Audiovestibular Manifestations in Patients With Ankylosing Spondylitis

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown origin affecting up to 1% of the population. Little is known about audiovestibular impairment in patients with AS, especially the presence of cochleovestibular dysfunction in these patients. To investigate audiovestibular manifestations in AS, we studied a series of 50 consecutive patients who fulfilled the modified New York diagnostic criteria for AS and 44 matched controls. Individuals with history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere and other vestibular syndromes, infections involving the inner ear, barotrauma, or in treatment with ototoxic drugs were excluded. Most patients with AS were men (80%). The mean age at the time of study was 52.5 years, and mean age at the onset of symptoms was 34.4 years. Twenty-nine (58%) patients showed abnormal hearing loss in the audiogram compared to only 8 (18%) controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). It is noteworthy that the audiogram shape disclosed a predominant pattern of high-frequency sensorineural hearing loss in AS patients (50%) compared to controls (18%) (p = 0.002). Also, AS patients exhibited abnormal vestibular tests more commonly than controls. AS patients had an increased frequency of head-shaking nystagmus (20%) compared to controls (0%) (p < 0.001). Moreover, patients (26%) showed a significantly increased frequency of abnormal caloric test compared to controls (0%) (p < 0.001). Finally, a significantly increased frequency of abnormal clinical test of sensory integration and balance with a predominant vestibular loss pattern was observed in patients (36%) compared to controls (5%) (p < 0.001). In conclusion, the current study demonstrates strong evidence for inner ear compromise in patients with AS.

Potenciais evocados auditivos em indivíduos com síndrome vestibular periférica

“…A tontura e a vertigem têm muitos fatores etiológicos (3,4,5,6,7). Diversos sinais da disfunção vestibular podem ser detectados por meio da anamnese, exame clínico, exame otoneurológico, além de exames que avaliam o sistema auditivo (8).…”

Audiovestibular Manifestations in Patients with Ankylosing Spondylitis - A Case Report and Review of the Literature

“…In the study by Amor-Dorado et al [5] , the incidence of abnormal results in vestibular tests was high. Erbek et al [8] determined vestibular pathology in 34% of the patients and statistically significant abnormal results in caloric tests.…”

“…Amor-Dorado et al [5] reported abnormal tympanometry results in 8% of the patients despite normal otomicroscopic examination and absence of any middle ear effusion. Amor-Dorado et al [5] explained this statement with the stiffness of the ossicular chain.…”

“…Amor-Dorado et al [5] found SNHL in 58% of the 50 patients with AS. Casellini et al [6] determined higher SNHL rates in 22 patients with AS than those in the control group.…”

“…Amor-Dorado et al [5] , considered that the risk of SNHL was higher in patients with the involvement of the hip, anterior uveitis, and presence of the HLA B27.…”