www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
ORIGINAL
ARTICLE
The
characteristic
of
otoacoustic
emissions
in
full-term
neonates
according
to
ABO
blood
groups
夽
Aifeng
Li
a,∗,
Guoqiang
Gao
b,
Ningyu
Wang
c,
Tao
Fu
a,
Fugao
Zhu
a,
Xiaoheng
Zhang
a,
Jie
Liu
aaTheAffiliatedHospitalofQingdaoUniversity,DepartmentofOtolaryngologyHeadandNeckSurgery,Qingdao,China bTheAffiliatedHospitalofQingdaoUniversity,DepartmentofObstetrics,China
cCapitalMedicalUniversity,BeijingChaoyangHospital,DepartmentofOtorhinolaryngologyHeadandNeckSurgery,China
Received17July2019;accepted27October2019 Availableonline10December2019
KEYWORDS ABOblood-group system; Spontaneous otoacoustic emissions; Distortionproduct otoacoustic emissions; Noise-induced hearingloss Abstract
Introduction:Previousresearchhassuggestedthatindividualswithdifferentbloodgroupsshow variedincidencesofnoise-inducedhearingloss.Thereducedotoacousticemissionsamplitudes indicatethehigherpossibilitiesofouterhaircelldamagefornoiseexposure.
Objective:Theobjectiveistoanalyzethecharacteristicsofotoacousticemissions,including theoccurrenceofspontaneousotoacousticemissionandtheamplitudesofdistortionproduct otoacoustic emissionatcertain frequencies infull term neonates withdifferent ABOblood groups.
Methods:A total of80 selected full-term femaleneonates who passedthe initial newborn hearing screenwereenrolledinto thestudy,withequalnumber ofparticipants infour ABO bloodgroups(BloodGroupA,BloodGroupB,BloodGroupAB,BloodGroupO).Measurementsof spontaneousotoacousticemissionanddistortionproductotoacousticemissionwereperformed inbothearsforallparticipants.
Results:(1)ThebloodgroupOparticipantsshowedsignificantlyfewerspontaneousotoacoustic emissionoccurrences thanthe otherthreebloodgroups (A=70%,B=80%,AB=67%,O=25%, p< 0.05). (2)The blood group Oparticipants showed lower DPOAEamplitudes at1257 Hz (M=4.55 dB,SD =8.36),1587 Hz (M=11.60 dB,SD =6.57), 3174Hz (M=7.25dB, SD= 5.99), 5042Hz (M=13.60, SD=6.70) thanparticipants with theotherthree bloodgroups
夽 Pleasecitethisarticleas:LiA,GaoG,WangN,FuT,ZhuF,ZhangX,etal.Thecharacteristicofotoacousticemissionsinfull-term neonatesaccordingtoABObloodgroups.BrazJOtorhinolaryngol.2020;86:774---80.
∗Correspondingauthor.
E-mail:hugf144@163.com(A.Li).
PeerReviewundertheresponsibilityofAssociac¸ãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial. https://doi.org/10.1016/j.bjorl.2019.10.012
1808-8694/©2019Associac¸˜aoBrasileiradeOtorrinolaringologiaeCirurgiaC´ervico-Facial.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).
inleftears(p<0.05).Inrightears, thebloodgroup Oparticipantsshowed reduced ampli-tudesat1257Hz(M=6.55dB,SD=8.36),1587Hz(M=13.60dB,SD=6.57),3174Hz(M=7.65dB, SD=6.43),5042Hz(M=13.65dB,SD=6.50)thanparticipantsfromnon-Obloodgroups(p<0.05). Conclusion: Femaleindividualswith bloodgroupOhavelower otoacousticemissions values thanindividualswiththeotherthreebloodgroups.Weneedtofurtherinvestigatethepossible relationshipsbetweenABObloodgroupandcochlearfunction,includingthepotentialinfluences ofnoisedamageoncochlearouterhaircells.
© 2019 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). PALAVRAS-CHAVE SistemaABOde grupossanguíneos; Emissõesotoacústicas espontâneas; Emissõesotoacústicas porprodutode distorc¸ão; Perdaauditiva induzidaporruído
Característicadasemissõesotoacústicasemneonatosatermosegundogrupos
sanguíneosdosistemaABO
Resumo
Introduc¸ão: Pesquisas anteriores sugeriram que indivíduos de diferentes grupos sanguíneos apresentamincidênciasdistintasdeperdaauditivainduzidaporruído.Asamplitudesreduzidas das emissõesotoacústicas indicaram maioresoumenorespossibilidadesde danosàscélulas ciliadasporexposic¸ãoaruídos.
