Prevalence of hearing loss due to ossicular chain involvement in rheumatoid arthritis

Ramesh S., Gurumoorthy A. D.


Background: Rheumatoid Arthritis (RA) is a chronic multisystem disease commonly affecting the synovial joints. Involvement of middle ear ossicular chain in RA may lead to hearing loss. The effects of hearing loss are profound, with consequences in the social, functional, and psychological well-being of the persons affected. Both conductive and sensorineural types of hearing impairments have been found in these patients in various studies. This study aimed at evaluating the prevalence of hearing impairment in our patients.

Methods: Pure tone and impedance audiograms were taken for 100 RA patients who came to the outpatient department. They were divided into three groups based on their disease activity (DAS28). The hearing thresholds were compared among these groups. Tympanographic features and acoustic reflexes were recorded. Disease duration was also taken into account for asessing the severity of hearing impairment.

Results: Out of 100 patients, 52 patients had significant hearing impairment audiometrically, of which 44 had sensorineural, 1 conductive and 7 mixed impairments. No significant difference was found between the hearing thresholds and the disease activity but those with high disease activity had higher incidence of abnormal tympanograms (72.2%) and absence of acoustic reflex (55.5%). Prevalence of hearing impairment was found to be increased with increasing disease duration, with steep rise between 5 and 10 years of disease duration.

Conclusions: Hearing impairment affects the quality of life adversely. Severity of hearing impairment is significantly associated with having a hearing-related handicap and with self-reported communication difficulties. Thus, hearing assessment if done routinely can improve the outcome in these patients. 


Disease activity, Hearing loss, Ossicular chain, Rheumatoid arthritis

Full Text:



Jeong H, Chang YS, Baek SY, Kim SW, Eun YH, Kim IY, et al. Evaluation of audiometric test results to determine hearing impairment in patients with rheumatoid arthritis: analysis of data from the Korean national health and nutrition examination survey. PLoS ONE. 2016;11(10):e0164591.

Huang CM, Chen HJ, Huang PH, Tsay GJ, Lan JL, Sung FC. Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data. BMJ open. 2018 Jan 1;8(1):e018134.

Ferrara P, Modica A, Adelfio M, Salli L, Pappalardo A. Audio-vestibular changes in patients with rheumatoid arthritis. Minerva medica. 1988 Dec;79(12):1043-7.

Raut VV, Cullen J, Cathers G. Hearing loss in rheumatoid arthritis. J Otolaryngol. 2001;30:289-294.

Ozcan M, Karakus MF, Gunduz OH, Tuncel U, Sahin H. Hearing loss and middle ear involvement in rheumatoid arthritis. Rheumatol Int. 2002;22:16-19.

Pascual-Ramos V, Contreras-Yáñez I, Rivera-Hoyos P, Enríquez L, Ramírez-Anguiano J. Cumulative disease activity predicts incidental hearing impairment in patients with rheumatoid arthritis (RA). Clinical rheumatology. 2014 Mar 1;33(3):315-21.

Reiter D, Konkle DF, Myers AR, Schimmer B, Sugar JO. Middle ear immittance in rheumatoid arthritis. Archives Otolaryngol. 1980 Feb 1;106(2):114-7.

Kvien TK, Uhlig T, ØdegÅrd S, Heiberg MS. Epidemiological aspects of rheumatoid arthritis. Ann New York Aca Sci. 2006;1069(1):212-22.

Elwany SA, Kamel T. Hearing and middle ear function in rheumatoid arthritis. J Rheumatol. 1986 Oct;13(5):878-81.

Colletti V, Fiorino FG, Bruni L, Biasi D. Middle ear mechanics in subjects with rheumatoid arthritis. Audiology. 1997;36:136-46.

Salvinelli F, Cancilleri F, Casale M, Luccarelli V, Di Peco V, D'ascanio L, et al. Hearing thresholds in patients affected by rheumatoid arthritis. Clin Otolaryngol Allied Sci. 2004 Feb;29(1):75-9.

Takatsu M, Higaki M, Kinoshita H, Mizushima Y, Koizuka I. Ear involvement in patients with rheumatoid arthritis. Otol Neurotol. 2005;26:755-61.

Öztürk A, Yalçin Ş, Kaygusuz İ, Şahin S, Gök Ü, Karlidağ T, et al. High-frequency hearing loss and middle ear involvement in rheumatoid arthritis. Am J Otolaryngol. 2004;25:411-7.