Relationship between disease activity and hearing impairment in patients with rheumatoid arthritis compared with controls

The characteristics of hearing impairment (HI) in rheumatoid arthritis (RA) are still poorly understood, and their association with disease activity is based on conflicting information. This study compared HI between RA patients and controls and between active and remission RA groups using multi-frequency audiometry. This study enrolled 88 RA patients and 50 controls. The pure-tone hearing thresholds at 500 to 4000 Hz for air (AC) and bone (BC) conduction were compared between RA and controls as well as between active and remission RA patients using DAS28-CRP scores. The pure-tone hearing thresholds for AC and BC were significantly higher at high frequencies (2000 and 4000 Hz) in the RA group for both ears compared with controls. In addition, the BC threshold at 1000 Hz for the right ear was higher in the RA group than controls. When active and remission RA patients were compared, the thresholds were higher only at 4000 Hz for both ears for AC and BC in patients with active RA. The air-bone gap differed significantly at 2000 and 4000 Hz in both ears. This study demonstrated that patients with RA have a heightened risk of HI, and disease activity increases this risk, particularly at high frequencies. Clinicians who manage RA should be aware of HI and consider performing audiological evaluations in RA patients with active disease in particular.     

Investigation of hearing in patients with allergic rhinitis

The aim of the current study is to investigate hearing function in patients with allergic rhinitis. Fifty-eight patients with positive skin prick test (Group 1) (116 ears) and 31 subjects with negative skin prick test (62 ears) as group 2 were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 8000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in both groups. There was statistically significant difference between pure-tone threshold of the group 1 and group 2 at 8000 Hz (p< 0.05). Based on our study, the patients with allergic rhinitis had better hearing than the control group at 8000 Hz.     

Extended high-frequency audiometry as early detection of hearing loss in primary Sjögren syndrome

The aim of the study is to evaluate hearing function by extended high-frequency audiometry in primary Sjögren Syndrome (pSS) and to correlate it with disease activity. All patients diagnosed with pSS were recruited within 1 year. Patients underwent otologic evaluation, extended high-frequency audiometry, tympanogram, and the ESSPRI scale evaluation. A total of 63 (60 female and 3 male) patients with mean age 49.5 ± 9.9 years with pSS were included. We detected a hearing loss prevalence of 95.2% (60 patients) in both ears in very high frequencies (10000–16,000 Hz). The hearing loss of all patients was sensorineural. There was no significant difference between the degree of disease activity and the hearing thresholds. We enrolled 188 subjects with a mean age of 47.20 ± 9.7 years as a healthy control group. We compared the hearing thresholds of both ears of patients with pSS versus the healthy control group and observed a significant difference in frequencies above 500 Hz. Sensorineural hearing loss was found in pSS patients in frequencies above 4000 Hz. Sensorineural hearing loss was highly prevalent in pSS patients, predominantly in very high frequencies. We claim that sensorineural hearing loss could be an associated symptom of primary Sjögren syndrome and suggest further research to support this conclusion.     

Early hearing loss detection in rheumatoid arthritis and primary Sjögren syndrome using extended high frequency audiometry

The aim of this study is to evaluate the hearing behavior of rheumatoid arthritis (RA) and primary Sjögren syndrome (PSS) patients and compare them with a healthy control group and with each other. A comparative cross-sectional study was performed with a group of 117 female RA patients, a group of 60 female PSS patients, and a 251 female healthy control group. Every subject underwent a series of studies including high-frequency audiometry, speech audiometry, and tympanometry. The high-frequency audiometry measured 250 to 16,000 Hz. The 117 patients with RA and the 60 with PSS were diagnosed according to American College of Rheumatology criteria / ACR 2010, and the validated classification of the American-European Consensus Group. Hearing loss was present in 36.8% of the RA group in 500–3000 Hz, 68.4% in 4000–8000 Hz, and 94.9% in 10,000–16,000 Hz. Hearing loss was present in 60% of the PSS group in 500–3000 Hz, 70% in 4000–8000 Hz, and 100% in 10,000–16,000 Hz. The hearing impairment prevalence of both groups was significantly different (p?<?0.05) when compared with the healthy control group. We also compared the hearing thresholds between RA and PSS patients, finding a significant hearing threshold increase in 500–3000 Hz of the PSS group. This study consolidates the association between RA and PSS with hearing impairment. A deeper hearing loss was reported in PSS than in RA patients, demonstrating a greater auditory and speech recognition repercussion.     