Objetivo: O objetivo do estudo foi analisar as características das emissões otoacústicas, incluindo aocorrência de emissões otoacústicas espontâneas e as amplitudes de emissões otoacústicasporprodutodedistorc¸ãoemdeterminadasfrequênciasemneonatosatermode diferentesgrupossanguíneosdosistemaABO.
Método: Foramincluídos80neonatosatermoselecionadosnatriagemauditivaneonatalinicial paraparticipardoestudo,comnúmeroigualdeparticipantesdegrupossanguíneosdosistema ABO (grupo sanguíneo A, grupo sanguíneo B,grupo sanguíneo AB egrupo sanguíneo O). As emissões otoacústicas espontâneas e emissõesotoacústicas por produtode distorc¸ão foram medidasemambasasorelhasdetodososparticipantes.
Resultados: (1)OsparticipantesdogruposanguíneoOapresentaramocorrênciasdeemissões otoacústicasespontâneassignificantementemenoresdoqueosdosoutrostrêsgrupos sanguí-neos(A=70%,B=80%,AB=67%,O=25%,p< 0,05).(2)OsparticipantesdogruposanguíneoO apresentaramamplitudesdeemissõesotoacústicasporprodutodedistorc¸ãomaisbaixasa1257 Hz(M=4,55dB,DP=8,36),1587Hz(M=11,60dB,DP=6,57),3174Hz(M=7,25dB,DP= 5,99),5042Hz(M=13,0,DP=6,70)doqueosparticipantesdosoutrostrêsgrupossanguíneos nasorelhasesquerdas(p< 0,05).Nasorelhasdireitas,osparticipantesdogruposanguíneoO apresentaramamplitudesreduzidasem1257Hz(M=6,55dB,DP=8,36),1587Hz(M=13,60dB, DP=6,57),3174Hz(M=7,65dB,DP=6,43),5042Hz(M=13,65dB,DP=6,50)emcomparac¸ão aosparticipantesdegrupossanguíneosnãoO(p< 0,05).
Conclusão:OsindivíduosdosexofemininodogruposanguíneoOapresentaramvaloresmenores deemissõesotoacústicasdoqueosindivíduosdosoutrostrêsgrupossanguíneos.Énecessário continuarainvestigaraspossíveisrelac¸õesentreogruposanguíneo ABOeafunc¸ãococlear, inclusiveaspossíveisinfluênciasdodanoporruídosàscélulasciliadasexternasdacóclea. © 2019 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Publicado por Elsevier Editora Ltda. Este ´e um artigo Open Access sob uma licenc¸a CC BY (http:// creativecommons.org/licenses/by/4.0/).
Introduction
Otoacousticemissions(OAEs)arelowlevelsoundsgenerated from the cochlea without any external stimulation. OAEs areanobjectiveindicationofnormalcochlearfunction.1It
canbefurtherclassifiedintotransientlyevokedotoacoustic emission(TEOAE),spontaneousotoacousticemission(SOAE) anddistortionproductotoacousticemission(DPOAE).
SOAEiswidelyrecognizedastheproductofself-sustained oscillationsofOuterHairCells(OHC).2Ithasbeensuggested
thatitmaybeinfluencedbymanyfactorsincludingmiddle earstatus,ageand gender.2 The prevalence rateofSOAE
issignificantlyhigherinfemalethaninmaleChinese new-borns.ThefrequenciesofSOAEinnewbornsappearedtobe higherthanthosereportedinnormalhearingadults.Atthe cochlearlevel,moststudiesreportedasymmetriesbetween right and left ears, manifested in a higher occurrence of SOAEinrightears.3
OHCaretypicallythefirstsectionoftheauditorysystem tobesignificantlyinfluencedbyexposuretocertain
environ-ments,suchasnoise.4Therefore,changesinOAEamplitude
canreflectearlyinjuriesofthecochlearOHC.Hall5reported
thatOAEtestingwastwiceassensitiveaspure-tone audiom-etryin detecting changes in the hearing threshold levels andsuggestedthatit couldimprovemonitoringfor Noise-Induced Hearing Loss(NIHL) in the workplace.A previous study6alsoindicated thatOAEcouldreflectnoise-induced
changesin cochlear OHC,which wasundetectedby pure-toneaudiometrictests.OAEmightthereforeactassuperior diagnosticpredictorforNIHL.AbnormallylowOAEresponse amplitudesmayalsosuggestgreaterriskofdevelopingNIHL. The blood groupsaredivided intofourgroups: A,B,O andAB,basedonthedifferentbloodgroupantigensonthe surfaceofredbloodcells.Differentbloodgroupscanhave variedsusceptibilitytocertaindiseases,duetodifferential geneticexpressionsofantigensoneachbloodgroup.Astudy conductedbyNair6suggestedthatairforcepersonnelwith
blood Group O had a higher incidence of NIHL compared topersonnelwithotherbloodgroups,whichwasconsistent withotherpublishedstudies.Dogru7foundapotential
cor-relationbetweenABOblood groupsandNIHLinastudyof 176 workers, where participants withblood Group O had higherincidencesof NIHLthan non-Oblood group partici-pants.ThesestudiessuggestthattheincidenceofNIHLhas apotentialrelationshipwiththebloodgroups.Bloodgroups couldthusbeapredictorofthedevelopmentofNIHL.
