Association Between Psoriasis with Arthritis and Hearing Impairment in US Adults: Data from the National Health and Nutrition Examination Survey

Abstract

Objective.Emerging data has linked inflammatory arthritis with hearing impairment (HI). The objective of this study was to investigate the relationship between psoriasis with arthritis (PsA) and HI in the US population. Given the known association of HI and depression, a secondary aim is to investigate the effect of PsA on mental well-being.Methods.Cross-sectional study using the National Health and Nutrition Examination Survey for adults aged ≥ 20 years (n = 10,747). Association of PsA with above outcomes was examined using multivariable generalized linear and ordinal logistic regression models, adjusted for demographics and medical comorbidities. Structural equation models examined the extent to which HI mediated the effect of PsA on mental health.Results.Individuals with PsA were more likely to report hearing difficulties (OR 1.50, p = 0.043), visit a mental health provider (OR 1.62, p = 0.084), have 1.62 more days of poor mental health over the previous month (p = 0.033), and have depression (OR 2.01, p = 0.015) compared to controls. HI mediated 6.5%, 8.3%, and 5.0% of the effect of PsA on the above mental health outcomes, respectively.Conclusion.PsA is independently associated with a significantly increased risk of HI, which partially mediates an association with worsened psychiatric outcomes.

Association of Psoriasis With Hearing Loss: A Systematic Review and Meta-Analysis

“…31 One case-control and two cross-sectional studies assessed the association of psoriasis with SNHL. 24,27,29 The metaanalysis of these three studies with 10,850 subjects illustrated a significant association of psoriasis with SNHL (pooled OR 3.85; 95% CI 1.07-13.9; I 2 = 94%; Figure 4). 24,27,29 The Semonov 2019 study used hearing impairment instead of SNHL, 24 which did not fully represent SNHL even though SNHL accounts for 90% of hearing loss.…”

“…Of the included 12 case-control or cross-sectional studies, 3 provided only diagnosis of SNHL 24,27,29 whereas the other 9 studies provided audiometric data. 25,26,28,[30][31][32][33][34][35] Of the nine studies with audiometric data, six studies with 532 subjects provided data on the mean and SD of hearing test in which we performed a meta-analysis.…”

“…Two of these studies investigated PTA thresholds, 25,26 and two other studies assessed the diagnosis of SNHL. 24,27 In the Akdag 2015 study, all frequencies across 500Hz to 6000 Hz in patients with psoriatic arthritis were significantly different from the healthy controls (MD 5.55, 95% CI 1.84 to 9.26 at 500 Hz; MD 5.75, 95% CI 2.99 to 8.51 at 1000 Hz; MD 8.15, 95% CI 4.76 to 11.54 at 2000 Hz; MD 13.15, 95% CI 5.34 to 20.96 at 4000 Hz; MD 17.05, 95% CI 8.56 to 25.54 at 6000 Hz). 25 In the Gunes 2016 study, patients with psoriatic arthritis showed significant differences from the healthy controls at PTA thresholds of 4000 Hz (MD 13.63, 95% CI 3.3 to 23.96) and 6000 Hz (MD 13.59, 95% CI 3.46 to 23.72), but there was no difference between the two groups in the pure tone average.…”

Otologic Manifestations of Psoriasis: A Systematic Review and Meta-Analysis

“…One population-based study (42) from the United States provided data on subjective hearing loss. Compared with subjects without psoriasis, subjects with psoriasis had fewer reports of "excellent" hearing and greater reports of "some difficulty," "a lot of difficulty," or "deaf " hearing.…”

Generalized pustular psoriasis with deficiency of interleukin‐36 receptor antagonist associated with sensorineural hearing impairment

“…3 Psoriasis is a T-helper 17-mediated autoimmune disorder with overproduction of pro-inflammatory cytokines such as tumor necrosis factor (TNF)α. TNFα has been shown to mediate damage to the inner ear, which can result in sensorineural hearing impairment. 4 Two pathways, the TNFα/IL-23/IL-17 axis and the functional activation of IL-36 receptor, are closely related and mutually reinforced in psoriasis including GPP. 5 The hearing impairment did not change by the treatment with brodalumab in our case, probably because the long time passed since the onset of hearing impairment.…”