2型糖尿病患者听力损伤的早发现研究

目的验证纯音测听和畸变产物耳声发射可以作为2型糖尿病患者听力损伤的早发现检测手段。方法收集2018年4—10月就诊于天坛社区卫生服务中心的39例(78耳)2型糖尿病患者及15名(30耳)健康体检者。先对观察组和对照组的受试者分别进行纯音测听(PTA)。计算观察组中主诉听力正常及下降的糖尿病患者纯音测听异常的比例,再比较观察组中主诉与纯音测听间的差异。然后,选取观察组与对照组中纯音测听正常的受试者,分别进行畸变产物耳声发射(DPOAE)检测,比较不同频率的幅值差异。结果观察组中,主诉听力正常的54耳中经纯音测听检查发现仍有32耳(59.26%)听力有不同程度的损伤,主诉听力下降的24耳中有23耳(95.83%)存在听力障碍。主诉与纯音测听间的差异有统计学意义(χ²=24.645,P<0.05)。接受DPOAE检测的两组幅值,各频点差异有统计学意义(P<0.05)。结论证实纯音测听和畸变产物耳声发射可以作为2型糖尿病患者听力损伤的早发现检测手段。     

How significant is sensorineural hearing loss in primary Sjögren's syndrome? An individually matched case-control study

OBJECTIVE: We evaluated whether sensorineural loss and vestibular abnormalities are common in patients with primary Sj?gren's syndrome (pSS) and whether such abnormalities are clinically significant. METHODS: In an individually matched case-control design, 48 patients with pSS underwent complete audiovestibular evaluation along with 48 age and sex matched individuals without otologic problems. Differences of > 20 dB between patient and control ears at any frequency tested were considered to be significant. RESULTS: Significant differences in hearing loss were seen at 4,000 Hz (6 vs 0 ears; p = 0.03) and at 8,000 Hz (9 vs 0 ears; p = 0.003). Small differences in hearing acuity were also observed in the lower frequencies, but the absolute mean difference was < 3 dB. A decrease of at least 60 dB in hearing acuity at any frequency up to 4,000 Hz was seen only in 3 elderly pSS patients. Abnormal brainstem auditory evoked responses were recorded in 7 patients and 5 controls, but no patient had retrocochlear lesions identified on magnetic resonance imaging. Four patients in each group had abnormalities on electronystagmography. CONCLUSION: pSS is associated with sensorineural hearing loss affecting preferentially the high frequencies, but clinically significant defects are not common. There is no evidence of retrocochlear disease or increased vestibular involvement in pSS.     

Evaluation of hearing and cochlear function by DPOAE and audiometric tests in patients with ankylosing spondilitis

The aim of this study was to investigate cochlear functions in patients with ankylosing spondilitis (AS). Prospective, case control study. Twenty-eight AS patients (56 ears) and 25 healthy control subjects (50 ears) were included in the study. Pure-tone audiometry at 250, 500, 1,000, 2,000, 4,000, 6,000 Hz and immittance measures including tympanometry and acoustic reflex and DPOAEs (Distortion Product Otoacoustic Emission) testing were performed in the patients and controls. Pure-tone audiometry findings of the patients and controls were significantly different in all frequencies (P < 0.05). Sensorineural hearing loss was found in 10 patients (35%) that was bilateral in seven and unilateral in three patients. On DPOAE testing, there was no statistically significant difference between the levels of noise floor of the patients and controls (P > 0.05). However, the DPOAE responses of the patients and controls were significantly different in 3,000, 4,000, 5,000 and 6,000 Hz frequencies (P < 0.05). There is a damage of outer hair cells in patients with AS, and damaged outer hair cell regions mostly corresponds to the basal and mid-portions of the cochlea.     

