Audio-vestibular symptoms in systemic autoimmune diseases

Immune-mediated inner ear disease can be primary, when the autoimmune response is against the inner ear, or secondary. The latter is characterized by the involvement of the ear in the presence of systemic autoimmune conditions. Sensorineural hearing loss is the most common audiovestibular symptom associated with systemic autoimmune diseases, although conductive hearing impairment may also be present. Hearing loss may present in a sudden, slowly, rapidly progressive or fluctuating form, and is mostly bilateral and asymmetric. Hearing loss shows a good response to corticosteroid therapy that may lead to near-complete hearing restoration. Vestibular symptoms, tinnitus, and aural fullness can be found in patients with systemic autoimmune diseases; they often mimic primary inner ear disorders such as Menière’s disease and mainly affect both ears simultaneously. Awareness of inner ear involvement in systemic autoimmune diseases is essential for the good response shown to appropriate treatment. However, it is often misdiagnosed due to variable clinical presentation, limited knowledge, sparse evidence, and lack of specific diagnostic tests. The aim of this review is to analyse available evidence, often only reported in the form of case reports due to the rarity of some of these conditions, of the different clinical presentations of audiological and vestibular symptoms in systemic autoimmune diseases

Hearing status in patients with rheumatoid arthritis

Background: Previous studies showed that one of the complications of rheumatoid arthritis disease was auditory disorder. The goal of the present study was to compare the auditory status in patients with rheumatoid arthritis and healthy individuals. Methods: In the present case-control study, 30 normal persons and 60 persons with rheumatoid arthritis with mean age of 46.72 and standard deviation of 6.76 of both genders were appraised using pure tone audiometry, tympanometry and speech audiometry. The mean disease duration in patients with rheumatoid arthritis was 12.51±6.09 years. Results: The frequency of hearing loss in rheumatoid arthritis group was significantly more than the control group (p=0.001). All patients had sensorineural hearing loss. Only in 5 of rheumatoid arthritis group, abnormal tympanometry (as type) was reported. Speech discrimination score analysis showed significant difference between the patients with rheumatoid arthritis and controls. In terms of hearing threshold level, the mean hearing threshold level (in 2000, 4000 and 8000 Hz frequencies) of the patients with rheumatoid arthritis was significantly higher than control group in both ears (p<0.05). A positive significant correlation was found among mean hearing threshold level in 4000 and 8000 Hz frequencies and rheumatoid arthritis duration in both ears. Conclusion: The frequency of hearing loss and the average hearing threshold in RA patients were higher than healthy individuals. The most common type hearing loss is sensorineural

The Impact of Rheumatoid Arthritis on Middle Ear Function

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and swelling of the joints. Middle ear joints may be subject to rheumatic involvement similar to other joints in the body. Results from previous studies examining audiological characteristics in individuals with RA have varied with respect to incidence and type of hearing loss, as well as incidence and type of middle ear involvement (increased or decreased stiffness). The purpose of this study was to compare audiometric, immittance, distortion-product otoacoustic emission (DPOAE), and energy reflectance (ER) results between participants with RA and normal control (NC) participants to further examine the effects of RA on middle ear function. Twenty-one participants with RA (38 ears) were matched 1:1 based on age and gender to 21 individuals (38 ears) without RA. The following measures were completed for all participants: pure-tone air- and bone-conduction thresholds, 226-, 678- and 1000-Hz tympanograms, acoustic reflex thresholds, acoustic reflex decay, and middle ear resonant frequency. ER and DPOAEs were measured for a subset of 16 RA (28 ears) and 16 NC (28 ears) matched participants. No significant difference in prevalence of hearing loss was found between groups. Individuals with hearing loss in both groups presented with sensorineural-type hearing loss, which was typically a mild to moderate high-frequency hearing loss. No significant differences were found between groups for air- and bone-conduction thresholds. A significantly greater number of ears from the RA group had thresholds poorer than the 95th percentile for their age range and gender across the audiometric test frequencies. Generally, younger individuals with RA had poorer thresholds at 1000 and 2000 Hz compared to normative data for age and gender. No differences were found between groups for static admittance, the number of notched versus single-peaked 678- and 1000-Hz tympanograms, acoustic reflex thresholds, ER, and DPOAE measurements. The RA group had a significantly lower mean resonant frequency, consistent with an increase in the laxity or an increase in the mass dominance of the middle ear system. These significant findings revealed the importance of considering audiological assessment of individuals with RA

