Is Macular Telangiectasia Type 2 Associated with Hearing Loss and Cochlear Dysfunction? A Prospective Case–Control Study

<b>Background/Objectives:</b> Macular telangiectasia type 2 (MacTel2) is a progressive parafoveal retinal disorder with emerging evidence supporting broader neurodegenerative and metabolic involvement. Given the vulnerability of cochlear structures to systemic and microvascular stressors, this study aimed to investigate whether MacTel2 is associated with measurable auditory dysfunction. <b>Methods:</b> This prospective case-control study included 42 participants: 21 patients with clinically and multimodally confirmed MacTel2 and 21 age- and sex-matched healthy controls. All participants underwent standardized audiological assessment, including tympanometry, conventional and extended high-frequency pure-tone audiometry (0.5-16 kHz), distortion product otoacoustic emissions (DPOAE; 0.5-8 kHz), and click-evoked auditory brainstem response (ABR). Hearing loss was graded using the World Health Organization (WHO) classification based on PTA4 (0.5, 1, 2, and 4 kHz), and a clinically relevant cutoff of PTA4 > 25 dB HL was additionally applied. DPOAE responses were considered absent when the signal-to-noise ratio (SNR) was <6 dB. <b>Results:</b> The MacTel2 and control groups were comparable with respect to age and sex distribution. Patients with MacTel2 demonstrated significantly higher air-conduction thresholds than controls across both conventional and extended high frequencies, with the largest differences observed in the extended high-frequency range (10-16 kHz). PTA4 values were significantly higher in the MacTel2 group in both better- and worse-hearing ears, and the prevalence of clinically relevant hearing loss (PTA4 > 25 dB HL) was significantly greater among MacTel2 patients. DPOAE amplitudes were markedly reduced at all tested frequencies (0.5-8 kHz) in the MacTel2 group, and frequency-specific DPOAE absence/reduction (SNR < 6 dB) was substantially more frequent in MacTel2 than in controls. In contrast, ABR wave I and wave V latencies and the I-V interpeak interval did not differ significantly between groups, suggesting preserved brainstem-level auditory conduction. Within the MacTel2 cohort, no significant correlations were observed between the disease grade and audiological measures. <b>Conclusions:</b> MacTel2 was associated with significantly impaired peripheral auditory function, characterized by elevated conventional and extended high-frequency thresholds and pronounced reductions or the absence of DPOAE responses, while ABR parameters remained comparable to those of controls. These findings support a predominantly cochlear (outer hair cell-related) involvement in MacTel2 and suggest that auditory screening including conventional pure-tone audiometry, with consideration of extended high-frequency audiometry and otoacoustic emissions when feasible, may be clinically relevant in this population.