Association of Alopecia Areata with Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

Abstract

Background: Immune-mediated melanocyte-related pathogenesis in alopecia areata (AA) may cause sensorineural hearing loss (SNHL). However, the relation between AA and SNHL has been unclear. Therefore, we aimed to investigate this association between AA and SNHL. Methods: We performed a systematic review and searched MEDLINE and Embase on July 25, 2022 for cross-sectional, case-control, or cohort studies that examined the association of AA with SNHL. The Newcastle–Ottawa Scale was used to evaluate their risk of bias. A random-effects model meta-analysis was performed to obtain the mean differences in frequency-specific hearing thresholds between AA patients and age-matched healthy controls and the pooled odds ratio for SNHL in relation to AA. Results: We included five case-control studies and one cohort study, with none of them rated with high risk of biases. The meta-analysis showed AA patients had significantly higher mean differences in pure tone hearing thresholds at 4000 Hz and 12000-12500 Hz. The meta-analysis also found increased odds for SNHL among patients with AA (OR 3.18; 95% CI 2.06-4.89; I2 = 0%). Conclusions: AA is associated with an increase of SNHL, especially at high frequencies. Otologic consultation may be indicated if AA patients present with hearing loss or tinnitus.

The Epidemiology of Hospital-Treated Alopecia Areata in Denmark, 1995–2016

“…A study based on claims data from the USA reported an association between the AT/AU subtype and higher occurrence of some autoimmune and inflammatory conditions [ 27 ]. Sensorineural hearing loss is a known disease manifestation of several autoimmune disorders and has been reported in patients with AA [ 28 ]. With regards to the higher prevalence of patients with AT/AU with a history of surgery in the previous 6 months in the present study, postsurgical stress could be associated with hair loss and thus it cannot be ruled out that some AA diagnoses represent misdiagnosed telogen effluvium.…”

Environmental Risk Factors, Protective Factors, and Biomarkers for Hearing Loss: An Umbrella Review

“…Regarding the underlying mechanisms, the influence of melanocytes on the structure and function of the auditory system has been considered as a plausible one 89 . Current evidence suggests that follicular melanocytes may be an important target in the autoimmune process of AA 90 ; additionally, melanocytes are located in the spiral ligament and in the stria vascularis of the inner ear, where they play a crucial role in the potassium channels that regulate cochlear potential and maintain auditory signaling 38 . Therefore, autoimmune‐mediated destruction of melanocytes in the cochlea by inflammatory responses and oxidative stress may cause impaired auditory function.…”

Deciphering the Complex Immunopathogenesis of Alopecia Areata

“…However, the worse outcome of the disease is indicated by a positive family history, childhood onset of AA, nail involvement, atopic dermatitis, and the existence of chronic lesions lasting longer than 12 months [ 16 ]. In addition to its impact on hair loss, AA is associated with the development of concurrent and potentially disease-modifying disorders, including atopic diatheses, like allergic rhinitis and particularly atopic dermatitis, appearing in more than 30% of AA patients [ 17 , 18 ]; autoimmune diseases such as vitiligo and psoriasis [ 19 ]; hidradenitis suppurativa [ 20 ]; thyroid disorders [ 21 ]; lupus erythematosus [ 6 ], pernicious anemia and celiac disease [ 22 ]; irritable bowel syndrome [ 23 ]; insulin resistance [ 24 ]; migraine [ 25 ]; audiologic and ophthalmic abnormalities [ 26 , 27 , 28 , 29 ]; and psychiatric comorbidities such as sleep disorders, anxiety, alexithymia, social phobia, and paranoid and major depression disorder [ 1 , 30 , 31 , 32 ]. AA disfigures the person’s appearance and significantly impacts self-esteem, sociocultural identity, and patient QoL [ 2 , 33 ].…”