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Sabz G, Rad F, Saraei A. The Relationship of Serum Ferritin Levels and Age with Hearing Disorders in Patients with Beta-Thalassemia Major. bloodj 2025; 22 (4) :316-326
URL: http://bloodjournal.ir/article-1-1600-en.html
The Relationship of Serum Ferritin Levels and Age with Hearing Disorders in Patients with Beta-Thalassemia Major
Gholamabbas Sabz , Fariba Rad * , Atefeh Saraei
Keywords: beta-Thalassemia Major, Iron Chelating Agents, Hearing Disorders
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References:
  1. Ansharullah BA, Sutanto H, Romadhon PZ. Thalassemia and iron overload cardiomyopathy: Pathophysiological insights, clinical implications, and management strategies. Curr Probl Cardiol 2025; 50(1): 102911. [DOI:10.1016/j.cpcardiol.2024.102911] [PMID]
  2. Wang LE, Muttar S, Badawy SM. The challenges of iron chelation therapy in thalassemia: how do we overcome them? Expert Rev Hematol 2025; 18(5): 351-7. [DOI:10.1080/17474086.2025.2489562] [PMID] []
  3. Herdata HN, Taufani V, Destiani E, Andid R. The association between serum ferritin levels and growth parameters in children with β-thalassemia major. AcTion: Aceh Nutrition Journal 2025; 10(3): 720-5. [DOI:10.30867/action.v10i3.2681]
  4. Tartaglione I, Carfora R, Brotto D, Barillari MR, Costa G, Perrotta S, et al. Hearing loss in beta-thalassemia: systematic review. J Clin Med 2021; 11(1): 102. [DOI:10.3390/jcm11010102] [PMID] []
  5. Musiek FE, Chermak GD. Handbook of central auditory processing disorder, volume I: Auditory neuroscience and diagnosis. USA: Plural Pub Inc; 2013.
  6. Alanazi AA. Understanding auditory processing disorder: A narrative review. Saudi J Med Med Sci 2023; 11(4): 275-82. [DOI:10.4103/sjmms.sjmms_218_23] [PMID] []
  7. Khavidaki GA, Gharibi R, Naderi M, Sedaghatkia H. The Investigation of Hearing Loss in Patients with Thalassemia Major Referred to Hazrat Ali Asghar (AS) Hospital in Sistan and Baluchistan Province (Iran). Maedica (Bucur) 2024; 19(4): 731-5. [DOI:10.26574/maedica.2024.19.4.731] [PMID] []
  8. Ashrafi M, Mohammadzadeh A. Hearing status of thalassemic patients treated with dessfroxamin. J Kermanshah Univ Med Sci 2012; 15(5): e79024. [Article in Farsi]
  9. Mohammed SH, Shab-Bidar S, Abuzerr S, Habtewold TD, Alizadeh S, Djafarian K. Association of anemia with sensorineural hearing loss: a systematic review and meta-analysis. BMC Res Notes 2019; 12(1): 283. [DOI:10.1186/s13104-019-4323-z] [PMID] []
  10. Aldè M, Ambrosetti U, Giuditta M, Cassinerio E, Piatti G. Effects on hearing after long-term use of iron chelators in beta-thalassemia: Over twenty years of longitudinal follow-up. Auris Nasus Larynx. 2024; 51(2): 271-5. [DOI:10.1016/j.anl.2023.10.005] [PMID]
  11. Horikawa C, Kodama S, Tanaka S, Fujihara K, Hirasawa R, Yachi Y, et al. Diabetes and risk of hearing impairment in adults: a meta-analysis. J Clin Endocrinol Metab 2013; 98(1): 51-8. [DOI:10.1210/jc.2012-2119] [PMID]
  12. Hasan AF, Salman HH, Khalaf JM. Evaluation of hearing in patients with Beta Thalassemia Major. Basrah Journal of Surgery 2018; 24: 47-51. [DOI:10.33762/bsurg.2018.160106]
  13. Badfar G, Mansouri A, Shohani M, Karimi H, Khalighi Z, Rahmati S, et al. Hearing loss in Iranian thalassemia major patients treated with deferoxamine: A systematic review and meta-analysis. Caspian J Intern Med 2017; 8(4): 239-49.
  14. Bhatia PL, Gupta OP, Agrawal MK, Mishr SK. Audiological and vestibular function tests in hypothyroidism. Laryngoscope. 1977; 87(12): 2082-9. [DOI:10.1288/00005537-197712000-00014] [PMID]
  15. Reisi N, Kargoshaei AA. Prevalence of hearing loss in patients with Beta thalassemia major, Hajar hospital of Shahrekord, 2002. Journal of Shahrekord University of Medical Sciences 2004; 6(2): 31. [Article in Farsi]
  16. Chahkandi T, Moffateh MR, Sharifzadeh Gh.R, Azarkar Z. Hearing impairment in patients with major thalassemia in Southern Khorasan Province, 2007. Journals of Birjand University of Medical Sciences 2011; 18(2): 102-8. [Article in Farsi]
  17. Campani F, Rezaei N, Yusefi GH. Evaluation of hearing and otolaryngologic disorders in patients with thalassemia treated with deferoxamine. Sci J Kurdistan Univ Med Sci 2009; 14(3): 47-55. [Article in Farsi]
  18. Faranoush  M,  Faranoush  P,  Heydari I, Foroughi-Gilvaee MR, Azarkeivan A, Parsai Kia A, et al. Complications in patients with transfusion dependent thalassemia: A descriptive cross-sectional study. Health Sci Rep 2023; 6(10): e1624. [DOI:10.1002/hsr2.1624] [PMID] []
  19. Poosheshdoost P, Faraji N, Zeinali T, Baghersalimi A, et al. Visual and auditory complications during deferasirox therapy in beta-thalassemia. Iran J Ped Hematol Oncol 2022; 12(4): 229-39. [Article in Farsi] [DOI:10.18502/ijpho.v12i4.10913]
  20. Tiwana BS, Aggarwal A, Bhagat S, Singh H, Sahni D, Yadav V. Assessing the auditory effects of oral chelation therapy drug Deferasirox in individuals with β-thalassemia major. World J Otorhinolaryngol Head Neck Surg 2024; 10(4): 309-14. [DOI:10.1002/wjo2.150] [PMID] []




