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. 2024 Dec 11;25(24):13290.
doi: 10.3390/ijms252413290.

Audiological Features in Patients with Rheumatoid Arthritis: A Systematic Review

Jiann-Jy Chen  1   2 , Chih-Wei Hsu  3 , Yen-Wen Chen  1 , Tien-Yu Chen  4   5 , Bing-Syuan Zeng  6   7 , Ping-Tao Tseng  1   6   8   9
Affiliations

Audiological Features in Patients with Rheumatoid Arthritis: A Systematic Review

Jiann-Jy Chen et al. Int J Mol Sci. .

Abstract

Hearing impairment in patients with rheumatoid arthritis has been underestimated for decades. Rheumatoid arthritis can affect both the middle ear (specifically, the incudomalleolar and incudostapedial joints) and inner ear (including the cochlea and acoustic nerve) simultaneously. Despite ongoing research, consensus on effective treatments for hearing impairment in these patients remains elusive. This systematic review aims to consolidate clinically relevant information for healthcare providers by summarizing current evidence on hearing impairment in rheumatoid arthritis patients. We conducted the current systematic review by searching platforms of PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect to retrieve eligible articles regarding hearing impairment related to rheumatoid arthritis. We extract any data on characteristics, pathophysiology, examination, and treatment related to rheumatoid arthritis. Based on the currently available evidence, we advocate for the use of specific audiometric tests to facilitate early detection of hearing impairment in these patients. Regular audiological assessments are recommended to monitor hearing ability and potentially prevent further deterioration. Finally, we propose a modified treatment protocol that integrates steroids, hydroxychloroquine, and non-invasive brain stimulation as a novel therapeutic approach for managing these symptoms. This protocol aims to offer clinicians new strategies to address hearing impairment in patients with rheumatoid arthritis effectively.

Keywords: cochleopathy; hearing impairment; neuropathy; ossicles; rheumatoid arthritis; steroid.

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Conflict of interest statement

The authors declared that there were no potential conflict of interest in this work.

Figures

Figure 1
Figure 1
PRISMA2020 Flowchart of current systematic review. Figure 1 illustrates the flowchart outlining the procedure of the present systematic review.
Figure 2
Figure 2
Schematic diagram of the physiopathology of rheumatoid arthritis in audiology dysfunction. Figure 2, which was drawn by the first author, illustrates the pathophysiology of rheumatoid arthritis-related antibodies and the formation of immune reactions contributing to audiological dysfunction. It overall consisted of six mechanisms, including (1) autoantibodies-induced vasculitis, (2) immune complex deposition in the labyrinthine artery, (3) degenerative changes in the organ of Corti, (4) direct neuritis, (5) incudomalleolar and incudostapedial joints stiffness, and (6) retro-cochlear auditory neuropathy.
Figure 3
Figure 3
Flowchart of the multi-aspect treatment protocol for managing audiology dysfunction related to rheumatoid arthritis. Figure 3 presents a modified multi-aspect treatment protocol focusing on a 3-phase trial involving steroids, hydroxychloroquine, and non-invasive brain stimulation for managing audiological dysfunction related to rheumatoid arthritis. Note: This is a proposal of a future study protocol.
Figure 4
Figure 4
A brief summary of the current systematic review. Figure 4 summarizes the key findings of the current systematic review.
See this image and copyright information in PMC

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