Conductive and sensorineural hearing impairment in juvenile idiopathic arthritis: a systematic review and meta-analysis

OBJECTIVES: To determine the prevalence of ossicular stiffness and cochlear dysfunction in patients with juvenile idiopathic arthritis (JIA) compared with healthy controls. METHODS: We searched PubMed (1966-27 December 2025), Embase (1947-27 December 2025), and the Cochrane Central Register of Controlled Trials (1996-27 December 2025). Studies of patients diagnosed with JIA who underwent audiological examinations (cochlear and middle ear function) were selected for the review. Random-effects models were used to calculate pooled relative risks (RR) and standardized mean differences (SMD). RESULTS: Seven studies (237 patients with JIA; 132 healthy controls) were included; six were judged high methodological quality (Newcastle-Ottawa score ≥ 8). Children with JIA exhibited a markedly higher prevalence of type As tympanograms (RR = 13.93, 95% CI 5.83-33.27) and elevated pure-tone hearing thresholds, with the largest effect observed at the extended high frequency of 16 kHz (SMD = 1.52, 95% CI 1.04-1.99). Pooled otoacoustic emission amplitudes trended lower in JIA but did not reach statistical significance (SMD = -1.72, 95% CI - 8.77 to 5.33; I² = 96%), although the single study reporting DPOAE suggested a marked reduction. CONCLUSION: JIA is associated with a quantifiable dual-compartment audiological burden-a markedly elevated risk of mechanical middle-ear stiffness and a frequency-dependent sensorineural deficit most pronounced beyond the conventional audiometric range. Tympanometry and extended high-frequency audiometry may provide complementary information for detecting subclinical auditory involvement in JIA. The potential role of OAEs, including DPOAE, requires confirmation in larger prospective studies.