In reference to A prospective study of cardiovascular risk factors and incident hearing loss in men.

By failing to ascertain the type and degree of hearing loss of a large cohort of professional men in their article titled ‘‘A Prospective Study of Cardiovascular Risk Factors and Incident Hearing Loss in Men,’’ Shargorodsky et al. confound the relation of new-onset hearing loss with cardiovascular disease risk factors. Treating hearing loss as a single yes/no entity fails to include important information about possible etiology. For example, they could have easily asked the participants on their questionnaires whether the loss was unilateral or bilateral. The vast majority of people with sudden unilateral sensorineural loss are diagnosed with sudden deafness, which has been suspected as having a vascular etiology. The richness of their database might possibly have uncovered important clues about the health status of people with incident unilateral hearing loss. Distinguishing high-frequency from low-frequency loss is important in examining the link between cardiovascular disease and hearing loss. As our group noted earlier, the strongest association of cardiovascular disease events was with low-frequency hearing loss in both sexes, more in women than in men. Because low-frequency loss is uncommon in adults and high-frequency loss is the hallmark of presbycusis, it is not surprising that few associations were uncovered in the present report. If we are to clarify the links between age-related hearing loss and age-related diseases, we need more detail, not less, about the nature and trajectory of the hearing dysfunction. Absent even rudimentary information about the type and degree of hearing loss in their subjects, the importance of the report of Shargorodsky et al. is unclear. It would not be a huge task to obtain the audiograms and complete this study.