Detection of hearing loss in rheumatoid arthritis patients using extended high frequency audiometry: Is it related to disease activity and severity?

Aim of the workTo evaluate audiological characteristics in rheumatoid arthritis (RA) patients compared with controls using extended high frequency audiometry and analyze their correlations with RA activity and severity to identify patients at higher risk of hearing loss.Patients and methodsThe study was carried out on 95 RA patients and 100 controls. Every subject underwent pure tone audiometry (PTA) from 250 through 8000 Hz, speech audiometry and extended high frequency audiometry (EHFA) from 10,000 to 20000 Hz. Disease activity score (DAS28) and RA medical records-based index of severity (RARBIS) were assessed.ResultsPatients were 85 females and 10 males with age mean 46.5 ± 1.1 years and disease duration of 9.57 ± 0.61 years. The hearing thresholds (HT) of patients were significantly higher than those of controls at all PTA (p < 0.001) and EHFA frequencies (p < 0.001). Hearing loss (HL) was detected in 68.4% and 64.2% by using PTA, while EHFA revealed it in 100% and 97.9% of right and left ears of RA patients respectively. Hearing loss was bilateral, symmetrical and sensorineural in all cases. HT of EHFA significantly correlated with age (r = 0.63, p < 0.001), age at onset (r = 0.51, p < 0.001), disease duration (r = 0.3, p = 0.03), DAS28 (r = 0.31, p = 0.01) and RARBIS (r = 0.21, p = 0.03).ConclusionBilateral symmetrical sensorineural hearing loss (SNHL) is significantly more frequent in RA patients compared to control. EHFA is valuable test to detect HL in patients with RA. Older age, longer disease duration, higher disease activity and severity are important factors for the development of HL in RA.     

新疆和田地区学龄儿童碘缺乏与听力关系的研究

本文使用日本MST-1N型听力计,于1989年9～10月间对新疆和田地区181名7～14岁学童进行了双耳纯音气导听力测定。测定对象共分4组(处于不同海拔高度上的3组缺碘学童及1组补碘对照组学童)。除测定听力外,还测定了智商、甲状腺吸~(131)I率、T_3、T_4、TSH、精神运动发育和骨龄等项指标。结果表明,缺碘地区学童平均听阈显著高于补碘对照组;听力损失在高频(8000Hz)及低频(1000Hz)最为严重;平均听阈与下列因素有显著负相关关系存在:海拔高度、性别、身高、体重、身高体重指数、敲击试验及智商。提示缺碘造成的听力障碍主要为高频(8000Hz)及低频(1000Hz)。采取补碘措施后,听力可有部分恢复,但不能完全恢复。平均听阈与甲状腺吸~(131)I率、T_3、T_4、TSH等指标无显著相关,故是一个较为独立的指标,把它作为亚临床克汀病的辅助诊断指标是合适的。     

Auditory acuity in type 2 diabetes mellitus

BACKGROUND AND OBJECTIVES:

The relationship between diabetes and hearing loss has been debated for many years. Hyperglycemia appears to have an effect on hearing loss and the proposed mechanisms are microangiopathy, neuropathy or a combination of both. The objective of this study was to evaluate a cross section of hyperglycemic subjects with age- and sex-matched normoglycemic controls with pure tone audiometry and compare the differences.

MATERIALS AND METHODS:

Forty-one type 2 diabetes mellitus subjects and 41 age- and sex-matched normoglycemic controls were subjected to a pure tone audiometric assessment followed by evaluation of their glycemic status and degree of glycemic control. The resulting data was statistically analyzed.

