Relationship between disease activity and hearing impairment in patients with rheumatoid arthritis compared with controls

Abstract

The characteristics of hearing impairment (HI) in rheumatoid arthritis (RA) are still poorly understood, and their association with disease activity is based on conflicting information. This study compared HI between RA patients and controls and between active and remission RA groups using multi-frequency audiometry. This study enrolled 88 RA patients and 50 controls. The pure-tone hearing thresholds at 500 to 4000 Hz for air (AC) and bone (BC) conduction were compared between RA and controls as well as between active and remission RA patients using DAS28-CRP scores. The pure-tone hearing thresholds for AC and BC were significantly higher at high frequencies (2000 and 4000 Hz) in the RA group for both ears compared with controls. In addition, the BC threshold at 1000 Hz for the right ear was higher in the RA group than controls. When active and remission RA patients were compared, the thresholds were higher only at 4000 Hz for both ears for AC and BC in patients with active RA. The air-bone gap differed significantly at 2000 and 4000 Hz in both ears. This study demonstrated that patients with RA have a heightened risk of HI, and disease activity increases this risk, particularly at high frequencies. Clinicians who manage RA should be aware of HI and consider performing audiological evaluations in RA patients with active disease in particular.

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

“…Cochlear-type sensorineural hearing impairment, including RA, has been reported to specifically affect the lower-frequency hearing ability [ 7 ]. By contrast, other studies reported that RA is associated with high-frequency hearing impairment [ 24 , 25 ]. Considering that adjustment of comorbid conditions was not performed in this study, interpretation of our data has limitation.…”

Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data

“… 4–6 With respect to the auditory system, previous studies have shown conflicting findings, in both hearing loss (HL) and the RA disease activity and severity. 7–10 …”

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.…”

“…This, however, is not independent of age. A significant association, especially at high frequencies, between hearing impairment and disease activity was detected in a study by Yildirim A, where the audiometric results of 62 patients with active disease was compared with 26 patients in remission ( Yildirim et al., 2016 ). Disease Activity Score in 28 Joints–C-Reactive Protein (DAS28-CRP) was measured based on a count of 28 tender joints, 28 swollen joints, patients global assessment and laboratory result of CRP, which is widely used in clinics ( Yildirim et al., 2016 , Jensen Hansen et al., 2017 ).…”

“…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.…”