Abstract

Hearing Loss and Rheumatoid Arthritis

Author(s): Jood Enabi

Background: Rheumatoid arthritis (RA) is a chronic, inflammatory condition that impacts approximately 1% of the population. While RA primarily affects the joints and surrounding areas, it can also have systemic effects involving organs such as the heart, lungs, skin, and eyes. Similarly, the auditory system can experience various issues during the progression of the disease. The prevalence of different types of hearing loss in individuals with RA varies significantly. Sensorineural hearing loss (SNHL) stands out as the most frequently observed form of hearing impairment in RA patients, with rates ranging from 25% to 72%. Less commonly, conductive hearing loss (CHL) and mixed hearing loss (MHL) have also been identified in the assessment of patients with RA early on the disease journey. Case: We present a case of a 39-year-old male who presented to the rheumatology clinic complaining of the gradual onset of worsening pain in the MCP and PIP joints of the bilateral hands associated with significant morning stiffness and swelling. It was associated with a previous history of decreased hearing in the bilateral ear, aural fullness, and occasional tinnitus a few months before being started on Plaquenil; pure tone audiometry confirmed minimal conductive hearing impairment on the right ear and mixed hearing loss with dominant conductive component on the left ear. His tinnitus resolved entirely, and his hearing improved significantly after treatment with steroids and methotrexate. Based on this case and previous literature, we conclude that rheumatoid arthritis is the cause of hearing loss in our patients. Conclusion: While it is widely acknowledged that there are numerous potential factors and various contributors to the development of sensorineural hearing loss (SNHL) in individuals with rheumatoid arthritis, the timing of our patient's hearing impairment, in the absence of substantial alternative evidence, suggests that rheumatoid arthritis is the likely cause of their SNHL. Although the use of ototoxic medications for different purposes and the influence of disease-modifying antirheumatic drugs (DMARDs) could be potential complicating factors, our patient has no record of prior usage. We also emphasize the variability in how autoimmune SNHL responds to steroids and underscore the importance of considering steroid-sparing agents, as they may offer benefits. Several studies have demonstrated improved outcomes with timely and appropriate medical intervention.