The Relationship of Serum Ferritin Levels and Age
with Hearing Disorders in Patients with
Beta-Thalassemia Major
 ‎
Gholamabbas Sabz1      , Fariba Rad2      , Atefeh Saraei3


1Department of Surgery, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
2Department of Basic Sciences, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
3Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
Received: 2025/10/08
Accepted: 2026/01/07
 





     http://dx.doi.org/10.61882/bloodj.22.2.160
    



Citation:
Sabz Gh, Rad F, Saraei A. The Relationship of Serum Ferritin Levels and Age with Hearing Disorders in Patients with Beta-Thalassemia Major. J Iran Blood Transfus. 2025: 22 (4): 316-326
    



Correspondence: Rad F., Associate Professor of Department of Basic Sciences, School of Medicine, Yasuj University of Medical Sciences.
Postal Code: 7591741417, Yasuj, Iran.
Tel: (+9835) 38249517         
E-mail: fariba.rad89@gmail.com		 A B S T R A C T
Background and Objectives
Patients with beta-thalassemia major are at risk of sensorineural hearing impairment due to iron deposition in the auditory system from chronic blood transfusions. This study was conducted to investigate the relationship between serum ferritin levels and age with hearing disorders in patients with beta thalassemia major in Yasuj, Iran.
Materials and Methods
In this cross-sectional, descriptive-analytical study, 96 patients with beta-thalassemia major in Yasuj were evaluated during the years 2024-2025. Demographic information, laboratory results, and audiometry data were collected. Statistical analysis was performed using SPSS with appropriate tests, including the independent t-test, chi-square and Mann-Whitney U test.
Results
The mean age of the patients was 25.27 ± 9.25 years. Hearing disorders was present in 10.42% (n=10) of patients. Among the 10 patients with hearing disorders, 90% (n=9) had sensorineural hearing loss, and 10% (n=1) had mixed-type hearing loss. Regarding severity, 50% (n=5) had mild, 10% (n=1) moderate and 40% (n=4) severe impairment. A total of 51% of the patients were concurrently using both deferoxamine and deferasirox. A significant association was found between increased age and hearing disorders (p= 0.04). However, no significant association was observed between hearing disorders and serum ferritin levels (P-value = 0.44).
Conclusions 
The significant association between increased age and hearing impairment carries a clear clinical message, older patients with thalassemia major represent a high-risk group for hearing disorders. This finding underscores the necessity of implementing a structured, lifelong audiological monitoring protocol, with increased screening, frequency in older patients to enable early defection and intervention.
Key words: beta-Thalassemia Major, Iron Chelating Agents, Hearing Disorders


Copyright © 2025 Journal of Iranian Blood Transfusion, Published by Blood Transfusion Research Center.
This work is licensed under a Creative Common Attribution-Non Commercial 4.0 International license.




