Hearing loss in rheumatoid arthritis: inflammation or hydroxychloroquine?

Abstract Background Extra-articular manifestations of rheumatoid arthritis (RA) include skin, eyes, heart, lung and auditory system leading to hearing loss (HL). All types of HL were reported in RA patients. Aim First is to evaluate the effect of RA disease and Hydrochloroquine (HCQ) drug on hearing using PTA and EHFA. Second, is to find if there is correlation between HL at different frequencies and age, disease duration, duration of HCQ intake, RA activity and pain scale. Methods 60 RA patients between 24 and 64 years from both genders (30 patients not treated with HCQ drug and 30 patients treated with HCQ drug) and 30 healthy volunteers were included in control group. All patients were assessed laboratory (ESR, CRP), and clinical (clinical activity index, DAS, VAS, PTA, EHFA). Results In rheumatoid group (either HCQ group or non HCQ group), 33 ears (55%), 28 ears (46.7%) respectively had sensorineural hearing loss (SNHL) with predominant high frequency loss in PTA. Using EHFA, 56 ears (93.3%) of rheumatoid patients using HCQ had SNHL compared to 30 ears (50%) of rheumatoid patients not using HCQ. In the rheumatoid group, the elevated hearing threshold is more strongly correlated to increase age of patients, prolonged disease duration, prolonged duration of HCQ intake than to current disease activity or subjective pain severity. Conclusion Both the inflammatory pathology of RA and HCQ exposure may be associated with HL in RA patients. Prolonged use of HCQ, older age of patients, and prolonged disease duration are associated with higher hearing thresholds. Very high frequencies (more than 8 kHz) showed greater hearing threshold changes in the HCQ group. Behavioral audiometric evaluations may be considered as part of routine clinical practice for RA patients. EHFA may be considered as a screening test for RA patients before and during medication, especially HCQ.