Evaluation of Audiometric Test Results to Determine Hearing Impairment in Patients with Rheumatoid Arthritis: Analysis of Data from the Korean National Health and Nutrition Examination Survey

Abstract

This study aimed to evaluate the association between rheumatoid arthritis (RA) and hearing impairment in the Korean adult population. Audiometric and laboratory test data from the 2010–2012 Korean National Health and Nutrition Examination Survey (KNHANES) were used for analysis. The relationship between RA and hearing impairment was analyzed, adjusting for various known risk factors associated with hearing impairment. RA was defined in the questionnaire as “RA diagnosed by a physician (yes/no) through a standardized interview.” We defined hearing impairment according to 2 categories of frequency (low/mid and high) as follows (average values in kHz): low/mid frequency, 0.5, 1.0, and 2.0, and high frequency, 3.0, 4.0, and 6.0. Of the subjects, 15,158 (weighted n = 32,035,996) completed the audiometric tests. The overall weighted prevalence of RA was 1.5%. The prevalence of hearing impairment was higher in the subjects with RA than in those without RA, in both, the low/mid- and high-frequency categories (21.1% vs 7.5%, p < 0.001 and 43.3% vs. 26.2%, p < 0.001, respectively). In the multivariable logistic analysis, RA (odds ratios [OR] 1.47, 95% confidence interval [CI] 1.05–2.06, p = 0.025) was an independent risk factor of low/mid-frequency hearing impairment along with age (OR 1.12, 95% CI 1.12–1.13, p < 0.001), current smoking (OR 1.27, 95% CI 1.03–1.56, p = 0.026), and college graduation (OR 0.53, 95% CI 0.39–0.72, p < 0.001). In the multivariable analysis of high-frequency hearing impairment, RA did not show any association with hearing impairment. This study suggests that RA is associated with low/mid-frequency hearing impairment after adjustment for various known risk factors. Further study is needed to verify the hearing impairment in RA.

An update on hearing impairment in patients with rheumatoid arthritis

“…The hearing impairment at high frequencies may be due to vasculitis/neuritis that affects the cochlea and cochlear nerve leading to SNHL in RA patients. On the contrary to the studies revealed a positive correlation between RA and hearing impairment ( Lasso de la Vega et al., 2016 , Yildirim et al., 2016 , Jeong et al., 2016 ), Lobo FS and Rahne T in separate case control studies did not find statistically significant increase in the incidence of hearing impairment in patients with RA compared to the control groups ( Lobo et al., 2016 , Rahne et al., 2017 ). Besides, Ahmadzadeh A in a case control study of 42 RA patients compared to the age- and sex-matched healthy individuals demonstrated a significantly higher bone conduction threshold in the patients with RA in low frequencies and in the mean of 500–2000 Hz frequencies.…”

“…SNHL was the most common hearing impairment, detected by pure tone audiometry, and affects particularly high frequency, though involvement of middle and low frequencies have also been reported ( Lasso de la Vega et al., 2016 , Yildirim et al., 2016 , Jeong et al., 2016 ). Extended high frequency audiometry, which evaluates very high frequencies (>8000 Hz), can detect hearing impairment at earlier stages.…”

“…Aging, gender, current smoking and level of education may affect prevalence of hearing impairment in RA ( Emamifar et al., 2016a , Lasso de la Vega et al., 2016 , Jeong et al., 2016 ). Elderly male patients with RA seem to be more prone to hearing impairment ( Lasso de la Vega et al., 2016 ).…”

“…Nicotine-related vasoconstriction and subsequent decrease in the oxygen concentration can cause external hair cells damage and declined cochlear function leading to SNHL in both active and passive smokers ( Emamifar et al., 2016a ). Higher level of education may play a protective role against hearing impairment, since individuals with higher level of education probably work in a better work place with less noise exposure ( Jeong et al., 2016 ).…”

Prevalence of hearing loss due to ossicular chain involvement in rheumatoid arthritis

“…Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects 1% of the worldwide population. 1 RA leads to the destruction of the cartilage and bone due to chronic synovitis and may consequently impair joint function.…”