Elevated ApoB/ApoA ratio is associated with increased risk of sudden sensorineural hearing loss

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Sudden sensorineural hearing loss (SSNHL) (n=1211). Intervention: Elevated apolipoprotein B to apolipoprotein A (ApoB/ApoA) ratio vs. Lower ApoB/ApoA ratio (continuous per 1-unit increase, or low-ratio tertile 0.13-0.58). Primary outcome: Risk of sudden sensorineural hearing loss (SSNHL) (OR 9.34, 95% CI 3.93-22.21).

Q: What does this research mean for the field?

An elevated ApoB/ApoA ratio is independently associated with an increased risk of sudden sensorineural hearing loss (SSNHL) in a linear dose-response manner. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Zhisong Yan; Weilin Chen; Xiaoyang Cao; Xiao Chen

doi:10.3389/fendo.2026.1955992

October 15, 2026Frontiers in EndocrinologyOpen Access

Elevated ApoB/ApoA ratio is associated with increased risk of sudden sensorineural hearing loss

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Key result

Elevated ApoB/ApoA ratio linked to ~9.3-fold higher risk of sudden sensorineural hearing loss.

OR 9.34
95% CI 3.93-22.21
n=1,211

Why the study?

The association between the apolipoprotein B to apolipoprotein A (ApoB/ApoA) ratio and sudden sensorineural hearing loss (SSNHL) risk in Nantong, China required investigation.

Is an elevated ApoB/ApoA ratio associated with an increased risk of sudden sensorineural hearing loss in Chinese adults?

Key Points

To evaluate the association between the apolipoprotein B to apolipoprotein A (ApoB/ApoA) ratio and the risk of sudden sensorineural hearing loss (SSNHL).
Cross-sectional study analyzing 1211 participants (674 normal hearing controls and 537 patients with SSNHL) in Nantong, China.
Evaluated the association using multivariable logistic regression adjusted for baseline demographics, comorbidities, and laboratory biochemical indicators.
Conducted sensitivity analyses using 1:1 propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and generalized additive dose-response models.
In the fully adjusted multivariable model, an elevated continuous ApoB/ApoA ratio was significantly associated with increased SSNHL risk (OR = 9.34, 95% CI: 3.93-22.21), which remained consistent after PSM adjustment (OR = 8.79, 95% CI: 3.26-23.66).
IPTW categorical analysis showed participants in the high-ratio group (0.78-1.34) had a higher risk of SSNHL than those in the low-ratio group (0.13-0.58) (OR = 2.28, 95% CI: 1.79-2.90).
Dose-response analysis revealed a significant linear positive correlation between the ApoB/ApoA ratio and SSNHL risk, with no significant interaction observed across age, sex, hypertension, or diabetes subgroups (all P for interaction > 0.05).

Study Design

Type

Cross-Sectional (n=1,211)

Multicenter

No

Structured PICO

Is an elevated ApoB/ApoA ratio associated with an increased risk of sudden sensorineural hearing loss in Chinese adults?

P

Population

1,211 adults aged 20-85 years in Nantong, China (537 with sudden sensorineural hearing loss and 674 normal hearing controls) evaluated in a single-center retrospective cross-sectional study.

E

Exposure

Elevated apolipoprotein B to apolipoprotein A (ApoB/ApoA) ratio (evaluated continuously per 1-unit increase and by tertiles: high-ratio group 0.78-1.34, medium-ratio group 0.58-0.78)

C

Comparator

Lower ApoB/ApoA ratio (continuous reference or low-ratio tertile group 0.13-0.58)

O

Outcome

Prevalence/risk of sudden sensorineural hearing loss (SSNHL), defined as sensorineural hearing loss of ≥30 dB over at least three contiguous audiometric frequencies occurring within 72 hours, diagnosed via clinical examination and standardized pure-tone audiometryhard clinical

Main Result

Odds Ratio: 9.34 (95% CI 3.93–22.21)

Limitations

Retrospective cross-sectional design cannot establish a causal relationship.
Single-center study representing a specific regional Chinese population, limiting generalizability.
Relied on a single admission biochemical test without longitudinal monitoring of apolipoprotein levels.
Detailed quantitative audiometric data (specific frequency thresholds and curve configurations) were not systematically extracted.
Unmeasured confounders such as smoking history, lifestyle habits, and prior use of statins or other lipid-lowering medications were not included in the models.
Retrospective cross-sectional design cannot establish causality
Single-center study in Nantong, China, limiting generalizability
Single baseline biochemical measurement without longitudinal tracking of lipid levels or hearing recovery
Lack of structured audiometric configuration and severity grade data in the electronic medical record
Missing adjustment for smoking, lifestyle factors, and prior statin/lipid-lowering medication use

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Implication

An elevated ApoB/ApoA ratio is independently and linearly associated with a significantly higher risk of sudden sensorineural hearing loss across age, sex, hypertension, and diabetes subgroups, suggesting utility as a metabolic biomarker for inner ear microvascular risk.

Abstract

Objective: To investigate the association between the apolipoprotein B to apolipoprotein A (ApoB/ApoA) ratio and sudden sensorineural hearing loss (SSNHL) risk in Nantong, China. Methods: This cross-sectional study included 1211 participants (674 with normal hearing, 537 with SSNHL). Baseline demographics, comorbidities, and biochemical indicators were compared. Multivariable logistic regression evaluated the independent association between the ApoB/ApoA ratio and SSNHL risk. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were applied for sensitivity analysis. Stratified and dose-response analyses were also conducted. Results: The groups differed significantly in age, sex, hypertension, BMI, and various metabolic markers (all P < 0.05). In the fully adjusted model, an elevated ApoB/ApoA ratio was significantly associated with increased SSNHL risk (OR = 9.34, 95% CI: 3.93-22.21). This positive association remained robust after PSM (OR = 8.79, 95% CI: 3.26-23.66). IPTW analysis showed the high-ratio group (0.78-1.34) had a higher SSNHL risk than the low-ratio group (0.13-0.58) (OR = 2.28, 95% CI: 1.79-2.90). Dose-response analysis indicated a significant linear positive correlation between the ratio and SSNHL prevalence, both before and after PSM. Stratified analyses demonstrated this association remained consistent across age, sex, hypertension, and diabetes subgroups (all P for interaction > 0.05). Conclusion: A high ApoB/ApoA ratio has a significant linear positive association with increased SSNHL risk. It serves as an independent clinical biomarker for SSNHL risk assessment, providing a basis for metabolic management.

Discussion

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Cite This Study

Yan et al. (2026) conducted a cross-sectional in Sudden sensorineural hearing loss (SSNHL) (n=1,211). Elevated apolipoprotein B to apolipoprotein A (ApoB/ApoA) ratio vs. Lower ApoB/ApoA ratio (continuous per 1-unit increase, or low-ratio tertile 0.13-0.58) was evaluated on Risk of sudden sensorineural hearing loss (SSNHL) (OR 9.34, 95% CI 3.93-22.21). An elevated ApoB/ApoA ratio was independently associated with a higher risk of sudden sensorineural hearing loss in the fully adjusted multivariable model (OR 9.34, 95% CI 3.93-22.21).

synapsesocial.com/papers/6aee6b8671a7594806220979 https://doi.org/10.3389/fendo.2026.1955992

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Elevated ApoB/ApoA ratio is associated with increased risk of sudden sensorineural hearing loss

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Elevated ApoB/ApoA ratio is associated with increased risk of sudden sensorineural hearing loss

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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