Type of Study: Research | Subject: Hematology
References
1. Ansharullah BA, Sutanto H, Romadhon PZ. Thalassemia and iron overload cardiomyopathy: Pathophysiological insights, clinical implications, and management strategies. Curr Probl Cardiol 2025; 50(1): 102911. [DOI:10.1016/j.cpcardiol.2024.102911] [PMID]
2. Wang LE, Muttar S, Badawy SM. The challenges of iron chelation therapy in thalassemia: how do we overcome them? Expert Rev Hematol 2025; 18(5): 351-7. [DOI:10.1080/17474086.2025.2489562] [PMID] []
3. Herdata HN, Taufani V, Destiani E, Andid R. The association between serum ferritin levels and growth parameters in children with β-thalassemia major. AcTion: Aceh Nutrition Journal 2025; 10(3): 720-5. [DOI:10.30867/action.v10i3.2681]
4. Tartaglione I, Carfora R, Brotto D, Barillari MR, Costa G, Perrotta S, et al. Hearing loss in beta-thalassemia: systematic review. J Clin Med 2021; 11(1): 102. [DOI:10.3390/jcm11010102] [PMID] []
5. Musiek FE, Chermak GD. Handbook of central auditory processing disorder, volume I: Auditory neuroscience and diagnosis. USA: Plural Pub Inc; 2013.
6. Alanazi AA. Understanding auditory processing disorder: A narrative review. Saudi J Med Med Sci 2023; 11(4): 275-82. [DOI:10.4103/sjmms.sjmms_218_23] [PMID] []
7. Khavidaki GA, Gharibi R, Naderi M, Sedaghatkia H. The Investigation of Hearing Loss in Patients with Thalassemia Major Referred to Hazrat Ali Asghar (AS) Hospital in Sistan and Baluchistan Province (Iran). Maedica (Bucur) 2024; 19(4): 731-5. [DOI:10.26574/maedica.2024.19.4.731] [PMID] []
8. Ashrafi M, Mohammadzadeh A. Hearing status of thalassemic patients treated with dessfroxamin. J Kermanshah Univ Med Sci 2012; 15(5): e79024. [Article in Farsi]
9. Mohammed SH, Shab-Bidar S, Abuzerr S, Habtewold TD, Alizadeh S, Djafarian K. Association of anemia with sensorineural hearing loss: a systematic review and meta-analysis. BMC Res Notes 2019; 12(1): 283. [DOI:10.1186/s13104-019-4323-z] [PMID] []
10. Aldè M, Ambrosetti U, Giuditta M, Cassinerio E, Piatti G. Effects on hearing after long-term use of iron chelators in beta-thalassemia: Over twenty years of longitudinal follow-up. Auris Nasus Larynx. 2024; 51(2): 271-5. [DOI:10.1016/j.anl.2023.10.005] [PMID]
11. Horikawa C, Kodama S, Tanaka S, Fujihara K, Hirasawa R, Yachi Y, et al. Diabetes and risk of hearing impairment in adults: a meta-analysis. J Clin Endocrinol Metab 2013; 98(1): 51-8. [DOI:10.1210/jc.2012-2119] [PMID]
12. Hasan AF, Salman HH, Khalaf JM. Evaluation of hearing in patients with Beta Thalassemia Major. Basrah Journal of Surgery 2018; 24: 47-51. [DOI:10.33762/bsurg.2018.160106]
13. Badfar G, Mansouri A, Shohani M, Karimi H, Khalighi Z, Rahmati S, et al. Hearing loss in Iranian thalassemia major patients treated with deferoxamine: A systematic review and meta-analysis. Caspian J Intern Med 2017; 8(4): 239-49.
14. Bhatia PL, Gupta OP, Agrawal MK, Mishr SK. Audiological and vestibular function tests in hypothyroidism. Laryngoscope. 1977; 87(12): 2082-9. [DOI:10.1288/00005537-197712000-00014] [PMID]
15. Reisi N, Kargoshaei AA. Prevalence of hearing loss in patients with Beta thalassemia major, Hajar hospital of Shahrekord, 2002. Journal of Shahrekord University of Medical Sciences 2004; 6(2): 31. [Article in Farsi]
16. Chahkandi T, Moffateh MR, Sharifzadeh Gh.R, Azarkar Z. Hearing impairment in patients with major thalassemia in Southern Khorasan Province, 2007. Journals of Birjand University of Medical Sciences 2011; 18(2): 102-8. [Article in Farsi]
17. Campani F, Rezaei N, Yusefi GH. Evaluation of hearing and otolaryngologic disorders in patients with thalassemia treated with deferoxamine. Sci J Kurdistan Univ Med Sci 2009; 14(3): 47-55. [Article in Farsi]
18. Faranoush M, Faranoush P, Heydari I, Foroughi-Gilvaee MR, Azarkeivan A, Parsai Kia A, et al. Complications in patients with transfusion dependent thalassemia: A descriptive cross-sectional study. Health Sci Rep 2023; 6(10): e1624. [DOI:10.1002/hsr2.1624] [PMID] []
19. Poosheshdoost P, Faraji N, Zeinali T, Baghersalimi A, et al. Visual and auditory complications during deferasirox therapy in beta-thalassemia. Iran J Ped Hematol Oncol 2022; 12(4): 229-39. [Article in Farsi] [DOI:10.18502/ijpho.v12i4.10913]
20. Tiwana BS, Aggarwal A, Bhagat S, Singh H, Sahni D, Yadav V. Assessing the auditory effects of oral chelation therapy drug Deferasirox in individuals with β-thalassemia major. World J Otorhinolaryngol Head Neck Surg 2024; 10(4): 309-14. [DOI:10.1002/wjo2.150] [PMID] []
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