Anotherpreviousstudyhypothesizedthattherewere sig-nificantlydifferentOAEsvaluesamongthefourbloodgroups innormalhearingindividuals.8Non-Obloodgroup
individu-alsdemonstratedhigherOAEprevalenceinSOAEandlarger DPOAEamplitudesatcertainfrequenciesthanbloodGroup Oindividuals.However,thedifferentperformancesofOAE amongthefourbloodgroupsinneonatesarenotclear, espe-ciallyduringthefirstmonth.Itisalsoworthwhiletofurther investigatethe relationshipbetween differentOAE ampli-tudeandthehematologicalriskfactorforNIHL.
Therefore,the aimsof thisstudy aretodetermine (1) the incidence of SOAE among the four blood groups in neonates;(2) DPOAEresponseamplitudes at selected fre-quenciesamongthefourblood groupsinneonates and(3) whetherthereisasignificant differenceinOAErecordings betweenleftandrightears.
Methods
Participants
80selected full-term femaleneonates were enrolled into the study from local hospital between January 2018 and December2018.Becausepreviousstudies9haveshown
sig-nificant gender differences of SOAE pass rates in normal full-termneonates, the participantsincluded in thestudy were all of the same gender. All participants included in the study fulfilled the following criteria: they were eth-nic Han Chinese; had accurate knowledge of their blood groups fromblood tests.There were 20 participants rep-resentingeachofbloodgroupsA,AB,B,andOrespectively. Becausethepopulation ofRh-negativebloodtypein eth-nicHanis present in0.9 %,participants wereassumed to haveanRh-positivebloodtype.10Theirgestationalagesat
birthranged from38to40weeks.Theirtesting agewere
7.3±3.5 days in blood Group O; 7.85±3.4 daysin blood Group A;7.5±2.5 daysin blood Group B;6.75±3.6days in blood Group AB, and there wasno statistic difference amongfourbloodgroups(p=0.765).Therewasnohistory ofauditorypathologyinthefamilymembersofany partici-pant.Theyhadnohistoryofearinfectionsormajorhealth problemssuchascongenitalhypothyroidism.Inordertobe included in the study, all subjects had passed the initial newbornhearscreeningtest.Theyhadrecordedmiddleear function, such as static admittance,equivalent ear-canal volume,tympanicwidthandtympanicpeakpressureinboth earsaftercleaningtheexternalcanal.Theparentsofeach neonatewereprovidedwithwritteninformedconsentprior toentryintothestudy.Theresearchstudywasapprovedby theHumanResearchEthicsCommitteeandwritteninformed consentwasobtainedfromeachparticipantbefore assess-ment(ResearchNumber:QYFYWZLL25542).
Designandprocedures
All auditorytests and recordswereperformed in a sound booth(<30dB)(A)whiletheneonateswerequietorsleeping toobtainamorepreciseandreliableresult.Anyrecording process that was disrupted, especially if the probes dis-turbedorunsealedbythemovementoftheneonates,was repeatedafteradjustingthe probeagainin theouter ear canal.
