions and innervate the OHCs of the cochlea Fig. D.The effect of DM on spiral ganglia in humans is still controversial. Makishima et al. observed that spiral ganglia in diabetic patients were significantly atrophied, and the number of SGNs was reduced by more than 50% , respectively, while the hearing recovery rates of the two groups were 30.3% and 36.8% (P = 0.409), respectively  (Toprak and Dedeoglu Astaxanthin (AST) is a non-provitamin A carotenoid with a strong antioxidant effect, and its ability to quench singlet oxygen and capture free radicals is more than 10 times greater than that of β-carotene. Toprak et al. showed that compared with non-diabetic rats, rats in the T1DM group had lower DPOAE and higher ABR (ABR: 35.8 ± 3.27 vs. 26.5 ± 1.41), decreased antioxidant enzyme levels and increased proinflammatory cytokine levels in cochlear tissue. Compared with T1DM rats, the hearing function of T1DM rats was recovered after AST treatment (DPOAE was increased and ABR was decreased (27.7 ± 2.91). In this treatment group, the antioxidant oxidase level in cochlear tissue was increased, and the proinflammatory cytokine level in cochlear tissue was significantly decreased (P < 0.05)  is called “a universal antioxidant”  is a triterpene glycoside isolated from the medicinal plant These studies suggest that AC may reverse the harmful effects of DM on hearing. However, these studies have only been performed in animal models. More clinical studies are needed.The harmful effects of DM on hearing have been reported in many studies. DM will not only increase the prevalence of hearing loss, but also aggravate deafness. Therefore, urgent attention needs to be paid to such harmful effects. Based on previous studies, we further concluded that patients with DM have a worse hearing threshold than normal people, and the main affected frequency will gradually progress from high to low frequency with age. However, the effect of DM on hearing is most prominent between 35 and 65 years old. The duration and severity of DM act as important risk factors in the progression of DRHL. Comparatively, there is no strong evidence that different types of DM (T1DM and T2DM) have distinct effects on hearing loss. In addition, several new risk factors have emerged, such as taking PPI or vitamin D deficiency. However, treatments for DRHL are still being explored. The effectiveness of glycemic control for hearing recovery in diabetic patients remains controversial. It seems that intensive SSNHL treatment combined with strict glycemic control can improve the hearing recovery rate of diabetic patients with this particular type of SNHL. From the perspective of antioxidants, some researchers have observed that AST, ALA, and AC can protect hearing in diabetic animals, such as reducing the degeneration of hair cells, improving the level of antioxidant enzymes in cochlear tissue, and restoring hearing function. If these treatments prove to be effective in diabetic patients, they are expected to become an adjunctive therapeutic option for patients with DRHL.


Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). Conclusions: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.Background: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. Methods: The analytic sample included 30,418 Americans aged ≥50 years from the 2006–2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. Results: Although overall ADL disability prevalence was 16.5%  in 2018, there were no changes in limitations during the study period ( The older adult population is rapidly increasing worldwide . In the Limitations in performing activities of daily living (ADL) are a frequently observed type of age-related disability. ADLs evaluate a person’s ability to complete basic self-care tasks, such as dressing and eating . The preSeveral investigations have previously evaluated the prevalence and trends of ADL limitations at a population-level and have indicated that there is a considerable prevalence of ADL limitations ,16,17,18We performed a secondary analysis of data from the 2006–2018 waves of the RAND Health and Retirement Study (HRS). The 2006 wave was selected to align with the concluding year of ADL disability prevalence estimates from other reports , whereasThe HRS uses a complex multistage probability design, which includes geographical stratification and oversampling for certain demographic groups. The University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board approved HRS protocols, and participants provided their written informed consent before study entry. Additional details about the HRS are available elsewhere .Respondents told interviewers their age, sex, race, and ethnicity. Respondents also told interviewers about their ability to perform six ADLs at each wave: walk across a small room, dress, bathe, eat, transfer in-and-out of bed, and use a toilet. Those indicating difficulty or an inability to complete a specific ADL were classified as having a limitation in that individual ADL task . SimilarAll analyses were conducted with SAS 9.4 software . HRS analytic guidelines informed our analyses. Survey weights were used to generate nationally representative prevalence estimates. Descriptive characteristics were shown as unweighted mean ± standard deviation and frequency (percentage) for continuous