{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:41Z","timestamp":1787027921883,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T00:00:00Z","timestamp":1664496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Technology Taiwan","award":["NMRPG3G6302"],"award-info":[{"award-number":["NMRPG3G6302"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The objective of the study was to investigate the relationship between obstructive sleep apnea (OSA) and auditory dysfunction, and to clarify the role of snoring sounds in contributing to auditory dysfunction. A comprehensive assessment of OSA and the auditory system was performed, including overnight polysomnography, detection of the intra-ear canal snoring sound energy (SSE), pure tone average (PTA), tinnitus pitch matching, the tinnitus handicap inventory (THI), and the Epworth sleepiness scale (ESS). The patients were identified as having tinnitus if their THI score was higher than zero or their tinnitus pitches were matched to specific frequencies. The median age, body mass index, and apnea\u2013hypopnea index score were 41 years, 26.4 kg\/m2, and 29.9 events\/h, respectively. Among the 50 participants, 46 (92%) had a normal PTA, and only 4 (8%) patients had mild hearing loss. There was no significant difference in PTA among OSA severities (p = 0.52). Among the 50 participants, 33 patients (66%) were identified as having tinnitus. In the tinnitus group (n = 33), the ESS score (p = 0.01) and intra-ear canal SSE of 851\u20131500 Hz (p = 0.04) were significantly higher than those in the non-tinnitus group (n = 17). OSA patients with a higher ESS score had a higher risk of tinnitus (odds ratio 1.22 [95% CI: 1.01\u20131.46]). OSA-related auditory dysfunction emerged in tinnitus rather than in hearing impairment. OSA patients with daytime sleepiness had a higher risk of tinnitus. High-frequency SSE can jeopardize cochlea and is a potential mechanism contributing to tinnitus. Detection of snoring sounds through an intra-ear canal device may be more precise in assessing acoustic trauma from snoring sounds to vulnerable auditory system and thus warrants further research.<\/jats:p>","DOI":"10.3390\/diagnostics12102374","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T01:43:01Z","timestamp":1664502181000},"page":"2374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Obstructive Sleep Apnea and Auditory Dysfunction\u2014Does Snoring Sound Play a Role?"],"prefix":"10.3390","volume":"12","author":[{"given":"Chun-Ting","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 23652, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-595X","authenticated-orcid":false,"given":"Li-Ang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan"},{"name":"Faculty of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-She","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei 10629, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9016-8098","authenticated-orcid":false,"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan"},{"name":"Faculty of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s00405-015-3714-6","article-title":"Audiologic profile of OSAS and simple snoring patients: The effect of chronic nocturnal intermittent hypoxia on auditory function","volume":"273","author":"Martines","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.amjoto.2016.03.004","article-title":"The evaluation of auditory system in obstructive sleep apnea syndrome (OSAS) patients","volume":"37","author":"Deniz","year":"2016","journal-title":"Am. J. Otolaryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/0194599810390859","article-title":"Association of obstructive sleep apnea and auditory dysfunctions in older subjects","volume":"144","author":"Hwang","year":"2011","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1002\/lary.26323","article-title":"Risk of tinnitus in patients with sleep apnea: A nationwide, population-based, case-control study","volume":"127","author":"Koo","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1002\/lary.25021","article-title":"Vestibular functions were found to be impaired in patients with moderate-to-severe obstructive sleep apnea","volume":"125","author":"Kayabasi","year":"2015","journal-title":"Laryngoscope"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.2147\/NSS.S331880","article-title":"Idiopathic Sudden Sensorineural Hearing Loss in Patients with Obstructive Sleep Apnea","volume":"13","author":"Chen","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.sleep.2008.03.012","article-title":"Hyperviscosity as a possible cause of positive acoustic evoked potential findings in patients with sleep apnea: A dual electrophysiological and hemorheological study","volume":"10","author":"McNamara","year":"2009","journal-title":"Sleep Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/sleep\/zsx106","article-title":"Damage of Inner Ear Sensory Hair Cells via Mitochondrial Loss in