Photo Credit: Curtoicurto
Researchers call for routine hearing assessments in patients with RA due to diminished hearing often being underdiagnosed in this patient population.
Although studies have shown a link between rheumatoid arthritis (RA) and middle ear and inner ear impairment, diminished hearing often goes underdiagnosed due to its subtle presentation.
To address this gap, Jiann-Jy Chen, MD, Ping-Tao Tseng, MD, PhD, and colleagues developed a systemic review of the literature on RA and hearing loss. The researchers aimed to provide clinicians with insightful strategies for identifying and treating patients with RA who have developed hearing impairment. The findings were published in the International Journal of Molecular Sciences.
Physician’s Weekly (PW) spoke with Dr. Tseng and Dr. Chen about the implications of their findings.
PW: Why did you feel this topic needed exploration?
Dr. Tseng: In my experience (not in clinics), I met many people with hearing problems. After referring them for surveillance, they found different autoimmune diseases that played essential roles in hearing impairment. Some were complicated with vestibular problems, such as vertigo, dizziness, or imbalanced movement. At least half of them were in a progressively worsening course.
However, if we did not notify them, they would not be aware of the necessity of surveillance. Therefore, it is important to remind the public of the audiological impairment related to autoimmune diseases.
What are the most important findings from your study?
Dr. Chen: In our systematic review, we addressed the importance of progressive disease severity, multiple aspects of impact in audiology, and potentially reversible course. Furthermore, based on the experience in tinnitus-specialty clinics, we provided a modified treatment protocol targeting rheumatoid arthritis-related audiological dysfunction.
How can these findings be incorporated into practice?
Dr. Tseng: The most important takeaways from our review that could be applied in clinical practice are the recommendations provided in our discussion. In our manuscript, we recommended some potential time points for referral consideration. For example, patients started to complain of audiological symptoms, and patients complained of vestibular symptoms or unexplained hearing impairment. Finally, although subjective, we recommend the clinicians to refer to ENT if they notice their patient often ignoring the clinician’s voice.
What makes this issue urgent in the healthcare landscape?
Dr. Chen: Actually, not only RA but other autoimmune diseases could contribute to audiovestibular dysfunction. For example, in another systematic review we worked on published in Diagnostics, we summarized the relationship between anti-phospholipid syndrome and audiovestibular dysfunction. Similarly, our team discussed the potential audiovestibular dysfunction related to systemic lupus erythematosus. The most important issue is that those subjects initially presented mild-to-moderate audiovestibular dysfunction and then developed clinical symptoms of such autoimmune diseases several years later (sometimes as long as 10 years).
What would you like future research to focus on?
Dr. Tseng: Although we addressed the current evidence regarding the relationship between audiovestibular dysfunction and autoimmune diseases, we could seldom provide direct histopathological approval for this phenomenon. Because the audiovestibular organs are small and deep in the head, performing a histopathological examination in our daily practice would be impossible and impractical. Therefore, developing a reliable and easily achievable device (or method) to detect audiovestibular dysfunction related to autoimmune diseases would be important.
Is there anything else you want clinicians to know?
Dr. Chen: As addressed in our original publication in the International Journal of Molecular Sciences, we want to remind readers or their relatives of the necessity of detailed investigation if they do not hear others’ voices.
