Otologic Manifestations of Psoriasis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Psoriatic skin lesions are often seen in the auricle and external auditory canal, but middle ear and inner ear manifestations are not easily identified. Several studies have indicated hearing loss and vestibular dysfunction with psoriasis, but the extent of association has not been well defined. Methods: A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies described audiometric or vestibular assessment of psoriasis patients. Meta-analysis was represented with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals. Results: A total of 13 studies with 589 psoriasis patients and 617 healthy controls were included. Age did not significantly differ between psoriasis patients (47.1 [12.4] yr) and healthy controls (45.4 [11.2] yr). Psoriasis area and severity index score was 9.9 (8.4), and body surface area scores was 7.9 (14.7). Pure-tone audiometry analysis showed higher mean hearing thresholds in psoriasis patients compared with healthy controls across all frequencies, with the greatest difference at 4000 Hz (MD,; p < 0.00001). Speech reception thresholds were worse with psoriasis (MD,; p < 0.0001). Abnormal stapedial reflex was more common in psoriasis (OR,; p = 0.004). Abnormal vestibular testing was more common in psoriasis for caloric testing (OR,; p < 0.0001). Two additional studies of 41,681 psoriasis patients and 80,273 healthy controls found that psoriasis patients were at higher risk for sudden sensorineural hearing loss (OR,; p < 0.0001). Conclusion:Our study shows that psoriasis is associated with hearing loss and vestibular dysfunction, but clinical significance remains undefined. The trends noted in our study require more investigation, and the pathophysiologic mechanisms need to be defined.

Consideration of health inequity in systematic reviews and primary studies on risk factors for hearing loss

“…Of the 251 primary studies, 248 were observational studies, and three were RCTs. Dineva et al included two RCTs [52], and Jeong et al included one RCT [41]. The observational studies consisted of 104 cohort studies, 59 case control studies, 55 cross‐sectional studies, 20 case studies, and 10 case series.…”

“…The most frequently reported PROGRESS‐Plus relevant data in the included SRs at baseline and in the analysis of results were personal characteristics associated with discrimination, the majority of which related to the age of participants (see Figure 2). A total of 11 reviews (64.71%) reported personal characteristics associated with discrimination at baseline (all relating to age) [38–41, 43, 44, 47, 49, 51–53], and three reviews (17.65%) reported data relating to personal characteristics associated with discrimination in the analysis of results (including one review which reported disability and two which reported age) (see Table 3) [38, 50, 53]. Less than half of SRs reported the gender of participants at baseline ( n = 7, 41.18%) [38, 40, 41, 43, 47, 49, 51], and two reported data relating to the gender of participants in the analysis of results (11.76%) (see Table 3) [38, 53].…”

“…Of the 17 included SRs, 10 considered physiological risk factors for hearing loss [38][39][40][41][42][43][44][45][46][47], four considered environmental risk factors [52][53][54], two considered demographic risk factors [49,50], and one considered behavioral risk factors [48]. Of the 251 primary studies, 248 were observational studies, and three were RCTs.…”

“…The occupation was the next most frequently reported data, including at baseline in 81 studies (32.66%) and in the results of 69 studies (27.82%) (see Table 3). All 17 SRs included studies which reported gender and personal characteristics at baseline, and 15 SRs included studies which reported gender and personal characteristics in the analysis of results, although in some reviews the latter was in a small proportion of included studies [38,[41][42][43][44][45][46][47][48][49][50][51][52][53][54]. Studies reporting data on occupation were included in a total of eight SRs [38,42,45,48,49,51,53,54].…”

“…Of the 64 SRs included in Briscoe et al [35], 17 met the inclusion criteria for this secondary analysis (see Table 2) [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. Of these, seven were published in 2021, and 10 were published in 2022.…”