Auditory pathway in rheumatoid arthritis. A comparative study and surgical perspectives

Conclusion. Rheumatoid arthritis (RA) patients present with both conductive and sensorineural deafness. Objective. To evaluate the prevalence and features of hearing impairment in patients with RA. Material and methods. A total of 28 RA patients underwent a rheumatological evaluation, including determination of rheumatoid factor, protein 2-glycoprotein I level and the Lee index. An audiological assessment consisting of pure-tone audiometry (PTA) and determination of auditory brainstem responses (ABRs) and transient evoked otoacoustic emissions (TEOAEs) was performed. The results were compared with those of 28 age- and sex-matched healthy subjects. Four selected RA patients underwent stapedectomy; PTA and TEOAEs were evaluated 6 months postoperatively. Results. Increased air conduction thresholds at 250, 500 and 1000 Hz were found in RA subjects in comparison to controls (p<0.001). RA patients showed higher air–bone gaps in PTA (p<0.05) and an increased Wave I latency in ABRs (p=0.03). Decreased reproducibility (p<0.001) and amplitude (p<0.001) of TEOAEs were found in RA subjects in comparison to controls. A significant correlation between disease duration and echo amplitude was noticed (r=0.389). After stapedectomy, a reduction in the air–bone conduction gap (11 vs 2 dB HL) was noticed; no significant difference in TEOAEs was found.     

Cricoarytenoiditis in rheumatoid arthritis: radiologic and clinical study

The cricoarytenoid (CA) joint involvement in rheumatoid arthritis (RA) is not uncommon. In this study, clinical assessment, laryngeal endoscopy, and high-resolution computed tomography (HRCT) were used in 15 patients with RA to evaluate the diagnostic criteria of CA joint involvement. Symptoms owing to CA joint involvement were present in 66.6% of the patients. The frequency of involvement was 13.3% on laryngeal endoscopy but 80.0% with HRCT assessment. The most common HRCT findings were CA prominence (46.6%), density and volume changes (46.6%), and CA subluxation (39.9%). In some of the patients, soft tissue swelling (20%) near the CA joint and narrowing in the piriform sinus (33.3%) were also observed. Radiologic abnormalities related to CA joint involvement generally precede clinical symptomatology. Therefore, HRCT evaluation may be a useful method in the assessment of CA joint involvement in RA patients to exclude possible causes of laryngeal signs and symptoms.     

Swallowing problems in rheumatoid arthritis.

Twenty-nine female patients with definite or classical rheumatoid arthritis (RA) and 30 controls were investigated in order to evaluate oral symptoms, particularly xerostomia, and swallowing difficulties in RA by means of a questionnaire, physical examination, stimulated saliva secretion, labial salivary gland biopsy, esophageal manometry and laboratory blood tests. Xerostomia was reported by 6 patients (21%), compared with no-one in the control group. Four of these 6 patients had decreased stimulated saliva secretion, compared with 2 of the remaining 23 patients. Dysphagia was experienced by 8 patients (28%), compared with one control subject. Dysphagia was associated with disease severity. Esophageal manometry revealed a decrease of the amplitude of the peristaltic pressure complex in the proximal part of esophagus in the RA group, indicating dysfunction of the striated muscles. No correlation was found between dysphagia and esophageal manometry results.     

Hearing loss in rheumatoid arthritis.

OBJECTIVE: Hearing loss, both sensorineural and conductive, has been reported in patients with rheumatoid arthritis (RA). The aim of this study was to try and ascertain the type of hearing loss and to determine the cause for any conductive element noted in these cases. DESIGN AND SETTING: A prospective case-control study in the otolaryngology department of a university teaching hospital in the United Kingdom. METHODS AND OUTCOME MEASURES: This study compared 35 patients with RA with 35 age- and sex-matched controls. All patients had pure-tone audiometry, speech discrimination, tympanometry, acoustic reflex, and acoustic reflex decay carried out. Statistical analysis of the two groups was carried out using the F test for differences in variation and the t-test for independent samples. RESULTS: Sensorineural hearing loss that was statistically significant (p < .05) at 500 Hz, 1 kHz, and 2 kHz in both ears was found in 60% of the RA group and in 34.29% of the control group. A conductive hearing loss that was statistically significant (p < .05) at 250 Hz, 500 Hz, 1 kHz, and 2 kHz in the right and left ears was found in 17.14% of the RA patients and in 5.71% of the control group. Speech discrimination did not show a statistically significant difference between the two groups. Tympanometry showed that the conductive element was probably owing to laxity of the middle ear transducer mechanism. Acoustic reflex and reflex decay did not show statistically significant differences between the two groups. CONCLUSION: Sensorineural hearing loss of the cochlear variety is a common finding in patients with RA, whereas conductive loss, although seen, is much less common. Increased laxity of the middle ear transducer mechanism is the likely cause of the conductive element.     

