Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily recognized for its impact on joints, causing pain, swelling, and stiffness. However, RA is a systemic condition, meaning its effects can extend throughout the body, impacting various organs and systems, including the ears. Research suggests individuals with RA may experience hearing difficulties at a higher rate than the general population.
Rheumatoid Arthritis and the Auditory System
RA is an autoimmune disorder where the immune system mistakenly attacks healthy tissues, leading to widespread inflammation. While often concentrated in the joints, this inflammatory process can affect almost any organ system, including the skin, eyes, heart, lungs, and nervous system. This systemic inflammation can lead to extra-articular manifestations, impacting delicate structures like those in the auditory system.
The auditory system is a complex network responsible for processing sound, consisting of three main parts: the outer, middle, and inner ear. The outer ear collects sound waves and channels them through the ear canal to the eardrum. The middle ear contains three tiny bones, known as ossicles—the malleus, incus, and stapes—which transmit vibrations from the eardrum to the inner ear. The inner ear houses the cochlea, a snail-shaped structure containing fluid and thousands of tiny hair cells, which convert sound vibrations into electrical signals. These electrical signals then travel along the auditory nerve to the brain, where they are interpreted as sound.
How Rheumatoid Arthritis Can Affect Hearing
RA can influence hearing through several mechanisms, reflecting its systemic inflammatory nature. Direct inflammation can affect ear structures, such as the small joints of the ossicles in the middle ear, limiting their movement and impairing sound transmission. Inflammation can also damage nerve cells in the inner ear, specifically the hair cells within the cochlea, which convert sound vibrations into electrical signals, impairing their function.
The autoimmune nature of RA means the immune system can mistakenly target ear tissues, potentially leading to autoimmune inner ear disease (AIED). AIED, though rare, is more prevalent in individuals with autoimmune diseases like RA. Additionally, inflammation of blood vessels, or vasculitis, a complication of RA, can reduce blood flow to the auditory system. This reduced blood supply can damage delicate hair cells and auditory nerves, impairing their function.
Certain medications commonly used to treat RA can also contribute to hearing changes. Non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and acetaminophen, often used for pain and inflammation management in RA, have been linked to ototoxic effects. These medications can restrict blood flow to the inner ear or affect the production of protective proteins, potentially leading to hearing loss over time. The risk may increase with high dosages or prolonged use.
Furthermore, secondary conditions that often co-occur with RA can independently affect hearing. Sjögren’s syndrome, another autoimmune disorder characterized by dry eyes and dry mouth, is frequently seen in people with RA and can also cause sensorineural hearing loss. Studies show that individuals with Sjögren’s syndrome can have higher rates of hearing loss compared to those with RA alone.
Recognizing Hearing Changes and Seeking Care
Recognizing changes in hearing is important for individuals with rheumatoid arthritis. Common symptoms of hearing loss can include muffled sounds, difficulty understanding speech, especially in noisy environments, needing to ask others to repeat themselves, and ringing or buzzing in the ears, known as tinnitus. Some individuals might also experience a feeling of fullness in the ear or dizziness. If any of these symptoms develop, it is advisable to seek medical attention.
Hearing loss associated with RA can manifest in different forms. Sensorineural hearing loss, which results from damage to the inner ear or auditory nerve, is the most common type reported in people with RA, affecting a significant percentage of patients. Conductive hearing loss, caused by problems in the outer or middle ear that prevent sound from reaching the inner ear, can also occur, for example, due to inflammation affecting the ossicles or the formation of rheumatoid nodules in the ear. Sometimes, a mixed hearing loss, involving both sensorineural and conductive components, may be present.
Diagnosing hearing loss involves a comprehensive evaluation, typically performed by an audiologist or an ENT specialist. Audiometry, including pure tone audiometry, is a standard test that measures hearing thresholds across different frequencies. In some cases, extended high-frequency audiometry may be used to detect subtle hearing changes earlier. Early diagnosis is important for timely management and to differentiate RA-related hearing changes from other common causes of hearing loss.
Management strategies for hearing loss in RA can vary depending on the underlying cause. If a medication is identified as contributing to hearing loss, adjusting the RA treatment regimen might be considered under medical supervision. For permanent hearing impairment, hearing aids or other assistive listening devices can often improve communication and quality of life. Consulting with a healthcare provider, such as an RA specialist, audiologist, or ENT specialist, is important to determine the most appropriate course of action and to ensure comprehensive care.