Examination of Hearing in a Rheumatoid Arthritis Population: Role of Extended-High-Frequency Audiometry in the Diagnosis of Subclinical Involvement

Abstract

Objective. The aim of this study is to analyze the high-frequency hearing levels in patients with rheumatoid arthritis and to determine the relationship between hearing loss, disease duration, and immunological parameters. Materials and Methods. A descriptive cross-sectional study including fifty-three patients with rheumatoid arthritis was performed. The control group consisted of 71 age- and sex-matched patients from the study population (consecutively recruited in Madrid “Area 9,” from January 2010 to February 2011). Both a pure tone audiometry and an extended-high-frequency audiometry were performed. Results. Extended-high-frequency audiometry diagnosed sensorineural hearing loss in 69.8% of the patients which exceeded the results obtained with pure tone audiometry (43% of the patients). This study found significant correlations in patients with sensorineural hearing loss related to age, sex, and serum anti-cardiolipin (aCL) antibody levels. Conclusion. Sensorineural hearing loss must be considered within the clinical context of rheumatoid arthritis. Our results demonstrated that an extended-high-frequency audiometry is a useful audiological test that must be performed within the diagnostic and follow-up testing of patients with rheumatoid arthritis, providing further insight into a disease-modifying treatment or a hearing loss preventive treatment.

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.…”

“…In a case control study, Lasso de la Vega et al. found a 33.6 time higher chance of hearing impairment, detected by extended high frequency audiometry compared to pure tone audiometry ( Lasso de la Vega et al., 2016 ). 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.…”

“…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 ).…”

“…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 ).…”