Laryngeal involvement in rheumatoid arthritis.

Twenty-nine female patients with definite or classical rheumatoid arthritis (RA) and 30 controls were studied in order to assess the prevalence of laryngeal involvement in patients with RA and the occurrence of extrathoracic airway obstruction. Laryngeal involvement was assessed by physical examination including direct fiberoptic laryngoscopy, respiratory function tests and low-voltage radiography. Physical examination revealed laryngeal involvement in 17 RA patients (59%), extrathoracic airway obstruction was indicated by spirometry in 4 (14%) and radiography revealed pathological findings in 3 patients (10%). One or more signs of laryngeal involvement were found in 20 patients (69%). Symptoms of breathing difficulties were common (75%) among patients with laryngeal involvement. The erythrocyte sedimentation rate and class-specific rheumatoid factors were not correlated to laryngeal involvement.     

Auditory pathway function after vestibular schwannoma surgery.

We studied seven patients before and after vestibular schwannoma surgery. Four patients became unilaterally profoundly deaf and three patients preserved their hearing. Cortical responses were recorded with a 122-channel whole-scalp SQUID neuromagnetometer using tone-burst stimuli to the healthy ear. Brainstem auditory evoked potentials (BAEPs) were measured using alternating clicks. Ten healthy volunteers served as a control group. In patients, preoperative cortical response latencies and strengths did not differ significantly from those of controls. However, 6 months after the operation the latency was, on average, 7 ms longer than preoperatively over both hemispheres. BAEPs were in the normal range both before and after the operation. These results suggest that unilateral lesion in peripheral auditory pathways also affects cortical reactivity to stimuli presented to the non-affected ear, possibly reflecting altered binaural interaction in the auditory pathways.     

Ear involvement in patients with rheumatoid arthritis.

OBJECTIVE: This study evaluates the degree of hearing impairment in patients with rheumatoid arthritis (RA) and examines the correlation between hearing impairment and the clinical data or chemical mediators. BACKGROUND: Both sensorineural hearing loss (SNHL) and conductive hearing loss (CHL) have been reported in patients with RA, but the results of most studies are not in agreement, and the pathophysiology of hearing impairment in RA is not well known. METHODS: Hearing in patients with RA and controls was examined using pure-tone audiometry and tympanometry. Also, the amounts of pro-inflammatory cytokines and matrix metalloproteinases in addition to antibodies against type II collagen in plasma of the patients with RA were determined using enzyme-linked immunosorbent assay. RESULTS: The frequency of SNHL in the patients with RA was higher than in normal controls (36.1% versus 13.9%), and bone conduction at 2,000 Hz differed significantly between the patients with RA and the controls (p < 0.01). Moreover, the presence of SNHL was related to ESR (p < 0.05), plasma interleukin-6 (p < 0.05), and plasma matrix metalloproteinase-3 (p < 0.001). On the other hand, CHL was not observed, whereas As-type tympanograms increased in the patients with RA (p < 0.01). Abnormal tympanograms were not related to any clinical findings or any chemical mediators tested. CONCLUSION: We demonstrated that there is increased SNHL in patients with RA, which may result from systemic inflammation and tissue injury, and increased latent-type CHL caused by stiffness of the middle ear system whose mechanisms are not yet clear.     

Auditory pathway encoding and neural plasticity in children with learning problems.

An inability to process auditory information, especially speech, characterizes many children with learning and attention problems. Our working hypothesis is that these speech-sound perception problems arise, at least in some cases, from faulty representation of the speech signal in central auditory centers. Preconscious neurophysiologic representation of sound structure by central auditory pathway neurons can be reflected by subcortical and cortical aggregate neural responses. These neurophysiologic responses can be modified by perceptual learning. Our research has shown that some children with learning problems demonstrate abnormal perception and neural representation of certain speech sounds. Differences between normal and learning-impaired groups can be attributable to aspects of neural synchrony that are reflected in aggregate neural responses. Deficiencies in neural synchrony in these children are apparent in subcortical (as well as cortical) representations of speech-sound structure, and these timing deficits are related to performance on speech-sound perception and learning measures. Moreover, impaired perception and neurophysiologic encoding of speech sounds can be improved with cue enhancement and can be modified by perceptual learning associated with auditory training.     

