Sudden sensorineural hearing loss (SSNHL) poses a significant challenge within clinical settings, with new evidence highlighting potential systemic origins linked to metabolic dysfunction-associated steatotic liver disease (MASLD).
MASLD, long recognized for its hepatic and cardiovascular burden, is now emerging as a risk factor for acute auditory deficits. A recent nationwide cohort analysis found that adults over 60 with MASLD had a 1.5-fold higher incidence of SSNHL compared with individuals with metabolic dysfunction but without hepatic steatosis after adjusting for age, sex, and comorbidities. This association highlights a potential link between liver disease and unexplained hearing impairment, suggesting that further research is needed to determine whether auditory screening should be considered in MASLD cohorts.
The mechanisms linking liver dysfunction and nerve-related hearing loss likely involve widespread inflammation throughout the body, the body's reduced ability to respond to insulin, and damage to small blood vessels. Chronic hepatic inflammation and altered lipid metabolism in MASLD can propagate oxidative stress and endothelial dysfunction, jeopardizing cochlear blood flow and neuronal integrity. Clinicians should recognize that metabolic derangements in MASLD not only accelerate atherosclerosis but may also disrupt the delicate cochlear microenvironment.
Further support comes from a review on extrahepatic impacts of MASLD, which details how MASLD extends beyond traditional organ systems to affect peripheral nerves and sensory organs. Recognizing these extrahepatic manifestations suggests that evaluating liver function markers could be considered when assessing sudden hearing loss, though further studies are required to establish this approach.
Given the emerging awareness of SSNHL risk among MASLD patients, gastroenterologists and otolaryngologists should consider developing collaborative care pathways. Incorporating audiometric screening into MASLD management, and conversely assessing metabolic liver markers in SSNHL clinics, can lead to earlier detection and more comprehensive interventions. Future research should aim to clarify whether targeted metabolic therapies could mitigate auditory outcomes in this population.
Key Takeaways:
- MASLD is associated with a heightened risk of SSNHL in older adults, indicating systemic involvement of hepatic pathology.
- Extrahepatic manifestations of steatotic liver disease include vascular and neural perturbations that may compromise cochlear function.
- Interdisciplinary collaboration between hepatology and otolaryngology enhances diagnosis and management of patients presenting with sudden hearing loss.
- Assessing liver function tests should be considered in the evaluation of SSNHL to unmask underlying metabolic drivers.