and categorical variables, respectively, to increase interpretability. Prevalence estimates for persons with limitations in specific ADL tasks were presented at each wave, and the overall prevalence of ADL limitations were similarly presented at each wave. ADL disability prevalence estimates were thereafter sub-grouped by age (50–64 years (middle-aged); ≥65 years (older)), sex , and race and ethnicity . Weighted prevalence estimates were coupled with 95% confidence intervals (CI).Distinct weighted multilevel logistic regression models analyzed trends in ADL disability for overall, age group, sex, and race and ethnicity. Repeated measures of individual participants in several waves were modelled using a random intercept for each participant to account for the longitudinal design. The dichotomous outcome was ADL disability in each model. For the overall model, the only explanatory variable was time . For examining age group trends, another model adjusted for time, age group (reference: middle-aged), and the time-by-age group interaction. Further, time, sex , and the interaction between time and sex were modeled for assessing trends by sex. In the last model, we included time, race and ethnicity (reference group: non-Hispanic White), and the interaction of these explanatory variables. An alpha level of 0.05 was utilized for all analyses.p = 0.52).The overall unweighted descriptive characteristics of the 30,418 participants are shown in p < 0.001). For example, the estimated prevalence of ADL disability in older Americans was 20.2%  in the 2018 wave, and the aligning ADL disability prevalence estimate in middle-aged Americans was 12.7% . ADL disability significantly increased in middle-aged Americans over time (p < 0.001), while ADL limitations decreased in older Americans (p < 0.001). p < 0.001). In the 2018 wave, the estimated prevalence of ADL disability in males was 14.4% , while the prevalence estimates were 18.3%  in females. However, there were no changes in ADL disability over time for both males (p = 0.06) and females (p = 0.11).p < 0.001) and non-Hispanic Black (p < 0.001) had a significantly higher estimated prevalence of ADL limitations compared to non-Hispanic White. For example, in the 2018 wave, the estimated prevalence of ADL disability was 23.2%  in Hispanic, 24.4%  in non-Hispanic Black, and 14.3%  in non-Hispanic White. The estimated prevalence of ADL disability by race and ethnicity is shown in The principal findings of this investigation revealed that, while many people in the United States are living with ADL limitations, significant changes in such limitations from 2006–2018 were not observed. Older Americans had a higher estimated prevalence of ADL limitations compared to middle-aged Americans; although the prevalence of ADL disability in older Americans declined, the prevalence of ADL disability in middle-aged Americans increased. Males had a lower ADL disability prevalence relative to females. Moreover, Hispanic and non-Hispanic Black had a higher prevalence of ADL limitations than non-Hispanic White. Our findings should be used to inform ADL screening, target sub-groups of Americans with an elevated prevalence of ADL limitations, and guide intervention framework.The substantial prevalence of ADL disability in Americans from 2006–2018 aligns with previous findings of Seeman et al.  on ADL dThe decreasing estimated ADL prevalence among older Americans during the study period could be attributed to factors that foster the prevention of ADL loss and the recovery of ADLs . The incOur finding of a higher ADL limitation prevalence in females than in males is consistent with the findings of another investigation assessing functional disability . This obSome study limitations should be noted. Our analyses were stratified by age, gender, and race and ethnicity; however, other sub-group analyses may be relevant and should be considered for future investigations as appropriate. For example, stratifying prevalence estimates by regions of the United States may help guide the customization of interventions according to geographic location. While we used a conventional ADL limitation definition, the degree of limitation in ADL tasks, and interpersonal and intrapersonal differences in these limitations should be considered in future investigations. First, ADL tasks vary in complexity. Some ADL tasks, such as walking across a small room, may require more general skills, including gross motor and perceptual abilities . MeanwhiWhile the estimated prevalence of ADL limitations in the United States is high, there were no observed changes in ADL limitations from 2006–2018 in Americans aged at least 50 years. Greater ADL disability prevalence estimates were observed among older adults compared to middle-aged adults. Although ADL disability prevalence approximations were higher for females, they were lower for males. In addition, prevalence estimations of ADL limitations were higher in non-Hispanic Black and Hispanic than in non-Hispanic White. Monitoring ADLs remains an easy and effective method for assessing age-related disability. Insights into prevalence and trends in ADL limitations among Americans are imperative for informing ADL screening, reaching population sectors with elevated prevalence of ADL disability, and advising interventions.