Tympanometry was performed in both ears using a screening middle ear analyzer (the Interacoustics AA220, Assens, Denmark) with appropriate calibration. Tym-panogramsofbothearswererecordedineachparticipant usinga1000Hzprobetone.AccordingtotheBaldwin classi-ficationmethod,positivepeaksuggestednormalmiddleear function.11
Asin Chen’sresearch,12 recordingsof SOAEandDPOAE
wereconductedusingtheCapellaOAE(Madsen,Denmark). An appropriatesizesilicon rubber measurementprobetip wasinsertedinrightandleftearcanalsinrandomizedorder forOAEmeasurement.
SOAE test: Five hundred epochs of 80ms after a syn-chronizing click stimulus (duration 1---1.5ms, intensity of 70---80dBSPL) were acquired (sampling frequency 25kHz). EachSOAErecordingneededtomeetthetwofollowing cri-teria:thespectralline(above500Hz)exceededtheaverage ofallotherspectralpeakswithin40Hzby3dBormoreand theabsoluteamplitudeofthesignalexceeded25Dbspl.13
DPOAEtest:To obtain robustresponses,twopure-tone stimuliat65/50dBSPL(f2:f1=1.22)werepresentedtothe ear simultaneously. A total of four f2 frequencies spaced at one-third octave intervalswere used1257Hz,1587Hz, 3174Hz,5042Hz.
Statisticalmethods
Statistical analysis was carried out with the use of the SPSSsoftware(V.17.0;SPSSInc.,USA).Theoccurrences of SOAEamongtheparticipantswiththedifferentbloodgroups andtheaverageamplitudesofDPOAEwithstandard devia-tionswereanalyzedbythedescriptivestatistics.Inferential statistic analysis was used for investigating the possible differences amongfour blood groups about DPOAE
ampli-tudes.Chi-squaretestswereusedtodetect differencesin SOAE prevalence in terms of numbers of ears with four bloodgroups. One-way ANOVAtestevaluatedpossible dif-ferencesinDPOAEamplitudesattestingfrequenciesamong fourbloodgroups. Thepost hocpairwisecomparisonwas usedtoascertainsignificant results.The selectedlevelof significancewasp<0.05.
Results
Overall,atotalof97/160yearsinthe80femaleneonates weretestedforSOAE.BilateralSOAEtestingwasnotpossible inallbabiesbecauseduringthetest,someneonatesbegan tocryorfeelhungry.Insuchsituations,theirmothersorthe baby’sguardiansdidnotallowthetesttobecontinuedand thedatawerenotcollectedfromeachear.
SOAEprevalenceinfull-termneonate
Table1 showedtheprevalence ofSOAEamongfourblood groups. A total of 97 out of 160 ears (60.63 %) displayed SOAE. A Chi-square test demonstrated significant differ-ence amongthe four blood groups X2 (3, n=160)=11.58,
p=0.009.
Post-hoctestsshowedsignificantdifferencesamongfour bloodgroupswithp=0.05.Thesubjectsinblood GroupO hadsignificantly feweroccurrences ofSOAEthan subjects inbloodGroupA(X2[1,n=80]=5.12,p=0.024)andblood
GroupB(X2[1,n=80]=10.453,p=0.001),alsobloodGroup
AB(X2[1,n=80]=4.114,p=0.043).Therewasnosignificant
differenceinotherthreebloodgroups.SOAEprevalencein earsidedemonstratedsignificantdifference(Table2).The bloodGroupOsubjectsdemonstratedthefewestnumberof SOAEtestedinrightears.Therewasasignificantdifference intheratioamongthebloodgroups (X2[80,n=3]=19.72,
p= 0.001).The blood GroupOsubjects demonstratedthe fewestnumberofSOAEtestedinleftears.Therewasa sig-nificantdifferenceintheratioamongthebloodgroups(X2
[80, n=3]=11.83, p= 0.008). The occurrence of SOAEin rightearsandleftearshadsignificantdifference(X2[160,
n=1]=4.425,p=0.035).
