{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:22:36Z","timestamp":1790886156218,"version":"4.1.0"},"reference-count":27,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2020,8,12]],"date-time":"2020-08-12T00:00:00Z","timestamp":1597190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 109-2314-B-039-038"],"award-info":[{"award-number":["MOST 109-2314-B-039-038"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Although studies have shown that per- and polyfluoroalkyl substances (PFAS) are potential environmental ototoxicants, epidemiologic study has been limited. I conducted a cross-sectional study to re-examine the associations between PFAS and hearing impairment. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999\u20132000, 2003-06, 2009-12, and 2015-16. Perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) were measured in serum samples. Participants were divided into quartiles for each PFAS. Air conduction pure-tone audiometry was administered. Hearing impairment (1: yes, 0: no) was defined as a hearing threshold of more than 25 dB at 500, 1000, 2000, 4000, and 8000 Hz in the worse ear. I assessed the relation of serum PFAS with hearing impairment by the generalized linear mixed model with a logit link and binary distribution. Tests for linear trend across quartiles of serum PFAS were conducted using the median serum PFAS in each quartile as a continuous variable. After adjusting for age, sex, body mass index, education, ethnicity group, and family income, I found positive correlations between PFOA and hearing impairment at 2000 Hz (p-trend &lt; 0.01) and 3000 Hz (p-trend = 0.02); between PFOS and hearing impairment at 500 Hz (p-trend &lt; 0.01), 2000 Hz (p-trend &lt; 0.0001) and 3000 Hz (p-trend = 0.02); between PFNA and hearing impairment at 2000 Hz (p-trend = 0.05), 3000 Hz (p-trend &lt; 0.01), 4000 Hz (p-trend = 0.02), and 8000 Hz (p-trend &lt; 0.01); between PFHxS and hearing impairment at 500 Hz (p-trend = 0.04), 1000 Hz (p-trend = 0.03), and 2000 Hz (p-trend &lt; 0.01). However, some of the findings were not significant when only comparing the highest with the lowest quartile of PFASs. In conclusion, several background serum PFASs are positively correlated with hearing impairment in the United States adult population.<\/jats:p>","DOI":"10.3390\/ijerph17165836","type":"journal-article","created":{"date-parts":[[2020,8,12]],"date-time":"2020-08-12T09:14:49Z","timestamp":1597223689000},"page":"5836","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Serum Per- and Polyfluoroalkyl Substances Are Associated with Increased Hearing Impairment: A Re-Analysis of the National Health and Nutrition Examination Survey Data"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-6034","authenticated-orcid":false,"given":"Ming-Chieh","family":"Li","sequence":"first","affiliation":[{"name":"Department of Public Health, China Medical University College of Public Health, Taichung 40402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2471\/BLT.13.128728","article-title":"The global burden of disabling hearing impairment: A call to action","volume":"92","author":"Olusanya","year":"2014","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.15585\/mmwr.mm6605e3","article-title":"Vital signs: Noise-induced hearing loss among adults\u2014United States 2011\u20132012","volume":"66","author":"Carroll","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.heares.2016.11.013","article-title":"Cellular mechanisms of noise-induced hearing loss","volume":"349","author":"Kurabi","year":"2017","journal-title":"Hear. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.7874\/jao.2017.00360","article-title":"Ototoxicity: A Challenge in Diagnosis and Treatment","volume":"22","author":"Ganesan","year":"2018","journal-title":"J. Audiol. Otol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.envres.2019.01.042","article-title":"Environmental ototoxicants, a potential new class of chemical stressors","volume":"171","author":"Fabelova","year":"2019","journal-title":"Environ. Res."},{"key":"ref_6","first-page":"e1","article-title":"The effects of combined exposure of solvents and noise on auditory function\u2014A systematic review and meta-analysis","volume":"66","author":"Nakhooda","year":"2019","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1080\/15287390600751447","article-title":"Persistent organic pollutants and adverse health effects in humans","volume":"69","author":"Li","year":"2006","journal-title":"J. Toxicol. Environ. Health Part A"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.envres.2014.12.002","article-title":"Gestational exposure to polychlorinated biphenyls and dibenzofurans induced asymmetric hearing loss: Yucheng children study","volume":"137","author":"Li","year":"2015","journal-title":"Environ. