Carotenoid Consumption Linked to Less Hearing Loss in Kids

Medscape

06-05-2025

Consuming foods high in carotenoids appeared to be modestly linked to a reduced risk for pediatric hearing loss, according to a poster presented at the Pediatric Academic Societies (PAS) 2025 Meeting.
'Pediatric hearing loss increases with age due to otitis media, trauma, ototoxic medications, and/or noise exposure, impacting behavioral and language development,' Julia M. Morales, medical student at Baylor College of Medicine in Houston, and her colleagues reported.
The hypothesis underlying the study focuses on the idea that dietary antioxidants may mitigate damage from oxidative stress from loud noises and other insults that can harm cochlear structures and exacerbate hearing loss. Carotenoids have antioxidant properties, and vitamin A, a carotenoid metabolite, has been shown to reduce the risk for hearing loss from infections in some low-resource settings.
'The findings are intuitively plausible,' Daniel Choo, MD, professor, Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, and Akron Children's Hospital, Akron, Ohio, told Medscape Medical News .
'There are significant data demonstrating that oxidative stress can damage or kill cochlear cells and subsequently cause sensorineural hearing loss,' said Choo, who was not involved in the study. 'Several lines of research also show that antioxidants can likely protect the cochlea from a variety of insults including noise trauma, chemotherapy-related, and some antibiotic (aminoglycoside)-related hearing loss, so proposing that the antioxidant effects of carotenoids might protect hearing doesn't seem unreasonable.'
The researchers analyzed data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), which provided dietary recalls for assessing carotenoid and vitamin A intake and both self-reported hearing loss and pure-tone audiometry for assessing hearing ability. The researchers calculated the association between carotenoid intake and pure-tone audiometry.
The sample included 2502 youths with an average age of 12 years, including 1048 children aged 6-11 years and 1454 adolescents aged 12-19 years. The incidence of mild speech-frequency hearing loss — loss of the ability to hear sounds within the frequency range of human speech — was 1.6% in the sample. In addition, 3.01% had mild high-frequency hearing loss, and 0.04% had moderate high-frequency hearing loss.
Self-reported hearing quality was rated as being excellent by 64.5% of participants, being good by 31.6%, having 'a little trouble' by 3.4%, having moderate trouble by 0.5%, and having a lot of trouble by 0.08%. None reported deafness. A little less than half the participants (45.8%) had a history of at least three ear infections.
The researchers did not identify any associations between carotenoid or provitamin A intake and ear infections. However, children with self-reported hearing loss consumed less beta-cryptoxanthin ( P < .001), lutein plus zeaxanthin ( P < .001), vitamin A from carotenoids ( P = .047), and provitamin A carotenoids ( P = .03).
The researchers also identified a link between high-frequency hearing loss and several carotenoids: Greater hearing loss was associated with a lower intake of alpha-carotene ( P < .002), beta-carotene ( P < .02), provitamin A carotenoids ( P < .015), and vitamin A from carotenoids ( P < .02). After adjusting for confounders, children consuming the highest quartile of beta-cryptoxanthin and alpha-carotene had about half the odds of high-frequency hearing loss (adjusted odds ratio [aOR], 0.47; P = .04 and aOR, 0.42; P = .01, respectively).
Similarly, a significant inverse association existed between speech-frequency hearing loss and beta-carotene, alpha-carotene, lutein plus zeaxanthin, provitamin A carotenoids, vitamin A from carotenoids, retinol, total vitamin A, and total carotenoids ( P < .01 for all). In the adjusted analysis, however, the intake of any carotenoids was not significantly associated with speech-frequency hearing loss.
'Speech-frequency hearing loss is often conductive, from ear infections, while high-frequency [hearing loss] reflects sensorineural damage from noise and oxidative stress,' the authors wrote. 'However, the lack of association with ear infection history indicates carotenoids may be more relevant to sensorineural than conductive pathways.'
Overall, the poster findings reinforce one reason that vegetables are a beneficial part of a healthy diet, with carotenoids, in particular, likely providing a protective effect for hearing, among other benefits, Choo said.
'The implications from this research are that children should have the 'proper' amount of carotenoids in their diet,' he said. 'However, this study doesn't really address how much carotenoids a child needs to achieve an otoprotective effect against sensorineural hearing loss. The research also doesn't specify what carotenoids should be ingested, how frequently, or in what format.'
Food sources of carotenoids in NHANES included carrots, sweet potatoes, bell peppers, spinach, kale, and broccoli. 'If nothing else, incorporating these vegetables into a child's diet is almost never going to be a bad thing,' Choo said.
Other limitations included the study's reliance on dietary recall and the lack of objective measurements for how much carotenoids the participants consumed, so the study lacks the rigor of a well-controlled study, Choo pointed out.
The research was funded by the US Department of Agriculture. The authors did not report having any disclosures. Choo is a site principal investigator for an otoferlin gene therapy trial funded by Akouos and Eli Lilly and consults for 3NT Medical and Decibel/Regeneron.