DPOAEfindingsinfourbloodgroups
Table 3 showed the thresholddata of DPOAE at four fre-quencies among four blood groups both in left and right earsand therewasnostatistical differenceacrossall the frequencies.Aone-wayANOVAtestshowedsignificant dif-ferenceofDPOAEamplitudes atselectedfrequenciesboth in right ears and left ears. In left ears, statistic analysis showedsignificant differences onamplitudes of DPOAEat 1257Hz (F[3.76]=9.396, p =0.001) (Table 4); at 1587Hz (F[3.76]=10.247,p= 0.002);at3174Hz(F[3.76] =14.273,
p= 0.001);at5042Hz(F[3.76]=10.610,p=0.001). Post-hoccomparisonshowedthatthebloodgroupO sub-jectshadlowerDPOAEamplitudesat1257Hz(M=4.55dB, SD=8.36), 1587Hz (M =11.60dB, SD=6.57), 3174Hz (M =7.25dB, SD=5.99) and 5042Hz (M=13.60dB, SD=6.70) than subjects with other three blood groups in left ears
0 5 10 15 20 25 30 1257Hz 1587Hz 3174Hz 5042Hz A m pl itud e (d B) L-A L-B L-AB L-O R-A R-B R-AB R-O
Figure1 ThebarchartshowedDPOAEamplitudesat1257Hz, 1587Hz, 3174Hz and5042Hz inLeft ears (L)andRight ears (R)amongfourbloodgroups.ThexaxisdisplayedtheDPOAE frequencies(Hz),theyaxisdisplayedthemeanamplitude(dB) evokedamong four bloodgroupsubjects. Verticalerrorlines standforstandarderror.
(p<0.05).Therewasnosignificantdifferenceamongother threebloodgroups(Fig.1).
Inrightears,statisticanalysisshowedsignificant differ-encesonamplitudesofDPOAEat1257Hz(F[3.76]=9.428,
p=0.002) (Table 4); at 1587Hz (F[3.76]=10.247, p= 0.001),at3174Hz(F[3.76]=17.910,p =0.001),at 5042Hz (F[3.76]=10.617, p= 0.001). In right ears, post-hoc com-parisonshowedthebloodGroupOparticipantshadreduced amplitudes at 1257 Hz (M=6.55dB, SD=8.36), 1587 Hz (M=13.60dB, SD=6.57), 3174 Hz (M=7.65dB, SD=6.43), 5042 Hz (M=13.65dB, M=6.50) than participants fromA, BandABgroups(p< 0.05).Nosignificantdifferenceswere foundamongotherthreebloodgroups(Fig.1).
Discussion
The purpose of this researchwas toverify the statistical differenceinSOAEincidenceandDPOAEamplitudeamong thefour blood groups inneonates. We carefully screened forgender,age,ethnicity,hearinglevel,physicalcondition andtestenvironmentwhenconductinganalysisofthe sub-jects.Forthe80femalesubjects,resultsshowedthatthe subjectswithbloodgroupOhadthelowestSOAEincidence amongthe four blood groups in both ears. Also,subjects withblood group O revealed lower DPOAE amplitudes at 1257Hz,1587Hz,3174Hzand5042Hzthanthosefromthe otherthreebloodgroups,bothinrightandleftears.OAEare thoughttorepresent thenormalfunctioning oftheactive feedbackmechanisminthecochlea.14ThefunctionofOHC
begins before 30 weeks of gestation. After its functional onsetinhuman, OHCundergosmaturational changesover aperiodofseveralweeks.15 SinceOAEcomesfromOHCof
thecochlea,thedifferencesinOAEamplitudeamongfemale subjectsalsoreflectpotentialdecreasedOHCactivities.
ThepresentstudyfoundthatbloodGroupOsubjectshad lowerSOAE incidencethan the other three blood groups, while DPOAEamplitudes at 1257Hz, 1587Hz, 3174Hzand 5042Hzwerealsofoundtobelowerthanotherthreeblood groups.ItcanbeinferredthatthefunctionofOHCinblood GroupOislessactivethanotherthreebloodgroups. Accord-ingtotheseresults,wesuggestthatindividualswithblood Group O may be more susceptible toNIHL than individu-als witha non-O blood group. The results of this present
Table1 SOAEprevalenceinfull-termneonates.
Group Numberoftesting
ears NumberofSOAE ears Prevalencerate (%) Chi-squaretest X2 p A 40 28 70 11.58 0.009 B 40 32 80 AB 40 27 67.5 O 40 10 25 Total 160 97 60.63
Table2 EarsideofSOAEprevalenceinfull-termneonates.
BloodgroupA BloodgroupB BloodgroupAB BloodgroupO Chi-squaretest
X2 p
Leftear 11.83 0.008
Numberoftestingears 20 20 20 20
NumberofSOAEears 12 14 12 4
Prevalencerate(%) 60 70 60 20
Rightear 19.72 0.001
Numberoftestingears 20 20 20 20
NumberofSOAEears 16 18 15 6
Prevalencerate(%) 80 90 75 30
Table3 DPOAEthresholdatfourfrequenciesinleftandrightearamongfourbloodgroupneonates.
