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Estrogen Exposure is Associated With Reduced Otosclerosis Risk in Obesity and Hormone Therapy

Year: 2026

Type: article

Abstract: Objective: To examine whether conditions associated with elevated-estrogenic states, including obesity, type 2 diabetes mellitus (T2DM), and postmenopausal estradiol hormone replacement therapy (HRT), are associated with the development of otosclerosis. Methods: We performed 3 retrospective cohort analyses using the US TriNetX network. Population included adults ≥18 years of age with an ear evaluation (the International Classification of Diseases [ICD]-10 Z01.1). Exposures included obesity (ICD-10 E66), T2DM (ICD-10 E11), and HRT (RxNorm 4083). Primary outcome of interest was otosclerosis (ICD-10 H80). Exclusion criteria for obesity and T2DM cohorts included type 1 diabetes (ICD-10 E10); for all cohorts, criteria included congenital ear abnormalities (ICD-10 Q16) or outcome of interest ≥20 years ago. 1:1 propensity score matching was performed on each cohort for demographics, metabolic comorbidities, ototoxic medications, lifestyle, body mass index, age, and sex. Relative risk with 95% confidence intervals was calculated; P < 0.05 represents statistical significance. Results: Otosclerosis occurred in 25 individuals with obesity with 52 controls (risk ratio [RR] = 0.48, P < 0.005). In the T2DM cohort, 15 cases were present, whereas the control population had 27 cases (RR = 0.56, P = 0.06). Among the estradiol HRT cohort, 303 cases were present compared with 369 in control (RR = 0.82, P < 0.05). Conclusions: Obesity and estradiol HRT are associated with a decreased risk of developing otosclerosis. A similar but nonsignificant trend was found in patients with T2DM. This suggests a protective role of estrogen against otosclerosis. Future studies may serve to elucidate longitudinal hormone profiling and identify a therapeutic local intervention for individuals with otosclerosis.

Source: Otology & Neurotology Open

DOI: 10.1097/ono.0000000000000083

Authors: Maia Smith, Sudhanvan Iyer, Delaney E.S. Clark, Simon Warren, Brian McKinnon

Institution: The University of Texas Medical Branch at Galveston

Language: English

Topic: Ear Surgery and Otitis Media

Subfield: Otorhinolaryngology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funders: National Institutes of Health, National Center for Advancing Translational Sciences