Audiovestibular Involvement in Systemic Sclerosis

Abstract

In order to evaluate the nature and association of audiovestibular disturbances and systemic sclerosis (SSC), 37 unselected SSC patients were studied with a detailed audiological and vestibular examination since November, 1987. Pure-tone audiometry, speech audiometry, impedance audiometry, brainstem response audiometry and vestibular function using electronystagmographic recording were performed. We found a rather frequent audiovestibular involvement (41 %). A hearing loss was found in 14 SSC patients; hearing loss was sensorineural in 10 cases and mixed in 4 cases. The latter revealed a finding similar to tympanosclerosis. Four patients showed altered vestibular test values and only one of these had normal hearing. Sensorineural deafness was the more frequent pathological finding and in all cases the site of lesion was cochlear. SSC appears to be directly responsible for audiovestibular damage, since in 12 out of 15 patients with such involvement, no other apparent cause could be revealed. SSC may be included among the autoimmune diseases which may cause audiovestibular disturbances.

Auditory and vestibular dysfunctions in systemic sclerosis: literature review

“…Of the eight studies that investigated changes, all identified hearing loss in most individuals with SS, and the prevalence in this finding ranged from 20 to 77%. The type of hearing loss was bilateral sensorineural (6,(9)(10)(11)13,16,17) in most cases, corroborating the physiopathology of the systemic disease. However, mixed (11,15,17) and unilateral (13,17) hearing loss were also described in few cases.…”

“…The most used study design for describing auditory and vestibular changes in individuals with SS was the crosssectional design, observed in five analyses (10)(11)(12)(13)(14) , followed by four case reports (6,9,15,16) , and one case-control study (17) . Because cross-sectional studies reported findings of a single moment, it was difficult to determine a temporal sequence between exposure to a specific factor and the subsequent development of the disease.…”

“…Only the studies by Berrettini et al (10) and Amor-Dorado et al (17) investigated auditory and vestibular involvement in patients with SS. However, six studies aimed at assessing or reporting only auditory changes in these patients (6,9,11,13,15,16) and only two (12,14) investigated vestibular dysfunctions (Chart 1).…”

“…Regarding vestibular changes, prevalence ranged from 11 to 63%, and the most common findings were changes in caloric testing, positional nystagmus, abnormal oculocephalic reflex, changes in clinical tests of sensory integration, and benign paroxysmal positional vertigo (6,10,12,17) . The prevalence of vestibular changes deserves the attention of professionals assist these patients, because these changes lead to balance changes, which, together with locomotive changes (characteristics of the disease), can be incapacitating and compromise the autonomy of patients with SS.…”

“…The basic audiological evaluation (tone audiometry, vocal audiometry, and acoustic immittance) was the most used evaluation method to identify these changes in individuals with SS (6,10,11,13,15,17) . However, the brainstem auditory-evoked potentials (BAEP) and vestibular evaluation were also used for diagnostic investigation (6,10,13,17) . The highest prevalence of peripheral auditory changes can be the reflex of the assessment instrument used in the studies.…”