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Rheumatoid arthritis is suspect in hearing loss; patients with RA are at higher risk of hearing impairment compared to healthy subjects.

Rheumatoid arthritis (RA), a debilitating, chronic, inflammatory disease, afflicts one percent of the U.S. population, but the toll it exacts is devastating. The disease can affect not just bones and joints, but organs, including the heart, lung, skin, and eyes, as well as the auditory system, with the resultant psychological impacts.

THREE TYPES OF RA RELATED HEARING LOSS. Hearing impairment in patients with RA can vary in intensity, but there are three prevalent types of hearing loss.

1 Sensorineural hearing loss (SNHL) is the common type of hearing impairment, affecting 25 to 73 percent of patients. This includes auditory neuropathy--when transmission of signals from the inner ear to the brain is affected; destruction of the cochlear hair cells--possibly induced by drugs (medications), such as salicylates, non-steroidal anti-inflammatory drugs, antimalarial, and some disease-modifying anti-rheumatic drugs; tinnitus may result from large doses of salicylates.


2 Conductive hearing loss (CHL), seen less frequently. This condition includes: synovial destruction of the incudostapedial (Incus, see diagram) and incudomalleolar (Malleus, see diagram) joints, which help transmit vibrations in the inner ear that are perceived as sound; these, like other joints in the body, can be affected by RA. Rheumatoid nodules are the most prevalent extra-articular manifestation in RA patients, which may present at different locations, frequently in the finger joints and at the wrists. In addition, medications such as methotrexate and tumor necrosis factor inhibitors may cause the nodules, or exacerbate their development; or, auditory neuropathy--the condition in which sound is not transmitted satisfactorily; physical reasons may not be obvious, and it may be due to vasculitis (inflammation), as part of mononeuritis multiplex, that is, a condition that affects separate nerve areas.

3 Mixed hearing loss (MHL), also seen less frequently; this diagnosis includes multiple aspects of the body's hearing system.

AGE FACTOR. Elderly patients and those with long disease duration, active disease, positive rheumatoid factor, and rheumatoid nodules are more likely to have hearing impairment. Age-related hearing loss is known also as presbycusis.

TREATMENT. Investigators found no common ground for managing hearing impairment in patients with RA. Treatment with oral steroids in addition to cessation of ototoxic (toxic to the ear) drugs is suggested, as well as, in special circumstances, intratympanic--that is, a drug placed into the middle ear--application of steroids. Other possibilities include methotrexate and TNF inhibitors. Regular testing is advised to monitor and treat impairment progression. In cases of CHL and MHL, surgery might be considered to repair the sound-conduction mechanism of the middle ear. As in the general, non-RA population, hearing aids and implantable devices should be considered.

Researchers concluded that hearing impairment in patients with RA is a multifactorial disease, since it can be affected by environmental and disease factors (smoking, rheumatoid nodules) as well as patient characteristics, such as age and behavioral habits. DM

WHAT YOU SHOULD KNOW about environmental factors

Smoking, alcohol, and noise can impact the auditory system in healthy subjects as well as in subjects with RA.

* Smoking: Even passive smokers are at risk of hearing impairment due to nicotine-related vasoconstriction (constriction of the blood vessels)--which results in a decrease in oxygen concentration, and which can harm external hair cells in the ear canal, resulting in declining cochlear function, causing SNHL RA smokers have increased risk of developing rheumatoid nodules and vasculitis.

* Alcohol: Long-term exposure to alcohol may harm cochlear function, especially the outer hair cells, which can lead to SNHL.

* Noise: Can cause a wide spectrum of metabolic and mechanical damage in the cochlea, leading to hearing loss. This is a significant cause of acquired hearing loss, which is often preventable through wearing of headsets, noise blockers, and other protective garb.
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Title Annotation:BONES & JOINTS
Publication:Duke Medicine Health News
Date:Jul 1, 2016
Previous Article:Mind & memory newsbriefs.
Next Article:Hearing is essential to our daily lives.

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