Age-related hearing loss affects a significant proportion of adults aged 60 years and above, with a prevalence of 65%. This condition has a negative impact on both physical and mental well-being, and while hearing interventions can help alleviate the effects of hearing loss, they cannot completely restore normal hearing or halt the progression of age-related hearing loss. Oxidative stress and inflammation have been identified as potential contributors to this condition. By addressing modifiable lifestyle risk factors that exacerbate oxidative stress, there may be an opportunity to prevent hearing loss. Therefore, this narrative review provides an overview of the major modifiable lifestyle risk factors associated with age-related hearing loss, that is, exposure to noise and ototoxic chemicals, smoking, diet, physical activity, and the presence of chronic lifestyle diseases, and offers an overview of the role of oxidative stress in the pathophysiology of this condition. Hearing loss is a global health issue that affects approximately one in five individuals, making it the third most significant cause of years lived with disability worldwide ,2. AlthoGiven the increasing prevalence of ARHL due to ageing demographics, there is a need for public health strategies aimed at reducing oxidative damage to manage the severity and burden of this condition. Although some factors contributing to oxidative stress are non-modifiable, there are several modifiable lifestyle risk factors that can be managed to promote antioxidant activity. These lifestyle risk factors include exposure to noise and ototoxic chemicals, smoking, a lack of regular physical activity, a poor diet, and the presence of chronic lifestyle diseases. This review will provide a comprehensive review of the role of these modifiable lifestyle risk factors in the development and progression of ARHL, including their proposed mechanism of increasing oxidative stress. Many of the studies included in this review report on risk ratios. This includes relative risk (RR), which compares the risk of one group relative to another, odds ratio (OR), which indicates the strength of association between one variable relative to another, and hazard ratio (HR), which compares the rate of change between one group relative to another . AdditioTo gather information for this review, a comprehensive literature search was performed in Medline and Embase via the OVID platform, in addition to Google Scholar. The search strategy involved using the keywords “hearing loss” or “presbycusis” in combination with “oxidative stress” and “lifestyle”, “noise”, “ototoxic”, “smoking”, “diet”, or “exercise”, and “risk”. The search was not limited by publication year. Relevant full-text articles written in English were collected and reviewed. Additionally, reference lists of relevant articles were examined to identify any additional suitable articles for inclusion in the review.Ageing is the biggest risk factor for ARHL and is characterised by a state of chronic oxidative stress and inflammation ,18. BroaOxidative stress and inflammation can also cause damage to the endothelium . MaintaiARHL is influenced by various lifestyle factors that can be modified to reduce the risk and progression of the condition. These modifiable factors include exposure to noise and ototoxic chemicals, smoking, an unhealthy diet, a lack of regular exercise, and the presence of chronic lifestyle diseases such as obesity, diabetes, and other cardiovascular health issues ,29,30,31According to the World Health Organisation (WHO), exposure to noise louder than 80 dB for more than 40 h per week can result in noise-induced hearing loss, which may progress to ARHL . Such non = 27,580 and n = 26,606, respectively) from the Trøndelag Health (HUNT) Study, investigated two decades apart, found that exposure to recreational firearms was associated with worse hearing at 3–6 kHz, with a stronger association observed with increasing number of lifetime shots and age [Research evidence generally supports the association between noise exposure and hearing loss. Data from two cross-sectional population-based cohorts  [Co-exposure to ototoxic chemicals and noise also increases hearing loss risk in older adults ,49. AmonSimilar to managing noise exposure, the primary recommendation for addressing ototoxicity is to avoid exposure to ototoxic