Trakya Bölgesinde Üçüncü Basamak Bir Sağlık Merkezinin Koklear İmplant Cerrahisi Deneyimleri

Amaç: Koklear implantlar (Kİ), iki taraflı ciddi veya ileri derecede işitme kaybı olan hastalarda işitmeyi iyileştirerek dil ve konuşma gelişimine yardımcı olur. Bu çalışmada, Kİ cerrahisi geçiren hastalarımızın sonuçlarını değerlendirdik. Gereç ve Yöntem: Kİ cerrahisi uygulanmış olan 31 hastada (35 kulak); preoperatif, perioperatif ve postoperatif klinik ve odyolojik bulgular, işitme kaybı etiyolojisi, cerrahi yaklaşım teknikleri ve komplikasyonlar retrospektif olarak değerlendirildi. Bulgular: Otuz bir hasta (13 yetişkin ve 18 çocuk) çalışmaya dahil edildi. Kortikal mastoidektomiyi takiben posterior timpanotomi sonrası 21 kulağa yuvarlak pencereden ve 14 kulağa kokleostomi ile elektrotlar yerleştirildi. Üç farklı firmadan farklı sayıda elektrotlu (22, 16, 12) Kİ’ler kullanıldı. Hiçbir hastada postoperatif komplikasyon görülmedi. Kontrole gelen 24 hastanın ortalama serbest alan odyogramı (FFA) ameliyat öncesi 95,2±19,13 dB, ameliyat sonrası 37,8±8,46 dB idi. Ameliyat sonrası işitme kazanımları ameliyat öncesi değerlerden anlamlı derecede farklıydı (p<0,001). Farklı marka cihazlar arasında anlamlı bir fark yoktu (p=0,340). Elektrotlar yuvarlak pencereden veya kokleostomi ile yerleştirildi ve bu iki grubun karşılaştırılmasında, postoperatif FFA değerleri (p=0,425) veya konuşma farkındalığı eşiği (SAT) ve konuşmayı algılama eşiği (SRT) değerleri (p=0,425) açısından istatistiksel olarak anlamlı bir fark görülmedi (p=0,132). Sonuç: Postoperatif dönemde herhangi bir komplikasyon olmaksızın elde edilen önemli işitme kazanımları, bu çalışmada kullanılan cerrahi tekniğin başarısını göstermektedir. Ayrıca elektrot yerleştirme yeri ve sayıları arasındaki farklılığın da ameliyat sonrası sonuçları etkilemediği söylenebilir

Audiological profile in primary Sjogren’s syndrome in an Indian setting.

Objectives This is a prospective study to determine the frequency and the profile of hearing loss among patients with confirmed diagnosis of primary Sjogren’s Syndrome (pSS) in an Indian setting. Secondary objective is to analyse the correlation between hearing loss and immunological variables which includes Anti SS-A antibody, Anti SS-B antibody, Anticardiolipin, Complement C3, C4 and Cryoglobulins. Literature Review Sjogrens Syndrome is a cell mediated autoimmune disease which primarily affects the exocrine glands. The disease primarily affects women, with a very high female-male ratio of 9:1 and is seen in 40-60 years age group (1). Hearing loss may be the first otological manifestation of this autoimmune disease (1). Sensorineural hearing loss (SNHL) is found in half patients with pSS and is correlated with presence of anticardiolipin (ACA) antibodies (1) Most studies done in the western countries ( 2,3,4,5) have shown that pSS is associated with significant sensorineural hearing loss(3). SNHL was found to be associated with disease duration, there was no correlation with age, presence of autoantibodies, systemic manifestations of disease, or drug therapy. Some of the studies (2,4) showed an association of hearing loss with immunological variables such as anti SS-A, anti SS-B, anti-phosholipid antibodies and anti- nuclear antibodies. This study is undertaken to see if the audiological profile is similar to the reported literature. Methodology All consecutive patients with established diagnosis of pSS as per the Modified American European Classification Criteria between 20-60 years attending at the Clinical Immunology and Rheumatology OPD of CMC Vellore were referred to the AudioVestibular clinic over a period of 10 months. These patients who fit into the inclusion, exclusion criteria underwent a history taking with detailed structured questionnaire and ENT examination, necessary audiological and blood tests. Frequency of hearing loss, its profile, relationship with immunological tests were analysed. All the data were entered into an excel sheet using Microsoft Excel and was analysed using SPSS version 11.0 Results and Conclusions: The frequency of primary Sjogren’s disease is high in this tertiary care rheumatology clinic in this Indian setting. The frequency of audiometrically confirmed hearing loss in pSS is 78.38 %. The commonest type of hearing loss was minimal to mild sensorineural hearing loss. The high frequencies were more affected than lower frequencies. The commonest tympanometry finding was A type curve . Acoustic reflex was absent in 18.92%. The frequency of hearing loss was found to be more in the 1st year after onset of SS than after 5 year duration. There seems to be no co-relation between hearing loss and age, sicca symptoms, systemic symptoms, immunological test results in pSS