a Murine Model of Sleep Apnea with Chronic Intermittent Hypoxia","volume":"40","author":"Seo","year":"2017","journal-title":"Sleep"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"719","DOI":"10.5664\/jcsm.5804","article-title":"Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study\/Study of Latinos","volume":"12","author":"Chopra","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"30559","DOI":"10.1038\/srep30559","article-title":"The Frequency and Energy of Snoring Sounds Are Associated with Common Carotid Artery Intima-Media Thickness in Obstructive Sleep Apnea Patients","volume":"6","author":"Lee","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1164\/ajrccm.168.12.954","article-title":"Obstructive hypopneas in children and adolescents: Normal values","volume":"168","author":"Witmans","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lee, L.A., Yu, J.F., Lo, Y.L., Chen, Y.S., Wang, D.L., Cho, C.M., Ni, Y.L., Chen, N.H., Fang, T.J., and Huang, C.G. (2012). Energy types of snoring sounds in patients with obstructive sleep apnea syndrome: A preliminary observation. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0053481"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/coa.13231","article-title":"Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnoea: A pilot study","volume":"44","author":"Lu","year":"2019","journal-title":"Clin. Otolaryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.2147\/NSS.S311125","article-title":"Snoring Sound Characteristics are Associated with Common Carotid Artery Profiles in Patients with Obstructive Sleep Apnea","volume":"13","author":"Chuang","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s11325-011-0517-x","article-title":"Is obstructive sleep apnea syndrome a risk factor for auditory pathway?","volume":"16","author":"Casale","year":"2012","journal-title":"Sleep Breath. Schlaf Atmung"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s11325-017-1530-5","article-title":"Severe obstructive sleep apnea is associated with cochlear function impairment","volume":"22","author":"Matsumura","year":"2018","journal-title":"Sleep Breath. Schlaf Atmung"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1044\/1092-4388(2005\/084)","article-title":"General review of tinnitus: Prevalence, mechanisms, effects, and management","volume":"48","author":"Henry","year":"2005","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_18","first-page":"S1","article-title":"Clinical practice guideline: Tinnitus","volume":"151","author":"Tunkel","year":"2014","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.heares.2016.05.009","article-title":"A systematic review of the reporting of tinnitus prevalence and severity","volume":"337","author":"McCormack","year":"2016","journal-title":"Hear. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/S1474-4422(13)70160-1","article-title":"Tinnitus: Causes and clinical management","volume":"12","author":"Langguth","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.tics.2015.08.002","article-title":"Frontostriatal Gating of Tinnitus and Chronic Pain","volume":"19","author":"Rauschecker","year":"2015","journal-title":"Trends Cogn. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s00405-011-1808-3","article-title":"The relationship between the Epworth Sleepiness Scale and polysomnographic parameters in obstructive sleep apnea patients","volume":"269","author":"Lee","year":"2012","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"751","DOI":"10.5665\/SLEEP.1042","article-title":"Tissue vibration induces carotid artery endothelial dysfunction: A mechanism linking snoring and carotid atherosclerosis?","volume":"34","author":"Cho","year":"2011","journal-title":"Sleep"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/MAO.0b013e31802e29f2","article-title":"Vibration-induced hearing loss: Mechanical and physiological aspects","volume":"28","author":"Sutinen","year":"2007","journal-title":"Otol. Neurotol."},{"key":"ref_25","first-page":"3124","article-title":"Is There a Relationship between Obstructive Sleep Apnea (OSA) and Hearing Loss?","volume":"22","author":"Ekin","year":"2016","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_26","first-page":"1204","article-title":"Not so good vibrations. Commentary on Lee et al. Heavy snoring as a cause of carotid artery atherosclerosis. SLEEP 2008;31(9):1207\u20131213","volume":"31","author":"Rahangdale","year":"2008","journal-title":"Sleep"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/10\/2374\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:44:11Z","timestamp":1760143451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/10\/2374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,30]]},"references-count":26,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["diagnostics12102374"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12102374","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,30]]}}}