Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

Abstract

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

Fig. 1.

Hearing aid adoption rates in patients depicted as a function of mean scores on the PPOS for hearing care professionals who are men (open squares; dashed line) and women (filled circles; solid line). PPOS, Patient-Practitioner Orientation Scale.

Fig. 2.

A life course framework for sex, gender, and hearing health. In this framework, sex-linked biology and gender (purple arrows) alone and through proximal risk factors (orange box) influences hearing capacity and response to interventions (blue boxes and arrows). One’s hearing capacity affects other physical capacities and earlier and later life functioning. Gender, also a social determinant of health (orange box), and gender-related experiences and behaviors determine an individual’s perception of hearing impairment, help-seeking behavior, and use of hearing health services (green boxes). Social determinants of health working alone and together also contribute to the prevalence of risk factors, subsequent hearing loss, access to care and successful rehabilitation. Gender also influences help-seeking behaviors and relations with health care providers which may alter therapeutic outcomes among those with hearing loss.