Audiovestibular Impairment in Patients with Systemic Autoimmune Rheumatic Diseases of Different Pathogenesis

Abstract

Background: Hearing impairment (HI) is classified into conductive, sensorineural, and mixed types. Sensorineural hearing loss in autoimmune diseases (AD), although not uncommon, is underdiagnosed. Autoimmune diseases may affect the vestibulocochlear system at variable degrees which is usually underdiagnosed due to unidentified specific antigens. Objectives: to assess audiovestibular system in a cohort of patients to aid in early recognition and management of a vital overlooked aspect of such comorbidity. Subjects and Methods: A total of ninety-eight adult patients complaining of different systemic autoimmune rheumatic diseases followed-up at outpatient rheumatology clinics were enrolled in this cross-sectional study. Patients were categorized into three sub-groups: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Behçet's disease (BD). Clinical, laboratory, audiological and vestibular assessment of disease activity among different groups was done. Results: Pure tone audiometry (PTA) values showed significantly increased prevalence of hearing loss in our AD patients compared to healthy control group (P <0.000). Regarding vestibular assessment, pathological saccades were discovered using the vHIT, particularly in horizontal canals. The patient's gain values were slightly lower than the control group; however, gain and gain asymmetry differed significantly in a few canals. Disease duration significantly correlated with hearing thresholds at high frequency in RA and SLE patients. DAS-28 in RA patients significantly correlated with hearing thresholds, however SLEDAI in SLE didn't reveal any correlation. Conclusions: Early audiovestibular screening in patients with autoimmune rheumatic diseases should be considered, especially in those with long disease duration as neglected impairment is prevalent.