两种腮腺肿瘤切除术比较

目的：比较两种切除腮腺肿瘤手术疗效及并发症发生率,探讨保留腮腺功能、减少手术并发症及术后面部畸形的最佳方法。方法：将我院收治确诊的31例腮腺肿瘤患者分为2组,传统腮腺浅叶切除术20例（浅叶组）,肿瘤包膜外0.5～1.0cm部分腺体连同肿瘤切除术11例（部分切除组）。结果：随访1～3年,浅叶组口干1例,部分切除术组无口干;两组分别有一过性额支症状1例和下颌缘支症状1例;浅叶组面部均不同程度出现凹陷畸形,部分切除组面部畸形不明显;两组随访期内均无复发。结论：肿瘤外0.5～1.0cm肿瘤与部分腺体切除术治疗腮腺良性肿瘤安全可行,面部畸形不明显,腮腺功能保留良好。     

Audiovestibular functions in rheumatoid arthritis

Audiologic, middle ear impedance and vestibular function tests were administered to 25 patients with classical or definite rheumatoid arthritis and 25 normal control subjects of 30 to 50 years age group. Any possible influence of other common causes of hearing loss was avoided by carefully selecting the patients. Six patients had mild sensorineural hearing loss and another had bilateral mixed hearing loss. Results of tone decay test, speech reception threshold, speech discrimination score and short increment sensitivity index tests suggested cochlear pathology being responsible for the sensorineural hearing loss. There was no statistical correlation between hearing loss or otoadmittance abnormality and duration or activity of rheumatoid arthritis or positivity of rheumatoid factor. Electronystagmographic recording of saccades and bithermal caloric induced nystagmus revealed no significant abnormality.     

Hearing loss in rheumatoid arthritis

OBJECTIVE: The objective of this study was to evaluate whether patients with rheumatoid arthritis (RA) are more likely to have subclinical hearing loss compared with persons without RA. METHODS: This is a case-control cross-sectional study of 29 patients with RA with disease duration greater than 5 years. Five males and five females were recruited into each decade category (age 40-49, 50-59, and 60-69). These cases were matched in a 1:1 ratio by sex and age to 30 control subjects. A comprehensive set of audiometric and disease severity assessments were performed. RESULTS: Seventeen (59%) of 29 patients with RA had abnormal hearing for at least one frequency (four in one ear, 13 in two ears) by audiometry as did 14 (47%) of 30 control subjects (five in one ear, nine in two ears). The percentage of patients with hearing loss (% RA vs. % control subjects) was: 45% versus 40% sensorineural, 10% versus 7% conductive, and 3% versus 0% mixed hearing loss. In RA versus control subjects, acoustic reflex threshold was abnormal in 17% versus 7%; speech reception threshold was abnormal in 10% versus 3%. Tympanometry and otoacoustic emission findings were similar in both groups. Word recognition did not differ between patients with RA and control subjects. In patients with RA/control subjects, hearing handicap, dizziness, and health assessment questionnaires were abnormal in 28%/7%, 14%/3%, and 72%/7%, respectively. CONCLUSION: There was no difference found in objective audiometric measurements in patients with RA compared with non-RA control subjects. Subjectively patients with RA were more likely to perceive themselves as having hearing disturbances, which may be related to overall disease related functional impairment.     

Abnormal electronystagmography in rheumatoid arthritis

OBJECTIVE: Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthritis, studies assessing the vestibular system in patients with rheumatoid arthritis are limited. The aim of this study was to assess the vestibular system in patients with rheumatoid arthritis. METHODS: The study consisted of 43 patients with rheumatoid arthritis and 30 healthy controls. Otorhinolaryngologic and neurotologic examinations, pure-tone audiometry, impedancemetry, electronystagmography including smooth pursuit, saccade, positional, and caloric tests were performed in all patients with rheumatoid arthritis and in controls. The erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor level were evaluated in all patients with rheumatoid arthritis. RESULTS: Audiograms revealed sensorineural hearing loss in 12 patients (27.9%) with rheumatoid arthritis and in two controls (6.6%); the difference was statistically significant (P=.033). In those with rheumatoid arthritis, the results of electronystagmography revealed central abnormalities in nine patients (20.9%), peripheral abnormalities in three (6.9%), and mixed abnormalities in three (6.9%). Smooth pursuit and saccade tracing impairments were significantly higher in patients with rheumatoid arthritis (P>.05). Canal paresis in patients with rheumatoid arthritis were significantly higher than those in the control group (P=.039). No association was found between electronystagmographic abnormalities in patients with rheumatoid arthritis and age, sex, duration of disease, the results of laboratory testing, sensorineural hearing loss, or medication use. CONCLUSION: Our results suggest an association of rheumatoid arthritis with vestibular system dysfunction as well as auditory impairment.     

