Sensorineural Hearing Impairment and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients Without Traditional Cardiovascular Risk Factors

Abstract

Objectives: This study aims to evaluate the association of hearing impairment with carotid intima-media thickness and subclinical atherosclerosis in rheumatoid arthritis (RA) patients. Patients and methods: A total of 41 RA patients (2 males, 39 females; mean age 46.5±10.2 years; range 20 to 63 years) with no known traditional cardiovascular risk factors were included. Routine clinical and laboratory assessments for RA patients were performed. Pure tone air (250-8000 Hz) and bone conduction (250-6000 Hz) thresholds were obtained, tympanograms and impedance audiometry were conducted. Sensorineural hearing impairment was defined if the average thresholds were ≥25 decibels. Carotid intima-media thickness was assessed and classified with a cut-off point of 0.6 mm. Results: Thirteen patients (31.7%) had normal audition, while 28 (68.3%) had hearing impairment. Of these, 22 had bilateral sensorineural hearing impairment. Four patients had conductive hearing impairment (right in three patients and left in one patient). Patients with sensorineural hearing impairment had increased carotid intima-media thickness in the media segment of carotid common artery compared to patients with normal hearing (right ear p=0.007; left ear p=0.075). Thickening of the carotid intima-media thickness was associated with sensorineural hearing impairment in RA patients. Conclusion: Rheumatoid arthritis patients should be evaluated by carotid intima-media thickness as a possible contributing factor of hearing impairment in patients without cardiovascular risk factors.

Relationship Between Chloroquine or Hydroxychloroquine Use and Hearing Disorders: A Systematic Review and Meta-Analysis

“…There was disagreement in the literature regarding the association between the use of chloroquine/hydroxychloroquine and hearing loss. Most studies reported the lack of association between the use of hydroxychloroquine/chloroquine and hearing loss [15,19,22,24,25]. Roverano, et al [15] reported that 16 patients using hydroxychloroquine (200 mg/day) had sensorineural hearing loss, but when comparing groups, there was no correlation between the presence of hearing loss and treatment with this drug.…”

“…Seven studies analyzed the use of chloroquine and/or hydroxychloroquine in participants with SLE [15][16][17][18][19][20][21], 6 in participants with rheumatoid arthritis [20,[22][23][24][25][26], 2 in participants with malaria [3,27], 2 without definition of the disease treated [28,29], and 1 in healthy participants [30].…”

“…The risk of bias was judged as low in 6 studies [17][18][19]21,22,24], moderate in 6 studies [16,23,[25][26][27]30], and high in 5 studies [3,15,20,28,29] (Supplementary Material 3 in the online-only Data Supplement; Figs. 2-4).…”

“…However, due to ethical issues, it is difficult to assess the pharmacodynamics of these substances in the auditory system of humans. Thus, these studies isolate other variables, such as the activity of autoimmune diseases [15,16,22,25], the combined use of these medications with other drugs [16,19,22,24,25], age [17,26], measurement of dose versus time of use of medications [17,19,[22][23][24][25]28,29], and the predisposition of individuals to develop hearing disorders [38]. Therefore, the assessment of hearing loss caused by medication becomes complex due to the difficulty of excluding biases that may confound the results of the studies.…”

Tracking Early Atherosclerosis by Audiometry; A Review of Studies in a High Risk Population

“…2 In rheumatoid arthritis, subclinical atherosclerosis pathology was associated with hearing impairment in a group of 41 patients. 36 Methotrexate in RA improved inflammation and audiograms 1 just as statin use improved hearing acuity 27,28 and lessens inflammation 37 in the general population. These results suggest that audiometry can be used to track improvement and deterioration of both hearing and atherosclerosis.…”