Audiovestibular Dysfunction and Hearing Loss in Patients with Psoriasis and Psoriatic Arthritis

Psoriasis is now considered a T cell-mediated chronic systemic inflammatory disease rather than only a simple skin disease. The relationship and coexistence of this common disease with many other comorbidities have gained increasing attention in recent years. Although psoriatic skin lesions are seen frequently in the auricle and external auditory canal, there are not many studies evaluating the possible effect of psoriatic disease (psoriasis with or without joint involvement) on the auditory system. Hearing impairment detected in psoriasis patients is mostly seen as subclinical hearing loss at high frequencies, but it can also have a significant impact on patients’ health and quality of life due to the possible risk of developing sudden sensorineural hearing loss. In this chapter, the frequency, pattern, and patient-related risk factors of hearing impairment and audiovestibular dysfunction in patients with psoriasis and psoriatic arthritis were extensively reviewed and discussed. In conclusion, it was emphasized that subclinical sensorineural hearing loss is a neglected but an important comorbidity in patients with psoriasis and psoriatic arthritis. The relationship between psoriatic disease and audiovestibular dysfunction supports the need for further studies aimed at better identification of the underlying pathogenic mechanisms, and accordingly to update diagnostic and even treatment approaches

SARS-CoV-2 (COVID-19) and audio-vestibular disorders

To describe the audio-vestibular disorders related to the newly SARS-CoV-2 infection, including the possible ototoxicity side-effects related to the use of drugs included in the SARS-CoV-2 treatment protocols. A systematic review was performed according to the PRISMA protocol. The Medline and Embase databases were searched from March 1, 2020 to April 9, 2021. Initially the search yielded 400 manuscripts, which were reduced to 15, upon the application of inclusion criteria. Sensorineural hearing loss (SNHL) is the most frequent audio-vestibular symptom described, occurring alone or in association with tinnitus and vertigo. The etiopathogenesis of the inner ear disorders related to COVID-19 infection is still poorly understood. The number of reports of COVID-19 infections associated to audio-vestibular disorders is increasing; even if the quality of the studies available is often insufficient, audio-vestibular disorders should be considered as possible manifestations to be included among the symptoms of this infection

Choosing between measures: comparison of EQ-5D, HUI2 and HUI3 in persons with hearing complaints

OBJECTIVES: To generate insight into the differences between utility measures EuroQol 5D (EQ-5D), Health Utilities Index Mark II (HUI2) and Mark III (HUI3) and their impact on the incremental cost-effectiveness ratio (ICER) for hearing aid fitting METHODS: Persons with hearing complaints completed EQ-5D, HUI2 and HUI3 at baseline and, when applicable, after hearing aid fitting. Practicality, construct validity, agreement, responsiveness and impact on the ICER were examined. RESULTS: All measures had high completion rates. HUI3 was capable of discriminating between clinically distinctive groups. Utility scores (n = 315) for EQ-5D UK and Dutch tariff (0.83; 0.86), HUI2 (0.77) and HUI3 (0.61) were significantly different, agreement was low to moderate. Change after hearing aid fitting (n = 70) for HUI2 (0.07) and HUI3 (0.12) was statistically significant, unlike the EQ-5D UK (0.01) and Dutch (0.00) tariff. ICERs varied from 647,209 euros/QALY for the EQ-5D Dutch tariff to 15,811 euros/QALY for HUI3. CONCLUSION: Utility scores, utility gain and ICERs heavily depend on the measure that is used to elicit them. This study indicates HUI3 as the instrument of first choice when measuring utility in a population with hearing complaints, but emphasizes the importance of a clear notion of what constitutes utility with regard to economic analyse

Parasympathetic nervous system dysfunction, as identified by pupil light reflex, and its possible connection to hearing impairment