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S0892-0362(01)00155-6","article-title":"Neurobehavioral deficits associated with PCB in 7-year-old children prenatally exposed to seafood neurotoxicants","volume":"23","author":"Grandjean","year":"2001","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1289\/ehp.1307909","article-title":"Association of Perfluoroalkyl Substances, Bone Mineral Density, and Osteoporosis in the U.S. Population in NHANES 2009-2010","volume":"124","author":"Khalil","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20306","DOI":"10.1007\/s11356-015-5546-8","article-title":"Urinary heavy metals, phthalates, perchlorate, nitrate, thiocyanate, hydrocarbons, and polyfluorinated compounds are associated with adult hearing disturbance: USA NHANES, 2011-2012","volume":"22","author":"Shiue","year":"2015","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"109686","DOI":"10.1016\/j.envres.2020.109686","article-title":"Perfluoroalkyl substances exposure and hearing impairment in US adults","volume":"187","author":"Ding","year":"2020","journal-title":"Environ. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"108729","DOI":"10.1016\/j.envres.2019.108729","article-title":"Serum beta-carotene modifies the association between phthalate mixtures and insulin resistance: The National Health and Nutrition Examination Survey 2003\u20132006","volume":"178","author":"Li","year":"2019","journal-title":"Environ. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1021\/es062686m","article-title":"Serum concentrations of 11 polyfluoroalkyl compounds in the u.s. population: Data from the national health and nutrition examination survey (NHANES)","volume":"41","author":"Calafat","year":"2007","journal-title":"Environ. Sci. Technol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1001\/jamaoto.2017.0953","article-title":"Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988\u20132010","volume":"143","author":"Su","year":"2017","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: Introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.reprotox.2008.12.010","article-title":"Gestational and lactational exposure to potassium perfluorooctanesulfonate (K+PFOS) in rats: Developmental neurotoxicity","volume":"27","author":"Butenhoff","year":"2009","journal-title":"Reprod. Toxicol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.reprotox.2011.08.004","article-title":"Toxicological evaluation of ammonium perfluorobutyrate in rats: Twenty-eight-day and ninety-day oral gavage studies","volume":"33","author":"Butenhoff","year":"2012","journal-title":"Reprod. Toxicol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.joto.2017.08.001","article-title":"Apoptosis in inner ear sensory hair cells","volume":"12","author":"Morrill","year":"2017","journal-title":"J. Otol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.heares.2018.11.002","article-title":"Tonotopy in calcium homeostasis and vulnerability of cochlear hair cells","volume":"376","author":"Fettiplace","year":"2019","journal-title":"Hear. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s40618-016-0572-z","article-title":"Thyroid disruption by perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA)","volume":"40","author":"Coperchini","year":"2017","journal-title":"J. Endocrinol. Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3591","DOI":"10.2174\/092986710792927895","article-title":"Oxidative stress in the cochlea: An update","volume":"17","author":"Poirrier","year":"2010","journal-title":"Curr. Med. Chem."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.envpol.2017.04.086","article-title":"Serum metabolome biomarkers associate low-level environmental perfluorinated compound exposure with oxidative \/nitrosative stress in humans","volume":"229","author":"Wang","year":"2017","journal-title":"Environ. Pollut."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.toxrep.2014.07.015","article-title":"Perfluorooctanoic acid exposure triggers oxidative stress in the mouse pancreas","volume":"1","author":"Kamendulis","year":"2014","journal-title":"Toxicol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2174\/1389200013338603","article-title":"Induction of CYP1A1. The AhR\/DRE paradigm transcription, receptor regulation, and expanding biological roles","volume":"2","author":"Ma","year":"2001","journal-title":"Curr. Drug Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ijheh.2011.10.016","article-title":"Exposure and effective dose biomarkers for perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) in infertile subjects: Preliminary results of the PREVIENI project","volume":"215","author":"Alessi","year":"2012","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"8045","DOI":"10.1007\/s11356-013-1628-7","article-title":"Effects of perfluoroalkyl acids on the function of the thyroid hormone and the aryl hydrocarbon receptor","volume":"20","author":"Long","year":"2013","journal-title":"Environ. Sci. Pollut. Res. Int."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/16\/5836\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:59:36Z","timestamp":1760176776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/16\/5836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,12]]},"references-count":27,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["ijerph17165836"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17165836","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,12]]}}}