Hearing impairment could be associated with rheumatoid arthritis, says review

Apart from the main manifestations of rheumatoid arthritis in persistent joint inflammation and joint damage, the condition may involve other organs and a recent review has looked into the potential link between rheumatoid arthritis and hearing impairment.

The auditory system can be affected during the course of the disease, but the association between rheumatoid arthritis and hearing impairment has not been clearly defined. A review of all published data on this link has now been carried out by Amir Emamifar, Kristine Bjoerndal and Inger M J Hansen from Odense University Hospital in Denmark and published in The Open Rheumatology Journal.

The objective of the review was to evaluate published clinical reports related to hearing impairment in people with rheumatoid arthritis. A thorough literature search was performed using available databases using a number of keywords.

The researchers came up with a number of findings including:

• Sensorineural hearing loss is the most common type of hearing impairment in rheumatoid arthritis patients with a prevalence of 25% to 72%. Conductive hearing loss and mixed hearing loss have also been reported less frequently;
• Possible pathologies include: Synovial destruction of incudostapedial and incudomalleolar joints by an inflammatory process, rheumatoid nodules, auditory neuropathy, destruction of the cochlear hair cells or the inner ear due to immune complex deposition and drug-induced ototoxicity;
• Environmental factors including smoking, alcohol and noise can deteriorate the condition. Passive smokers are also at risk of hearing impairment. Long-term exposure to alcohol can affect the cochlear function leading to sensorineural hearing loss. Similar to healthy individuals, noise can damage the cochlea leading to hearing impairment in rheumatoid arthritis patients;
• Elderly Patients and those with longer disease duration, active disease, seropositivity, elevated acute phase reactants and rheumatoid nodules are more likely to have hearing impairment;
• Pure Tone Audiometry: Shows hearing impairment in rheumatoid arthritis patients for all frequencies from low to very high;
• Transiently Evoked Otoacoustic Emissions: can detects various amount of cochlear dysfunction at an early stage.

The researchers concluded that further research should focus on the pathologies of hearing impairment more precisely, since it can lead to better treatment options.

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