Context Although the pupil light reflex has been widely used as a clinical diagnostic tool for autonomic nervous system dysfunction, there is no systematic review available to summarize the evidence that the pupil light reflex is a sensitive method to detect parasympathetic dysfunction. Meanwhile, the relationship between parasympathetic functioning and hearing impairment is relatively unknown. Objectives To 1) review the evidence for the pupil light reflex being a sensitive method to evaluate parasympathetic dysfunction, 2) review the evidence relating hearing impairment and parasympathetic activity and 3) seek evidence of possible connections between hearing impairment and the pupil light reflex. Methods Literature searches were performed in five electronic databases. All selected articles were categorized into three sections: pupil light reflex and parasympathetic dysfunction, hearing impairment and parasympathetic activity, pupil light reflex and hearing impairment. Results Thirty-eight articles were included in this review. Among them, 36 articles addressed the pupil light reflex and parasympathetic dysfunction. We summarized the information in these data according to different types of parasympathetic-related diseases. Most of the studies showed a difference on at least one pupil light reflex parameter between patients and healthy controls. Two articles discussed the relationship between hearing impairment and parasympathetic activity. Both studies reported a reduced parasympathetic activity in the hearing impaired groups. The searches identified no results for pupil light reflex and hearing impairment. Discussion and Conclusions As the first systematic review of the evidence, our findings suggest that the pupil light reflex is a sensitive tool to assess the presence of parasympathetic dysfunction. Maximum constriction velocity and relative constriction amplitude appear to be the most sensitive parameters. There are only two studies investigating the relationship between parasympathetic activity and hearing impairment, hence further research is needed. The pupil light reflex could be a candidate measurement tool to achieve this goal

Determinants and Consequences of Hearing Impairment and Tinnitus:Netherlands Longitudinal Study on Hearing

Chapter 1 comprises an overview of current insights into the pathophysiology and consequences of hearing loss and tinnitus, of which specifically the consequences they have for work-related health. It also explains the study design of the Netherlands Longitudinal Study on Hearing (NL-SH). Chapter 2 describes the 10-year change in hearing ability among NL-SH participants, considering factors such as age, education, sex, and lifestyle factors like alcohol use and smoking. The results showed an average decline of 0.89 dB signal-to-noise ratio (SNR) over a decade. The decline was more pronounced in older age groups (51 to 60 and 61 to 70 years) compared to younger ones (i.e. 18 to 30, 31 to 40, and 41 to 50 years). Additionally, participants with a history of smoking experienced a faster decline in speech recognition in noise during the follow-up period. Chapter 3 investigates the association between cardiovascular disease (CVD) risk factors and speech recognition in noise over time. Specifically, interactions between CVD risk factors on the longitudinal change in hearing ability were analyzed. CVD risk factors are known to cluster and interact, increasing the cumulative risk for CVD. However, we found that none of the CVD risk factors or two-way interactions of CVD risk factors were significantly associated with a decline in the speech reception threshold in noise over time. In a cross-sectional analysis using all measurement rounds, obesity, rheumatoid arthritis, and hypertension were associated with overall higher (more unfavorable) speech reception thresholds. In Chapter 4, we analyzed the potential association between beta blocker use and hearing ability in adults and examined whether this effect is dose-dependent. Hearing ability was not affected by beta blockers, but this result is not conclusive for all types of beta blockers as the study involved mostly beta-1 selective agents and no non-selective beta blockers. In Chapter 5 we analyzed the longitudinal association between changes in speech recognition in noise and the need for recovery after work (NFR), job demand, and job control, using 5-year measurement intervals. Decreased hearing ability was associated with increased NFR, but no significant associations with job demand or job control were found. The uptake of hearing solutions during the same period did not significantly impact NFR. In the study in Chapter 6, we analyzed potential risk factors for the development of tinnitus 5 years later. Further, we aimed to identify risk factors associated with annoyance caused by new-onset tinnitus. Higher levels of somatization and a history of smoking were associated with the development of tinnitus 5 years later. Increased levels of anxiety and poor speech recognition ability in noise were associated with higher levels of tinnitus annoyance in new-onset tinnitus. Chapter 7 investigates the relationship between tinnitus and NFR and whether the level of tinnitus annoyance affects NFR. After adjusting for confounding factors, tinnitus was not associated with NFR. Similarly, higher levels of tinnitus annoyance did not significantly impact NFR after adjustments