RESULTS:

The auditory thresholds in hyperglycemic subjects were higher in all age groups in all the frequencies suggestive of sensorineural hearing loss. The hyperglycemic subjects with poor control of their blood sugar levels (HbA1C > 8%) had elevated auditory thresholds in all the test frequencies. The fasting blood sugar level in hyperglycemic subjects showed a trend towards significant difference at higher frequencies, the postprandial blood sugar levels showed significant differences at higher frequencies. There was no effect of duration of diabetes mellitus on the hearing thresholds in hyperglycemic subjects.

CONCLUSION:

Subjects with hyperglycemia have a sensorineural hearing loss when evaluated with a pure tone audiometer in all frequencies than a normoglycemic control group. The study showed that post prandial blood sugar levels and HbA1C levels had a direct bearing on the auditory acuity of the hyperglycemic subjects.     

Hearing loss in the nursing home. An institutional issue

One hundred ninety-eight nursing home admissions underwent audiometric assessment and answered questions regarding hearing difficulty in common listening situations. Twenty-four percent demonstrated normal thresholds (0-25 dB) in the speech frequencies with only mild losses at 4000 Hz. Fifty-four percent had normal thresholds through the speech frequencies with moderate to profound losses at higher frequencies, or mild losses (26-40 dB) in the speech frequencies. Such persons would be at risk in daily listening situations. Twenty-two percent had moderate or greater losses (greater than 40 dB) through the entire frequency range. Sixteen percent of this significantly impaired group were not identified as having a hearing loss by either the admitting RN or physician. Sixty percent of residents reported trouble in a group if they could not see the speaker's face, when watching television, and/or when using the telephone. The data indicate that a systematic hearing screening program is the most reliable means of identifying hearing loss and functional hearing handicap on an individual basis. The high prevalence of hearing problems suggests that this handicap also needs to be addressed from the perspective of institutional policy. Staff training and environmental modification should be undertaken to give hearing support to the entire nursing home population.     

High-frequency sensorineural hearing loss in patients with ankylosing spondylitis: is it an extrarticuler feature of disease?

Objective The aim of this study was to investigate the ear involvement, especially at extended higher frequencies than those previously studied, in patients with ankylosing spondylitis (AS). Patients and methods We prospectively evaluated 45 consecutive patients with AS. All patients underwent a complete physical examination of the ear, nose, and throat and an audiologic evaluation that included pure-tone audiometry at conventional and extended high frequencies, the determination of a speech discrimination score and the uncomfortable loudness level, and impedance audiometry. Thirty healthy volunteers were included as controls. Results The mean age of the patients was 39.6 ± 9.1 years (range 19–63 years) and that of the controls was 10.6 ± 8.1 years (range 1–30 years). There was no statistically significant difference between the two groups with respect to conventional frequency air conduction threshold and bone conduction threshold. There was a statistically significant difference at 14,000–16,000 Hz at extended high frequencies in 32 patients with AS (71.1%) versus 12 controls (40%). At 14,000–16,000 Hz, eight patients demonstrated a sensorineural hearing loss caused by extraspinal involvement. There was a significant difference between the patients with or without extraspinal involvement, and a positive correlation was noted between the duration of disease and the hearing level at 10,000–16,000 Hz. Conclusion Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may be an extra-articular feature of that disease. A long duration of disease and extraspinal involvement are important parameters for ear involvement in patients with AS.     

Hearing impairment in type 2 diabetics and patients with early diabetic nephropathy

Aims

The study was to investigate the hearing function in subjects with non-diabetic nephropathy and diabetic nephropathy and analyze related clinical indexes of hearing impairment.

