Association of Sensorineural Hearing Loss in Patients With Alopecia Areata

Abstract

Alopecia areata (AA) is a common autoimmune disease, leading to chronic and relapsing hair loss. 1 Current evidence suggests that follicular melanocytes may be an important target in the autoimmune process of AA. 2 In addition to their presence in the skin, melanocytes are also present as intermediate cells in the stria vascularis of the cochlea, which are critical for normal hearing. In patients with Vogt-Koyanagi-Harada disease, a rare autoimmune disorder that targets melanocytes, sensorineural hearing loss (HL) is a common complication in late-stage disease. Few studies have found audiological abnormalities in patients with AA 3,4 ; however, existing studies are limited by their cross-sectional designs and small sample sizes. This nationwide population-based cohort study was conducted to investigate the risk of HL in patients with AA using claims data from the National Health Insurance Research Database in Taiwan.Methods | This study was approved by the Institutional Review Board of Taipei Veterans General Hospital (2018-07-016AC). The institutional review board waived the requirement to obtain informed consent owing to the use of deidentified data (VGHIRB No.: 2018-07-016AC). We identified patients with AA diagnosed by dermatologists between January 1, 1998, and December 31, 2011. The diagnosis of AA was established according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 704.01. For each patient with AA, 10 controls were selected after matching for age, sex, monthly premium, and residence. The primary outcome assessed was new-onset HL, which was identified by ICD-9-CM code 389. The diagnosis of HL was established by otorhinolaryngologists and was classified into conductive HL (ICD-9-CM code 389.0), sensorineural HL (ICD-9-CM code 389.1), mixed HL (ICD-9-CM code 389.2), and others (ICD-9-CM codes 389.7, 389.8, and 389.9). Participants were observed until a diagnosis of HL, death, or December 31, 2013. Cox regression model was used to calculate adjusted hazard ratios with 95% CIs. Two-sided P values <.05 were considered statistically significant. Data management and analyses were performed using the Statistical Analysis System (SAS) software, version 9.4 (SAS Institute).

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