Effects of multiple sclerosis on the audio-vestibular system: a systematic review

Abstract

ObjectiveSystematically investigate the effects of multiple sclerosis (MS) on the audio-vestibular system.MethodsSystematic review of literature investigating audio-vestibular conditions in persons with MS (PwMS) aged ≥18 years. PubMed, Scopus, NICE and Web of Science were searched. Randomised controlled trials, and cohort, case–control, observational and retrospective studies in English, published from 2000 to 21 November 2021, evaluated PwMS with at least one outcome (pure tone audiometry, auditory brainstem response, otoacoustic emissions, cortical auditory evoked potentials, functional MRI assessing auditory function, vestibular evoked myogenic potentials, videonystagmography, electronystagmography, posturography, rotary chair, gaps in noise, word discrimination scores, duration pattern sequence test), were included. Study selection and assessments of bias were independently conducted by two reviewers using the Risk of Bias Assessment Tool for Non-randomized Studies, Newcastle-Ottawa Scale (NOS) and the NOS adapted for cross-sectional studies.Results35 studies were included. Auditory function was evaluated in 714 PwMS and 501 controls, vestibular function was evaluated in 682 PwMS and 446 controls. Peripheral auditory function results were contradictory between studies; some found abnormalities in PwMS, and others found no differences. Tests of brainstem and central auditory functions were more consistently found to be abnormal in PwMS. Most vestibular tests were reported as abnormal in PwMS, abnormalities were either peripheral or central or both. However, quantitative analyses could not be performed due to discrepancies between studies in results reporting, test stimulus and recording parameters.ConclusionsAlthough abnormal results on auditory and vestibular tests were noted in PwMS, specific effects of MS on the audio-vestibular system could not be determined due to the heterogeneity between studies that restricted the ability to conduct any quantitative analyses. Further research with consistent reporting, consistent stimulus and consistent recording parameters is needed in order to quantify the effects of MS on the auditory and vestibular systems.PROSPERO registration numberCRD42020180094.

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“…Of these, four articles analyzed OAE in patients with headache disorders (13)(14)(15)18), two studies evaluated patients with PD (8,9), and only two considered findings in MS. (7,16) We did not find any articles that analyzed OAE in patients affected by AD. The study exploring auditory function in patients with 'migraine' included a variety of migraine and headache subtypes: one study analyzed patients with vestibular migraine (13), one with cephalgic migraine (14), one study included both acephalgic and vestibular migraine patients (18), and one study analyzed auditory function in patients with tension-type headache (15).…”

“…Due to its high sensitivity, OAE can identify dysfunction of cochlear hair cells even in subclinical states ( 6 ). DPOAE is used to record auditory inner ear function in patients with neurological conditions ( 7–10 ). Accordingly, patients with MS ( 7 ), Parkinson’s disease (PD) ( 8 ), AD ( 9 ), and migraine ( 10 ) may show abnormalities in the test, reflecting OCH dysfunction, no unifying mechanism has yet been proposed to account for their abnormal DPOAE measures.…”

“…DPOAE is used to record auditory inner ear function in patients with neurological conditions ( 7–10 ). Accordingly, patients with MS ( 7 ), Parkinson’s disease (PD) ( 8 ), AD ( 9 ), and migraine ( 10 ) may show abnormalities in the test, reflecting OCH dysfunction, no unifying mechanism has yet been proposed to account for their abnormal DPOAE measures. Patients with these disorders may show cochlear OHC dysfunction ( 7–10 ).…”

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“…Numerous studies of vestibular function in MS have shown abnormalities in vestibular evoked potentials, electronystanography, static posturography ( 3 , 4 ) and dynamic visual acuity ( 5 ). Furthermore, worse vestibular function is associated with greater disability ( 6 ).…”