Laryngeal involvement in rheumatoid arthritis

The prevalence of laryngeal involvement in Rheumatoid Arthritis (RA) ranges from 13 to 75%. The specific RA manifestations include the cricoarytenoid arthritis and the presence of rheumatoid nodules in the vocal folds.ObjectiveThe objective of this study is to evaluate the prevalence of dysphonia and laryngeal alterations on videolaryngoscopy in RA patients and their association with disease activity.MethodThis is a clinical cross-sectional study that evaluated patients with rheumatoid arthritis as to their disease activity score in 28 joints (DAS-28), laryngeal symptoms, application of a Portuguese version of the Voice Handicap Index and videolaryngoscopy findings, comparing them with a control group.ResultsWe evaluated 47 (54%) patients with rheumatoid arthritis and 40 (46%) controls. The prevalence of dysphonia and videolaryngoscopy changes was respectively 12.8% and 72.4% in patients with RA. The mean of DAS-28 was 3.3 ± 1.2; 26 (74.3%) of 35 patients presenting active disease had laryngeal changes (p = 0.713). Posterior laryngitis was the most common diagnosis (44.7%).ConclusionThe prevalence of laryngeal disorders in RA patients was 72.4% and the prevalence of dysphonia was 12.8%. There was no significant relationship between laryngeal disorders and disease activity.     

Voice disorders in rheumatoid arthritis

The report presents three patients with coincidence of voice disorders and rheumatoid arthritis. Material consisted of 3 females aged 39, 48 and 74 years. Methods included phoniatric examination, videolaryngoscopy, stroboscopy and acoustic voice analysis MDVP). Results: In the two youngest patients the laryngoscopic changes were located on vocal folds, mostly as yellow nodules. The appropriate mobility of both vocal folds was found. The MDVP analysis particularly revealed changes in parameters describing perturbation of amplitude in both cases. In the third case oedema in the region of the crico-arytenoid joints and vestibular folds were observed. MDVP analysis showed slight disturbances in the parameters describing frequency perturbation.     

Meniere's disease in Uppsala and Osaka. A comparative study

A total of 100 patients with Meniere's disease, 50 at the University Hospital of Uppsala and 50 at the Osaka City University Hospital, were submitted to a test battery using the same methods, and the results obtained at the two hospitals were compared. Briefly the findings were as follows. There was no significant difference in age at examination or in the duration of illness. No significant difference was detected with regard to a) the average hearing loss or the types of audiogram, b) the incidence of spontaneous or positional nystagmus, or c) caloric and optokinetic test results. A linear correlation was found between caloric responses and pure tone audiograms in both the Uppsala and Osaka patients.     

Tympanic-membrane structure--new views. A comparative study

In recent years, the rat has attracted increasing interest as an experimental animal in otological research. In the present study, the structure of the rat tympanic membrane (TM) is compared with that of a traditional experimental animal, the guinea pig, and with the human TM. The normal guinea pig TM consists mainly of a single layer of coarse fiber bundles, in contrast to the more solid layers of radial and circular fibers in man and rat. The investigation reveals similar architectural features in the rat and human TM, whereas the guinea pig TM differs structurally.     

Changes in auditory ossicles in rheumatoid arthritis: scanning electron microscopic study

The aim of this study was to define the existence of surface changes on auditory ossicles caused by rheumatoid arthritis. The study comprised of nine pairs of auditory ossicles (mallei and incudes) from autopsy of patients with rheumatoid arthritis, and five pairs of ossicles from persons without RA, taken during autopsies. The specimens were studied with JEOL JSM 5300 type scanning electron microscope. Surface changes of auditory ossicles were defined, affected areas were calculated, and expressed in percentage of total surface. Changes in auditory ossicles in patients with rheumatoid arthritis are significantly higher than in control ossicles, both on ossicular surface and articulations. Increased lysis of incudes, especially in the region of long propagation, corresponds to vascular damage. Articular degeneration is also present, indicating specific rheumatoid alteration. Both changes are statistically more intense in cases with longer duration of disease. In conclusion, rheumatoid arthritis reduces vascularity of auditory ossicles and causes degeneration of articular surfaces.