Bloodgroup Thresholdat
1257Hz(dB) Thresholdat 1587Hz(dB) Thresholdat 3174Hz(dB) Thresholdat 5042Hz(dB) One-wayANOVA F p Leftear Otype 18.75±3.00 19.15±3.08 19.05±3.02 20.00±2.99 0.628 0.599 Atype 19.95±3.20 19.00±3.01 19.40±2.93 20.45±3.03 0.866 0.462 Btype 19.55±3.03 19.50±3.01 19.00±2.95 18.50±3.46 0.557 0.645 ABtype 18.60±3.05 20.20±3.32 19.90±3.18 19.35±2.85 1.025 0.386 Rightear Otype 19.35±2.82 19.20±3.17 18.80±3.00 19.15±2.90 0.112 0.947 Atype 19.20±2.73 19.25±2.80 20.40±3.15 18.65±3.03 1.256 0.295 Btype 18.85±3.12 19.05±2.86 19.35±2.93 20.00±2.99 0.571 0.636 ABtype 18.80±3.21 18.80±3.00 19.00±2.81 19.80±2.76 0.521 0.669
researchareconsistent with previous researchconducted byDogru.7DogrustudiedthatNIHLwasfoundin23persons
withbloodGroupA(32.0%),35withbloodGroupO(58.3%), 10withbloodGroupB(38.5%)and7withbloodGroupAB (38.9%),respectively.PeoplewithbloodGroupOaremore susceptibletoNIHLthanthosewithnon-Obloodgroups.
Apreviousstudy12 discoveredthatbloodgroupO
parti-cipantsexhibitedsignificantlylower SOAEprevalence(3.3 %)andreducedamplitudesofDPOAEonaveragethan par-ticipants with a non-O blood group. The blood Group O populationhasgeneticsusceptibilitytofactorssuchaslarger earcanal volume,ossicular chain mass,or a moreactive cochlearefferent system,16 whichaffect theperformance
of OAE. The large external auditory canal volume weak-ens OAE signals, which is not conducive tothe detection device thatrecords the OAE. Thereis aclose correlation
betweentheregulationofSOAEandthecochlearefferent system.Duetomedialolivocochlearsystemdysfunction,the reduced inhibitory function leads to a higher occurrence and larger amplitudes of OAE.17 An alternative
explana-tion for the asymmetries in OAE could be the difference instrengthoftheefferentsysteminfluencebythemedial olivocochlearsystemontheOHC.18Thedifferentprevalence
in ear-side might also depend on the asymmetries of the efferentauditory systemwhich ledtotheasymmetries of hearingsensitivity.19,20
The present studyindicated that SOAEoccurrence and DPOAE amplitudes at the selected frequency for blood Group O were statisticallydifferent fromthe other three blood groups in neonates. This suggests that people with bloodGroupOcontaincertaingeneticpredisposingfactors, whichmayinfluencetheimperfectgrowthofcochlearOHC
Table4 DPOAEamplitudesatfourfrequenciesinleftandrightearamongfourbloodgroupneonates. DPOAE frequency Amplitudeof bloodgroupO (dB) Amplitudeof bloodgroupA (dB) Amplitudeof bloodgroupB (dB) Amplitudeof bloodgroupAB (dB) One-wayANOVA F p Leftear 1257Hz 4.55±8.36 8.20±8.20 16.85±7.24 13.00±7.60 9.396 0.001 1587Hz 11.60±6.57 17.95±6.53 21.30±4.68 19.10±5.26 10.247 0.002 3174Hz 7.25±5.99 13.45±2.82 15.25±2.69 13.30±4.13 14.273 0.001 5042Hz 13.60±6.70 19.95±6.24 23.30±4.38 21.10±5.28 10.610 0.001 Rightear 1257Hz 6.55±8.36 10.20±8.20 18.85±7.24 15.10±7.64 9.428 0.002 1587Hz 13.60±6.57 19.95±6.53 23.30±4.68 21.10±5.26 10.247 0.001 3174Hz 7.65±6.43 14.25±2.77 16.25±2.69 14.25±2.57 17.910 0.001 5042Hz 13.65±6.50 19.90±6.26 23.25±4.39 21.10±5.24 10.617 0.001
and have an effect on the performances of OAE. Human bloodgroupantigensaretransientlyexpressedindeveloping cochlearhaircells.Thistemporalantigenexpressionseems tocorrespondtothemaineventsofinnereardivision(e.g., haircelldevelopment,synaptogenesis,ciliogenesis).21
Pre-viousstudies12 haveshownthatthenumberof OHCin the
bloodgroupOpopulationarefewerthaninthenon-Oblood group,andthefunction ofOHCarelessactive.It maybe possible thatthe blood groupO population is moreprone to spontaneoushair cell loss at an earlier age.22