chemicals. While it may be difficult to avoid exposure to ototoxic drugs, as they are often used to treat life-threatening conditions, multidisciplinary care can help reduce co-exposures to noise that can exacerbate hearing loss . In the Smoking directly increases oxidative stress and triggers an inflammatory response in the body ,65. ThisOn the other hand, smoking cessation has been shown to increase the concentration of protective antioxidants in the plasma and improve resistance to oxidative challenge . This map ≤ 0.05) [Overall diet quality is associated with hearing loss . The Nat ≤ 0.05) . A high- ≤ 0.05) . This di ≤ 0.05) . A recen ≤ 0.05) , which s ≤ 0.05) .Research evidence in adults supports associations between specific nutrients, ARHL, and oxidative and inflammatory pathways ,28,29,53Few studies have investigated the links between dietary flavonoids and ARHL in adults. Blue Mountains Hearing Study data found that higher intakes of one flavonoid subclass, isoflavone, were associated with a significant reduction in the risk of developing ARHL by 36%  . HoweverCarbohydrate nutrition has also been investigated in relation to the prevalence and incidence of ARHL . When coAlcohol is associated with alcohol-induced oxidative stress through the process of ethanol metabolism, which produces ROS . HoweverThe UK Biobank study also provided some longitudinal evidence that coffee consumption in men but not women is protective against hearing loss. Among 343 men, those who consumed 1 or ≥2 cups/day equally lowered their risk of hearing loss by 28%  . As coffCompared to other modifiable lifestyle risk factors, fewer studies have explored the relationship between exercise and ARHL risk; however, the findings are promising. For example, among women in the Nurses’ Health Study II, higher physical activity intensity  in h/week) significantly reduced hearing loss risk by 14%  and 17% , respectively. Walking at least 2 h/week also significantly reduced hearing loss risk by 10% , with an additional 5% risk reduction among women who walked ≥4 h/week. Similar benefits were observed in the Niigata Wellness Study in Japan with muscular and performance fitness in 21,907 adults aged 20–79 years , and leiThe benefits of regular exercise on ARHL are likely due to reductions in oxidative stress and inflammation associated with ageing through the management of obesity, sarcopenia, and mitochondrial dysfunction ,77. SpecEngaging in unhealthy lifestyle behaviours has been linked to the development of lifestyle diseases, such as obesity, diabetes, and cardiovascular disease. Studies have shown that the presence of these conditions may heighten the risk of ARHL ,60,61,62n = 489,354 participants and 55,410 cases) [2 increase in BMI , and a larger waist circumference  [2 increase in BMI and larger waist circumference were associated with a 15%  and 11%  increase in hearing loss risk, respectively. One of the included studies was the Nurses’ Health Study II, which showed a dose-dependent association between BMI and self-reported hearing loss in adults within obese class I (BMI 30–34 kg/m2) had a 17%  increased risk compared to 22%  for obese class II (BMI 35–39 kg/m2) and 25%  for obese class III (BMI ≥40 kg/m2) [Yang et al.’s meta-analysis included 14 studies (0 cases) . The cro8, 1.68) . Indicat0 kg/m2) . Similar0 kg/m2) .There were also mixed findings from two studies investigating underweight and hearing loss risk; one study observed a 22% increased risk  , while tn = 20,194 participants and 7377 cases) showed that the overall pooled odds of having any hearing loss was 2.15 (95% CI = 1.72–2.68) times greater among diabetic adults than non-diabetics [Evidence from Horikawa et al.’s meta-analysis of 13 cross-sectional studies  can lead to improved health and function, as well as protection against age-related diseases ,88,89,90With ageing demographics, the prevalence of ARHL will increase. Practicing healthy and safe lifestyle behaviours appears to have a role in delaying age-related oxidative damage to the inner ear and, thereby, can help to preserve auditory cells and inner ear function. Although most of the significant associations were small, findings from meta-analyses support a link between ototoxic chemical exposure, obesity, and diabetes with ARHL, while a number of studies also reported a link between noise exposure and smoking with ARHL.