Estrogen deficiency and risk of hearing loss in pediatric Turner syndrome

Yan Huang; Liyang Liang; Yanfang Ye; Lina Zhang; Li Ling; Zhe Meng; Wei Liu; Jia Guo; Zulin Liu; Zhen Zhao; Zhigang Zhang; Yu Si

doi:10.1172/JCI197932

Estrogen deficiency and risk of hearing loss in pediatric Turner syndrome

Yan Huang,¹ Liyang Liang,² Yanfang Ye,³ Lina Zhang,² Li Ling,³ Zhe Meng,⁴ Wei Liu,⁵ Jia Guo,⁵ Zulin Liu,² Zhen Zhao,¹ Zhigang Zhang,¹ and Yu Si¹

Published March 3, 2026 - More info

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Abstract

BACKGROUND. Estrogen deficiency and progressive hearing loss (HL) are significant concerns in individuals with Turner syndrome (TS). However, whether childhood estrogen deficiency increases HL risk and whether estrogen replacement therapy (ERT) prevents hearing deterioration are still unclear.

METHODS. This prospective cohort study recruited children with TS from a tertiary referral center between 2016 and 2024. All participants received standardized recombinant human growth hormone therapy. Longitudinal monitoring data of hormone levels, metabolic parameters, and annual audiological examinations were recorded. The primary analysis used a multivariate Cox model to estimate the adjusted hazard ratio of hearing loss between estrogen-deficient and estrogen-normal TS patients without prior exogenous estrogen exposure. The secondary analysis compared annual pure tone average (PTA) and its changes between the ERT and non-ERT groups in a substudy.

RESULTS. Among 87 prepubertal pediatric TS patients, 48 (55.2%) were estrogen-deficient, 38 HL events occurred over 35-month median follow-up. The estrogen-deficient group had higher HL incidence (27 cases, 56.3%; 20.6/100 person-years [PY]) versus estrogen-normal (11 cases, 28.2%; 8.6/100 PY), with estrogen deficiency independently increasing HL risk (HR = 2.93; 95%CI:1.21–7.12). Notably, estrogen deficiency also independently predicted abnormal DPOAE with an even higher effect size (HR = 3.98, 95% CI: 1.35–11.76). The substudy found that initiating ERT at age of 12 significantly preserve auditory function, with the ERT group showing markedly lower PTA and slower hearing deterioration (–1.24 dB/y vs. 1.13 dB/y right ear; –1.85 dB/y vs. 1.04 dB/y left ear, P = 0.001).

CONCLUSION. Childhood estrogen deficiency is a modifiable risk factor. Initiating ERT around early adolescence may help hearing preservation.

TRIAL REGISTRATION. ChiCTR2300068063.

FUNDING. National Natural Science Foundation of China (82173154 and 82471155), Fundamental Research Funds for the Central Universities, Clinical Research 5010 Program, Sun Yat-sen University: 2024004.

Estrogen deficiency and risk of hearing loss in pediatric Turner syndrome

Yan Huang,¹ Liyang Liang,² Yanfang Ye,³ Lina Zhang,² Li Ling,³ Zhe Meng,⁴ Wei Liu,⁵ Jia Guo,⁵ Zulin Liu,² Zhen Zhao,¹ Zhigang Zhang,¹ and Yu Si¹

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Estrogen deficiency and risk of hearing loss in pediatric Turner syndrome

Yan Huang,1 Liyang Liang,2 Yanfang Ye,3 Lina Zhang,2 Li Ling,3 Zhe Meng,4 Wei Liu,5 Jia Guo,5 Zulin Liu,2 Zhen Zhao,1 Zhigang Zhang,1 and Yu Si1

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Yan Huang,¹ Liyang Liang,² Yanfang Ye,³ Lina Zhang,² Li Ling,³ Zhe Meng,⁴ Wei Liu,⁵ Jia Guo,⁵ Zulin Liu,² Zhen Zhao,¹ Zhigang Zhang,¹ and Yu Si¹