Hearing and cochlear function of patients with ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder that primarily affects the spine and sacroiliac joints. Recent studies described audiovestibular impairment in AS patients. The aim of this study was to evaluate the hearing and function of the cochlear system in patients with AS. Thirty-seven AS patients and 20 healthy controls were evaluated prospectively. Otorhinolaryngologic examinations were performed in all patients together with pure tone audiometry, speech discrimination test, tympanometry, and distortion product otoacoustic emission (DPOE). Disease duration, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, and hematologic findings (CRP and ESR) were also collected. Pure tone audiometry findings of the patients and controls were significantly different in all frequencies (p < 0.01). Speech discrimination scores were also significantly different (p < 0.01). No significant difference was found between DPOE responses of the patients and controls (p > 0.05). There was no correlation between disease duration, BASDAI scores, hematological findings, and audiometry findings (p > 0.05). This study demonstrated that there is an association between AS and hearing loss, but the cochlea is not the main source of hearing loss.     

Hearing difficulties are common in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is well known to affect many different organ systems. Previous work suggests that this includes the auditory system and that measures of hearing may be related to indices of RA disease activity. The aims of this study were to determine whether hearing loss in young subjects with rheumatoid arthritis is greater than would be expected in the normal population and whether disease activity or duration correlate with hearing levels. About 55 patients (less than 50 years old) with RA were sampled from a secondary-care-level population. Pure-tone audiograms, transient evoked otoacoustic emissions (TEOAEs) and rheumatological assessment including disease duration and the DAS28 disease activity score were carried out. Subjective hearing loss was a common symptom with a prevalence of 29.6% (95% CI 17.8–42.2%). The prevalence of conductive hearing loss was 1.9% (95% CI 0.3–9.7%)). Subjects with RA had worse hearing than expected at low and middle frequencies (250 Hz to 2 kHz). TEOAEs were absent in 15 of 84 (18%, 95% CI 11–27%) normal ears. No relationship was demonstrated between hearing thresholds and markers of disease activity or other rheumatological parameters. Hearing loss is common in young people with RA and should be sought by clinicians caring for this patient population. TEOAEs are absent in a higher proportion of patients than expected, and this may be a marker of early asymptomatic hearing loss. It may be conductive or sensorineural and may take any configuration, including low-frequency loss.     

Decision criteria for pure-tone detection used by two age groups of normal-hearing and hearing-impaired listeners

Response criteria from a yes-no task and detection thresholds from two test procedures were measured for four groups of adults: younger normal-hearing, older normal-hearing, younger hearing-impaired, and older hearing-impaired. The two test procedures were an audiological procedure (which does not control for response bias) and a 21FC adaptive procedure (which does control for bias). The signal was a 500 or 4000 Hz tone presented in quiet. All four groups showed an equally conservative response bias in the yes-no task. In addition, neither age nor hearing loss affected the difference (6.5 dB) between the two threshold measures.     

Sensorineural Hearing Loss in Patients with Inflammatory Bowel Disease: A Subclinical Extraintestinal Manifestation

Isolated case reports in which symptomatic hearing loss develops suddenly during the course of inflammatory bowel disease (IBD) have been reported, but the presence of subclinical sensorineural hearing loss (SNHL) associated with IBD has been investigated in only two preliminary studies.In order to research this further, we aimed to investigate the presence of subclinical SNHL in IBD by comparison with a control group and to examine possible relations between the bowel disease parameters and hearing loss.Otoscopy, tympanometry, and pure tone audiometry were carried out in 39 patients with IBD (21 Crohn's disease [CD], 18 ulcerative colitis [UC]) and 25 healthy age- and sex-matched controls. All patients and control subjects had normal otoscopy findings and tympanometry was unremarkable, excluding middle ear disease and conductive hearing loss. Analysis of each frequency examined showed that the average hearing thresholds were increased significantly in the study group compared to those of the control group at higher frequencies (2, 4, and 8 kHz). When these parameters were compared with the control group according to subgroups of IBD, a significant difference was determined for the UC group at frequencies of 2, 4, and 8 kHz and for the CD group only at the frequency of 4 kHz. Although there was a trend of increment in SNHL as the age of the patient and duration and extent of UC increased, no significant correlation was observed between SNHL and these parameters or sex, activity, involvement site, medication history of IBD, and coexistence of other extraintestinal manifestations. In conclusion, it was demonstrated that a subclinical SNHL may be associated with UC and somewhat with CD, affecting mainly the high frequencies. In light of this finding, it may be advisable to investigate labyrinth functions as well as other extraintestinal manifestations in patients with IBD. This article was presented at the 12th United European Gastroenterology Week, 2004, in Prague, Czech Republic.     

