Ossicular Bone Damage and Hearing Loss in Rheumatoid Arthritis: A Correlated Functional and High Resolution Morphometric Study in Collagen-Induced Arthritic Mice

Abstract

Globally, a body of comparative case-control studies suggests that rheumatoid arthritis (RA) patients are more prone to developing hearing loss (HL). However, experimental evidence that supports this hypothesis is still lacking because the human auditory organ is not readily accessible. The aim of this study was to determine the association between bone damage to the ossicles of the middle ear and HL, using a widely accepted murine model of collagen-induced arthritis (RA mice). Diarthrodial joints in the middle ear were examined with microcomputer tomography (microCT), and hearing function was assessed by auditory brainstem response (ABR). RA mice exhibited significantly decreased hearing sensitivity compared to age-matched controls. Additionally, a significant narrowing of the incudostapedial joint space and an increase in the porosity of the stapes were observed. The absolute latencies of all ABR waves were prolonged, but mean interpeak latencies were not statistically different. The observed bone defects in the middle ear that were accompanied by changes in ABR responses were consistent with conductive HL. This combination suggests that conductive impairment is at least part of the etiology of RA-induced HL in a murine model. Whether the inner ear sustains bone erosion or other pathology, and whether the cochlear nerve sustains pathology await subsequent studies. Considering the fact that certain anti-inflammatories are ototoxic in high doses, monitoring RA patients’ auditory function is advisable as part of the effort to ensure their well-being.

CT Scan Showing Ossicular Chain Arthritis Associated With Ossifying Labyrinthitis as Rare Signs of Relapsing Polychondritis

“…Mixed HL with normal tympanic membrane is classically associated with otosclerosis or third window lesions like semicircular canal dehiscence or enlarged vestibular aqueduct (with pseudo-conductive HL). Another hypothesis would be rheumatoid arthritis as these lesions were described in murine model histopathology (5). Here, imaging ruled out these differential diagnoses and clinical and biological results were not consistent with rheumatoid arthritis.…”

Evaluation of hearing in patients with rheumatoid arthritis compared with controls

“…Diarthrodial type incudostapedial and inkudomalleolar joints in the middle ear can be affected by RA. [3] While the ankylosis in the joints leads to a decrease in ossicular movements, more importantly its piston effect does not change. It has been reported that SNHL is more common in RA patients (24-60%) and it is caused by RA influencing the inner ear.…”

Idiopathic Inflammatory Arthritis in the Auditory Canal in a Patient With Hearing Impairment: A Case Report and Literature Review

“…Although hearing impairment occurs frequently in patients with autoimmune disease, the pathogenesis of hearing impairment remains controversial [ 13 , 15 ]. Bone defects in the middle ear were observed in murine models of RA and destruction of the incudostapedial and incudomalleolar joints can result in impaired conduction [ 18 , 34 ]. However, it does not necessarily lead to a hearing impairment [ 6 , 17 , 23 ].…”