Screening for Hearing Impairment: A critical issue in patients with Rheumatoid Arthritis Interview with:


Dr. Emamifar

Dr. Amir Emamifar, MD
Department of Rheumatology
Odense university Hospital
Svendborg Hospital, Denmark

Associate Professor Inger Marie Jensen Hansen, PhD, DMsci Department of Rheumatology, Odense university Hospital, Svendborg Hospital, Denmark. University of Southern Denmark.

Dr. Hansen


Associate Professor
Dr. Inger Marie Jensen Hansen, PhD, DMsci

Department of Rheumatology
Odense university Hospital
Svendborg Hospital
University of Southern Denmark What is the background for this study?

Response: Rheumatoid arthritis is a systemic, inflammatory disease that affects 1% of the general population. Apart from main articular manifestations, rheumatoid arthritis may involve other organs including heart, lung, skin, and eye. The auditory system can be affected during the course of the disease as well; however the association between rheumatoid arthritis and hearing impairment has not been clearly defined. It seems that hearing impairment in rheumatoid arthritis is a multifactorial disease affecting by environmental factors and disease and patient characteristics. We did a comprehensive review of all published data to reveal the potential link between rheumatoid arthritis and hearing impairment. What are the main findings?

Response: Based on our review the main findings can be summarized as follows:

  • 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. What recommendations do you have for future research as a result of this study?

Response: We think that future research should focus on the pathologies of hearing impairment more precisely, since it can be a lead to better treatment options and prevent further morbidities in rheumatoid arthritis patients. A major problem is that most of the previous studies suffer from lack of enough sample size. In order to measure the extent of hearing impairment in rheumatoid arthritis it is reasonable to conduct a meta-analysis which limits the effect of sample size on the results. Is there anything else you would like to add?

Response: Until now, there is no consensus regarding the management of hearing impairment in rheumatoid arthritis patients. Treatment is based on empirical grounds. Oral steroid is an option after a detailed physician consultation. Limited data suggest using steroid-sparing agents such as Disease Modifying Antirheumatic drugs to decrease side effects of long-term corticosteroids. Anti-oxidants may play a protective role for the inner ear. Regular audiometric assessment should be performed. Patients will benefit from the reduction or ideally cessation of smoking and alcohol consumption. Like other causes of hearing impairment in the normal population, different types of hearing aids and implantable devices can be used in rheumatoid arthritis patients with hearing impairment.

Citation: Emamifar A, Bjoerndal K, Hansen IMJ. Is Hearing Impairment Associated with Rheumatoid Arthritis? A Review. The Open Rheumatology Journal. 2016;10:26-32. doi:10.2174/1874312901610010026.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.