Journal of Clinical and Diagnostic Research. 2018 Mar, Vol-12(3): MC01-MC05 1 1 DOI: 10.7860/JCDR/2018/28260.11239 Original Article The Effects of Rheumatoid Arthritis in Hearing Loss: Preliminary Report Ear, Nose and Throat Section INTRODUCTION Rheumatoid arthritis is a chronic progressive autoimmune disease [1,2] that can cause articular, extraarticular and systemic effects [2]. Joints destruction due to RA leads to some malfunctions of the body, decreased quality of life, and disabilities of working performance [3]. Furthermore, RA also contributes to impairment of other organs such as eyes, heart, lung, and skin [4]. Auditory system can also be affected by the various pathologies that occur in this disease because incudomalleolar and incudostapedial joints are true diarthrosis that can be subjected to rheumatoid lesions [5,6]. Previous studies reported that RA is usually correlated with hearing impairment [5-8]. Impairment in ossicular joints in the middle ear, vasculitis, neuritis, and the effect of ototoxic drugs used could be the causes, although pathogenesis of hearing impairment is yet to be ascertained [5,8]. Ozcan M et al., found hearing impairment at 51.4% in RA group and only at 14.3% in control group. In RA patients who were suffering from Sensorineural Hearing Loss (SNHL) [4-10], Conductive Hearing loss (CHL) [4,8,9], as well as Mixed Hearing Loss (MHL) [4] had been reported [9]. SNHL was the most frequently reported; up to 72% and correlated with inner ear impairment [4]. CHL was reported at lower prevalence rate of 0-24.3% [8,9], meanwhile MHL was reported at 10.8% [7]. Previous study stated that SNHL in RA patients had significant correlation with ESR increased [10]. Dikici O et al., also reported that hearing impairment could correlate with increasing ESR, disease duration, and platelet count [5]. They found a concurrent in the hearing threshold increased with ESR increased as well as platelet count in patients with rheumatoid nodules. The prevalence of RA in the world is very small (1% of the population) [4,5,8,10]. The same fact is also true in Indonesia where the prevalence of RA ranges from 0.2 to 0.3% [11]. Because of very little research on this disease due to the lack of prevalence, we would like to confirm the results of research that has been done about the relationship between RA with hearing loss. The hospitals we are conducting are tertiary referral hospitals from local hospitals so we hope this can give an idea of the condition of RA in some areas. In response to this, we performed this study to find out the correlation between RA and hearing loss. MATERIALS AND METHODS This cross-sectional, analytical, prospective study was carried out in Otorhinolaryngology-Head and Neck Surgery and Rheumatology Department of Adam Malik General Hospital, Sumatera Utara, Indonesia from January to June 2015. Based on consecutive sampling method, the number of subjects studied was as many as 38 subjects in the period of six months, consisting of 19 subjects as RA group and 19 subjects as non-RA group for comparison. Patients who met the ARA criteria [12] were included in the RA group. While other joints disease patients who did not meet ARA criteria were included in the non-RA group. This study has gained ethical clearance from the Health Research Ethical Committee of Sumatera Utara University and informed consent from all subjects. Inclusion criteria: Patient’s aged 16-50 years with no history of earache, congenital hearing loss, ear infections, ear trauma, acoustic trauma, etc., affecting the auditory function were included. Exclusion criteria: Patient’s diagnosed with systemic disease such as diabetes mellitus, hypertension, hyperlipidemia, etc., were excluded. RA diagnosis was conducted by rheumatologist according to criteria of ARA. RA diagnosis can be confirmed if these four criteria were occurred and lasted for six weeks; stiffness of joints in the morning, arthritis of ≥3 joints, hand joints arthritis, symmetric arthritis, rheumatoid factor of serum, rheumatoid nodules, or radiographic changes. The subjects were recorded based on gender, age, disease duration and presence of rheumatoid nodule and then underwent laboratory evaluation of ESR and platelet count. In addition, clinical examination of ears, nose, throat, head, and neck was performed MUHAMMAD EDY SYAHPUTRA NASUTION 1 , TENGKU SITI HAJAR HARYUNA 2 Keywords: Erythrocyte sedimentation rate, Pure tone audiometry, Sensorineural hearing loss, Tympanometry ABSTRACT Introduction: Rheumatoid Arthritis (RA) is a chronic inflammation that can cause systemic manifestations. Auditory system can also be affected by this disease. Sensorineural and conductive hearing loss have been reported but the results remain controversial. Aim: The aim of this study was to find out the correlation between RA and hearing loss. Materials and Methods: This cross-sectional, analytical, and prospective study included 19 subjects with RA and 19 subjects with other joints disease as comparison from January to June 2015. Pure tone audiometry and tympanometry examinations were conducted for all subjects. Pearson Chi- square test was used to analyse the correlation between RA and hearing impairment as well as the correlation between diseases duration, Erythrocyte Sedimentation Rate (ESR), and platelet count; and hearing threshold. Independent samples t-test was used to analyse the difference in mean of air and bone conduction thresholds, air-bone gap values, as well as hearing thresholds in both groups. Results: Hearing impairment was 78.9% in RA group and 21.1% in comparison group (p<0.05). Sensorineural hearing loss was the most common finding in RA (52.6%). There were significant correlations of disease duration and ESR with hearing loss degree in RA (p<0.05). The significant difference was obtained in air-bone gap values at 500 Hz to 4000 Hz (p<0.05). Conclusion: Rheumatoid arthritis can cause hearing loss.