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J Nat Sci. Author manuscript; available in PMC 2015 October 02. Published in final edited form as: J Nat Sci. 2015 August ; 1(8): .

Assessing Systemic Stress in Otolaryngology: Methodology and Feasibility of Hair and Salivary Cortisol Testing Dane J. Genther1,2,*, Mark L. Laudenslager3, Yoon-kyu Sung2, Caitlin R. Blake2, David S. Chen1,2, and Frank R. Lin1,2,4,5 1Department

of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., Suite 6210, Baltimore, Maryland 21287, USA

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2Center

on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, Maryland 21205, USA

of Psychiatry, University of Colorado School of Medicine, 12700 E. 19th Ave., Building RC2, Aurora, Colorado 80045, USA

3Department

4Department

of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Cr., John R. Burton Pavilion, Room 163, Baltimore, Maryland 21224, USA 5Departments

of Epidemiology and Mental Health, Johns Hopkins University Bloomberg School of Public Health, 615 Wolfe St., Baltimore, Maryland 21205, USA

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Abstract Objective—Elevated systemic stress is a predictor of adverse health outcomes, and stress can be objectively quantified by cortisol concentration. Despite its utility, such testing is rarely performed in otolaryngology. This manuscript provides details on the principles, methodology, and feasibility of performing laboratory assessments of hair and salivary cortisol to inform researchers wishing to incorporate these novel tests in future otolaryngologic studies. Methods—Participants were older adults with hearing impairment. One hair sample and eight saliva samples were collected. Feasibility of study design was assessed through rates of participation in hair and saliva sampling and protocol adherence for saliva collection. Area under the curve (AUC) was used to evaluate overall secretion, and cortisol awakening response (CAR) was used to evaluate the dynamic secretion response.

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Results—From 9/1/2013 to 12/31/2013, 26/30 (86.7%) eligible participants agreed to hair sampling. All 30 subjects agreed to collect saliva, with 29 (96.7%) adhering to the collection protocol. Mean AUC was 401.2 nmol/L per hour, and CAR was 4.5 nmol/L.

*

Corresponding Author. Dane J. Genther, M.D. 601 N. Caroline St. JHOC 6210, Baltimore, MD 21287, USA. Telephone: (410) 955-1932; Fax: (410) 955-6526. [email protected]. Conflict of Interest Disclosures All authors do not report any conflicts of interest beyond those outlined in the financial disclosures section.

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Conclusions—Evaluating systemic stress in an otolaryngologic population using hair and saliva is feasible with acceptable participation and adherence. Repeat measurements over time will allow for evaluation of changes in systemic stress in relation to treatment. Keywords Cortisol; feasibility; methodology; hair cortisol testing; salivary cortisol testing; systemic stress

Introduction

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Systemic stress refers to the body’s nonspecific responses to attempt to adapt to a perturbation, and elevated stress can lead to an increase in allostatic load, which is the sum of all physiologic effort to compensate for perturbations caused by a stressor [1]. Chronic stress and allostatic load have been associated with the exacerbation or development of various disease states, including poor mental health, impaired cognitive function, cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, and poor pregnancy outcomes [1-3]. Various otolaryngologic populations with chronic disease, such as hearing loss, prolonged vestibular dysfunction, chronic sinusitis, recalcitrant tracheal or glottic stenosis, or advanced cancer, would likely benefit from research examining how these conditions contribute to chronic stress and broader health outcomes.

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Allostatic load is often determined through measurement of systemic cortisol levels. Cortisol is a well-recognized, reliable biomarker of stress and allostatic load [1]. Current standard laboratory tests to determine cortisol levels use urine or blood samples; however, these media have significant disadvantages. A useful urine sample typically requires a 24-hour collection period, mandating that the collecting individual remain home or transport a large collection container throughout the day, and collection of blood is invasive and requires specially trained personnel. Fortunately, additional media for testing that address the disadvantages of conventional media have recently been identified. Testing of hair, the most novel medium, allows for determination of a person’s average cortisol level over the previous 3-month period, and saliva testing allows for determination of an individual’s realtime cortisol level. Both of these media offer the advantages of being non-invasive, easily collected with minimal instruction, and biochemically stable in a variety of environments.

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These newer media have been used as research tools to determine stress levels in various medical specialties. However, to date, there are no reports of the use of hair cortisol testing in an otolaryngologic population, and there are no detailed descriptions of the protocols related to hair and salivary cortisol testing in the otolaryngology literature. Therefore, to inform researchers wishing to incorporate these novel tests in future otolaryngologic studies, we herein provide details on the principles, methodology, data analysis techniques, and feasibility of performing laboratory assessments of hair and saliva for cortisol analysis. Preliminary data were gathered as part of a larger prospective study (Studying Multiple Outcomes after Aural Rehabilitative Treatment [SMART] study) that is investigating the impact of hearing aids and cochlear implants on cognitive and social functioning in older adults.

J Nat Sci. Author manuscript; available in PMC 2015 October 02.

Genther et al.

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Materials and Methods Study Population Participants were adults aged 50 years and older who were enrolled in the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study, a prospective observational study aimed at evaluating the cognitive, social, and physical functioning of older adults with post-lingual hearing impairment before and after treatment with a hearing aid or cochlear implant. To qualify for the study, participants were required to be English-speaking, use verbal language as their primary means of communication, and to be receiving a hearing aid for the first time or with minimal prior use (

Assessing Systemic Stress in Otolaryngology: Methodology and Feasibility of Hair and Salivary Cortisol Testing.

Elevated systemic stress is a predictor of adverse health outcomes, and stress can be objectively quantified by cortisol concentration. Despite its ut...
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