Biologi-caldifferencesbetweenbloodgroupscanprovideevidence to explain the disadvantages of blood group O individu-als in auditory physiology. Individuals withblood group O lackhisto-bloodGroupAtransferaseandhisto-bloodGroup B transferase while individuals with a non-O blood group containAandBtransferase.23Alackofthesefunctional
pro-teinscanhavepotentiallynegativeeffectsonthecochlear functionofthebloodGroupOpopulation.Also,the concen-trationofvonWillebrandfactor(vWF)inthebloodGroupO systemislowerthanthatofnon-Obloodgroups.24vWFisa
carrierproteinforfactorVIII,whichpreventsproteolysisof factorVIII.BloodGroupOindividualshavereducedclotting factorsintheirblood,whichmayhaveplayedanimportant roleinrapidbiologicaltissuerepairmechanisms.For exam-ple,whenthefinetissuesaredamaged,theywillcoagulate andavoidaggravateddamage.
Althoughhearingsensitivityisatanormalrange,theOHC arepronetosubtledamageduetoseverevibrationofthe basementandtectorialmembranes,whenOHCareexposed tonoiseenvironments.Atthesametime,thebloodvessels and capillaries which areresponsible for supply nutrients tothecochleararealsodamaged.Becausetheblood coag-ulation processin blood groupO individuals isnot asfast andeffectiveasinnon-Obloodgroup,itcannotinhibit fur-ther damage to tissues that can be damaged at an early stage,andconsequentlythenumberofhealthyOHCis fur-ther reduced.A betterunderstanding of thephysiological functionofbloodgroupantigenassociatedwithOHC devel-opmentcouldhelpexplaintheauditoryinferiorityofblood groupOindividuals.
The findingssuggest that an ABOblood group is a risk factor for development of hearing loss, increasing the susceptibilitytoNIHL.Althoughtheresponses maybe sig-nificantlylower,thosecouldstillbeadequatefornewborns
topass the screening test. This suggests that the loss of OHCs inindividuals withblood Group Omay notbe large enoughtocausean elevationinthreshold.The difference in blood groups could simplybe a genetic predisposition. It is not a congenital hearing defect in newborns. Other factorssuchaslargerearcanal volumeor stronger effer-entsystemhave effectsonOAE amplitude.Thereduce of OHCscanbeinfluencedseparatelyby,orbyacombinationof environmental,medical(thislastsentenceisquiteunclear tome).
Infuturelargescalestudiesareclearlyneededtoconfirm the present findings. Moreover, the measurement of non-linearandlinearTEOAEshouldbeusedtodetect cochlear responses.SOAEandDPOAEamplitudesalonecannotreflect thecochlearfunctioncompletely.ApartfromDPOAE ampli-tudes, the fine structure and frequency space of DPOAE componentsarealsoofimportancetoindicatecochlear sta-tus.Therefore,itwouldbeusefultocomparetheamplitudes causedbyeachDPOAEcomponentinfuturestudies.
Conclusions
Thecurrentresearchshowedthatthefemalesubjectswith bloodGroupOhadsignificantlyfeweroccurrenceofSOAE, andsignificantlylowerDPOAEamplitudesatfrequenciesof 1257Hz,1587Hz,3174Hzand5042Hzbothinleftandright earswhencomparedwithotherthreebloodgroupsubjects. Thecurrentresearchsuggestedthatindividualswithblood GroupOmighthaveauditoryinferiorityataphysiologiclevel andsupportedtheviewthatbloodGroupOindividualsmight havehigheropportunitytosufferNIHL.Weneedtofurther studytherelationship betweenABObloodgroupand audi-toryfunction,especiallymolecularaspectsofOHCandthe functionoftheefferentsystem.Itcanbeusedtoassessthe effectof ABO blood group onauditory sensitivity, speech comprehensionandauditoryprocessing.
Conflicts
of
interest
Acknowledgements
Wethankalloftheco-authorsfortheirhelpinthecollection ofdataandhelpfuladviceforthismanuscript.
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