As America ages, hearing loss is on the rise, with one in four people between 65 and 74 years of age and half of those over age 75 unable to carry on an in-person conversation without difficulty hearing. In recent years, there has been growing awareness that hearing loss is even more common in people with rheumatoid arthritis (RA) and other kinds of inflammatory arthritis, such as psoriatic arthritis.
“[Inflammatory] arthritis and the drugs used to treat it may put patients at risk of developing hearing impairment. Talk to your physician if you detect any worsening in your hearing,” says Amir Emamifar, MD, PhD, research fellow at the University of Southern Denmark and section of rheumatology at Svendborg Hospital.
For other types of arthritis such as osteoarthritis, there have been published case studies but there is still need for more research in this area, he says.
Types of Hearing Loss in Inflammatory Arthritis
In a 2016 review, Dr. Emamifar and colleagues reported that the most common hearing impairment in rheumatoid arthritis — affecting as many as 72 percent of patients in some studies — is sensorineural hearing loss. This type of hearing loss results from problems in the inner ear (the place where sound vibrations are translated into nerve impulses by hair cells in a fluid-filled structure called the cochlea) or the nerve that transmits sound and balance information from the inner ear to the brain.
In a large national study from Korea published in March 2019, researchers found that people with RA (primarily those over 50 years of age) were 40 percent more likely than those without the condition to develop another hearing problem: sudden deafness. This type of unexplained and rapid hearing loss usually affects one ear only and can occur in autoimmune diseases such as inflammatory arthritis as well as other medical conditions and drug exposures.
“This is a good study with new and important findings,” says Dr. Emamifar.
Causes of Hearing Loss in Inflammatory Arthritis
What’s the link between inflammatory arthritis and trouble hearing? In various studies, several possibilities have been raised:
- Joints between tiny bones inside the ear can be damaged by inflammatory arthritis, just like joints elsewhere in the body.
- While usually located at points of pressure under the skin, rheumatoid nodules sometimes develop in the ears and can interfere with hearing.
- Clusters of antibodies and antigens are overproduced in RA, and deposits of these clusters on hair cells of the inner ear can destroy the cells.
- Inflammation of blood vessels (vasculitis), a serious complication of RA, can damage the hair cells’ ability to send sound information to the auditory nerve and brain.
- Medications used in inflammatory arthritis, including salicylates and other NSAIDS, antimalarial drugs, and some other disease-modifying antirheumatic drugs can affect hearing.
Symptoms of Hearing Loss
Given the increased risk of hearing loss and the importance of treatment, Dr. Emamifar has proposed that people be screened for hearing loss at the time they are diagnosed with rheumatoid arthritis and at regular intervals afterward, but this isn’t currently part of standard care. That means it’s up to you to speak up to your health care providers if you think there’s a problem.
How will you know? Frankly, since hearing loss can creep up gradually, you may not be the first to catch on. Instead, it may be your family and friends who notice that you don’t respond to them, misunderstand what they’re saying, frequently need things to be repeated, or set the volume on the TV or radio much higher than they do. Common symptoms of hearing loss you may notice: speech sounding muffled or trouble carrying on a conversation in settings with background noise, such as a restaurant or at home with the dryer going.
“Symptoms of hearing loss may also be subtle, such as a ringing or noise in the ear, a sensation that your ear is blocked or something is stuck in it, or difficulty picking up on certain words in conversations. Be aware of possible symptoms of hearing loss and talk to your doctor. You’ll need to see an audiologist for a comprehensive hearing test so your hearing loss can be detected and any available treatments initiated quickly,” says Maura Cosetti, MD, director of the Cochlear Implant Center at the Ear Institute at New York Eye and Ear Infirmary of Mount Sinai Medical Center.
If you develop sudden hearing loss, seek medical help immediately. Prompt treatment greatly increases the chance you will recover some or all of your hearing.
Evaluation and Treatment of Hearing Loss
Arthritis doesn’t change how an audiologist will evaluate your hearing, but you do need a complete assessment — not just a pass/fail screening test. Your exam is likely to include listening to tones at different pitches, using vibrations to send tones directly to the bones of your inner ear, and seeing how well you can understand spoken words at different volumes and in different environments.
Extended high-frequency audiometry, a sensitive test that detects some types of hearing loss before they interfere with understanding speech, may help detect arthritis-related hearing loss earlier than other standard tests, according to Dr. Emamifar.
Treatments for hearing loss depend on the location and type of problem and may include removal of ear wax, surgery, the use of hearing aids, or a cochlear implant. For people with arthritis and hearing loss, your rheumatologist may consider starting or intensifying the use of disease-modifying antirheumatic drugs, supplementing these with steroids (either oral or injected into the middle ear), and eliminating drugs such as hydroxychloroquine and chloroquine, which may damage hearing. Sudden hearing loss is treated with steroids.
How to Help Prevent Hearing Loss
To help prevent or minimize future hearing loss, take these steps:
Avoid loud noises. “Noise protection is important for everyone, including those with arthritis,” says Dr. Cosetti. Both volume and duration count, so avoid prolonged exposure. Turn down the volume on your music. Take breaks and keep your distance from loudspeakers and other noisy equipment at events. Use earplugs or protective earmuffs when you can’t get away or must use loud equipment.
Stop smoking and avoid secondhand smoke. Nicotine constricts blood vessels so the hair cells in your inner ears get less oxygen. Once damaged, the hair cells can’t respond to sound.
Avoid or cut back alcohol consumption. Alcohol can also damage hair cells in the inner ears, as well as slow your brain’s processing of auditory signals.