自身免疫性甲状腺疾病患者血清瘦素水平观察

目的 观察自身免疫性甲状腺疾病(AITD)中Graves病(GD)和桥本氏甲状腺炎(HT)患者血清瘦素水平,探讨瘦素在AITD发病机制中的免疫学作用.方法 102例体质量指数(BMI)和年龄等因素相匹配的女性AITD初诊患者,根据临床表现及实验室检查结果分为3组:GD甲亢组,HT甲低组,亚甲低组,另设性别、年龄、BMI匹配的对照组.免疫化学发光法检测血清FT3、FT4、sTSH,ELISA法检测血清瘦素水平.结果 GD甲亢组血清FT3、FT4水平[(19.74±15.39)、(78.25±58.68)pmol/L]明显高于对照组[(4.87±0.25)、(15.96±3.15)pmol/L],而sTSH[(0.15±0.08)mU/L]和瘦素水平[(8.73±1.92)μg/L]明显低于对照组[(3.81±0.19)mU/L、(12.38±3.51)μg/L].组间比较差异均有统计学意义(P＜0.01或＜0.05).而HT甲低组兀FT3、FT4水平[(3.36±0.26)、(6.95±3.29)pmol/L]均明显低于对照组(P＜0.05),而sTSH[45.48±35.83)mU/L]和瘦素水平[(17.17±3.82)μg/L]明显高于对照组(P＜0.01或＜0.05).亚甲低组FT3、FT4水平[(4.67±0.60)、(14.87±2.14)pmol/L]与对照组比较差异无统计学意义(P＞0.05),而sTSH[(13.67土8.66)mU/L]和瘦素水平[(16.25±3.67)μg/L]均明显高于对照组(P＜0.01或＜0.05).结论 瘦素在AITD发病机制中可能具有一定的免疫调节作用,而AITD患者瘦素水平也可能受sTSH影响.     

Assessment of the ear and otoacoustic emission findings in fibromyalgia syndrome

OBJECTIVE: We aimed to assess otoacoustic emission (OAE) findings in fibromyalgia (FM) syndrome. METHODS: Thirty-two ears of 16 female patients with FM syndrome and 30 ears of 15 healthy female controls were also included in the study. Pure tone audiometry, speech discrimination testing, tympanometry and otoacoustic emission testing (both transiently evoked and distortion product) were performed. RESULTS: There was no significant difference between the pure tone hearing results of the patients and controls (p > 0.05). There was no significant difference between the distortion-product-otoacoustic emission results of the patients and controls. Audiologic findings of the patients with and without otologic symptoms were not significantly different than controls (p > 0.05). CONCLUSION: Although FM patients generally have subjective symptoms related to ear, clinical or laboratory assessments usually fail to find out any objective finding related to these subjective symptoms. The otologic functions seem spared in FM syndrome.     

Noise in the workplace and audiometric examinations in workers of a ceramic factory.

732 workers from several loudest production departments in a pottery plant were examined. The noise level measurements were carried out at a regular course of work. Auditory sensitivity threshold was determined via air conduction, at frequencies of 250, 500, 1000, 2000, 4000 and 8000 Hz. Functioning of the organ of hearing under conditions of noise at the workplace was analysed. The influence of several noise levels--up to 85 dB/A/ and higher, and the relation between the length of service and hearing sensitivity threshold were investigated. The largest exposures were recorded in the batching and milling plant, sorting and kilns departments.