Autoimmune diseases linked to hearing loss and tinnitus

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Did you know that hearing loss can be linked to an underlying condition, not just age or noise exposure? When this happens, the disease is often an autoimmune disease such as rheumatoid arthritis (RA) or lupus.

Research indicates that hearing loss, tinnitus and other hearing problems are more common in people with autoimmune disorders, so much so that audiologist Trisha Milnes encourages all of her autoimmune disease patients to ask hearing tests.

His clinic even makes a point of reaching out to patients with certain autoimmune diseases, asking them questions about their hearing, said Milnes, chief of audiology and speech-language pathology at Charlie Norwood Virginia Medical Center. , a facility of the Veterans Health Administration. “It’s very necessary,” she explained.

What is an autoimmune disease?

The immune system is our body’s way of fighting microorganisms that can make us sick. When functioning normally, the immune system can correctly identify and defeat infections. But sometimes the immune system misidentifies tissues in the body as dangerous, causing harmful types of inflammation when no real threat is present. This dysfunction can occur spontaneously, without a clear cause, or can sometimes occur as a reaction to an infection.

According to studies, autoimmune diseases are increasingly common. A well-known autoimmune disease is type 1 diabetes. Other autoimmune diseases you may have heard of include rheumatoid arthritis, Hashimoto’s autoimmune thyroiditis, Sjögren’s syndrome, celiac disease , ankylosing spondylitis, Graves’ disease, vitiligo, lupus and psoriasis. (Note that allergies are not considered an autoimmune disease.)

How are autoimmune diseases related to hearing loss?

Not all autoimmune diseases affect hearing, but many do. Often, hearing damage is linked to harmful inflammation of the delicate anatomy of the ear or disruption of blood flow to the ear. The severity of hearing loss can vary. Depending on the underlying disease, it can affect one or both ears, can develop suddenly or slowly, and can affect different frequencies (tones).

Given the complexity of hearing and the immune system, it is not always possible to know what role an autoimmune disease played in hearing loss. Autoimmune diseases can flare up and then go into remission, and a person may never realize the connection to their hearing loss.

“In many cases, although the hearing loss is permanent, the cause of the damage may be transient, so there is no way to diagnose the cause of the damage after it has occurred,” explained Aaron Abend, executive director of Autoimmune Registry, Inc. .

Treatment may include corticosteroids that limit blood vessel inflammation and immune attack on the inner ear. For some autoimmune diseases, plasma transfers can remove antibodies that attack blood phospholipids. Other treatments increase blood flow to the inner ear or suppress the immune system. When the hearing loss is permanent, hearing aids may be recommended.

Inner ear autoimmune disorder

The autoimmune disease most directly related to hearing is autoimmune inner ear disorder (AIED). In this rare condition, immune cells attack the inner ear, leading to progressive hearing loss that can fluctuate. Hearing loss can be sudden, but according to an article in the Hearing Journal, the onset of AIED is usually slower and takes days or even months.

It can occur on its own, but data shows that about a third of patients with AIED also have a systemic autoimmune disease, such as lupus or rheumatoid arthritis.

Rheumatoid arthritis (RA)

Rheumatoid arthritis (RA) is a chronic autoimmune disease that begins in the joints, usually in the hands, wrists and knees, and in severe cases can spread to internal organs. Studies vary widely in estimating the number of RA patients who develop hearing loss, but the answer varies by 72%. Patients with RA who are exposed to cigarette smoke are at higher risk of hearing loss.

A 2020 research overview concluded that people with RA were more than four times more likely to have sensorineural hearing loss, but had no greater risk of conductive (blockages) or mixed hearing loss. In most cases, RA affects both ears and hearing loss can fluctuate. It usually affects the higher pitches, showing a drop on an audiogram at the higher frequencies.

Lupus

Systemic lupus erythematosus is a chronic autoimmune disease that can affect the joints, skin, kidneys, blood cells, brain, heart, lungs and ears. Sometimes hearing loss is the first symptom a patient notices. Studies vary widely in estimating the percentage of lupus patients who have hearing-related symptoms, but a recent estimate puts it at around 25%.

With lupus, hearing loss often begins in one ear, affecting high-pitched sounds, before spreading to the other ear and affecting lower-pitched sounds, known as reverse-slope hearing loss. It can also cause tinnitus (ringing in the ears), dizziness or fullness of hearing. Auditory processing disorder (APD) can also be a problem.

Fibromyalgia

Although fibromyalgia has not historically been considered an autoimmune disease, recent evidence suggests that the disease, characterized by widespread pain and muscle weakness, is triggered by antibodies, which are part of the immune system. Emerging evidence also indicates that the disease is associated with more than double the risk of hearing loss, causing problems such as high-frequency hearing loss, hyperacusis, APD and dizziness.

Lyme disease

Lyme disease is caused by exposure to bacteria carried by ticks. There are reports that it can trigger lupus and separate research at Johns Hopkins in Baltimore demonstrates how the bacterium impairs immune cells. The infection may trigger autoimmune activity in people with genetic vulnerability.

In 2021, a hospital team in Krakow, Poland reported that of 86 patients hospitalized with sudden hearing loss over a year, nine showed signs of Lyme infection and had regained some or all of their hearing after antibiotic treatment. People with advanced Lyme also develop APD, hyperacusis, tinnitus, dizziness, and poor balance, but not necessarily through autoimmune activity.

Other terms

Thyroid problems and hearing loss

Changes in thyroid levels, as in the case of Hashimoto and Graves, can affect the ears, causing sensorineural or conductive hearing loss.

Dermatological problems

Skin conditions can also affect hearing. Vitiligo, which creates patches of skin without pigment, has been linked to a higher risk of sensorineural hearing loss. Psoriasis, which causes patches of itchy scaly skin, increases the risk of sudden sensorineural hearing loss by 50%.

Sudden hearing loss in one or both ears is considered a medical emergency. The sooner you seek treatment, the more you will save your hearing.

Meniere’s disease

It is unclear whether Ménière’s disease – which causes intermittent episodes of hearing loss, tinnitus, ear fullness and vertigo – is an autoimmune disorder, although it appears that the two often overlap, according to this study.

Other factors that can affect your hearing

A woman takes a pill.
Some drugs needed for autoimmunity
problems can lead to hearing loss or tinnitus.

Many autoimmune diseases can cause pain, and people may come to rely on aspirin, acetaminophen (Tylenol), or NSAIDs like ibuprofen. Frequent use of over-the-counter painkillers has been linked to hearing loss, likely because they affect blood flow to the cochlea in the inner ear. There are many other medications that can cause hearing loss or tinnitus.

Are you dealing with unexplained fatigue? This dragging sensation is one of the most common and frustrating symptoms of autoimmune disease and is also more common in people with hearing problems, although it is not necessarily related to the degree of hearing loss. . It’s possible the combination could affect you, notes Ben Hornsby, an associate professor of hearing and speech sciences at Vanderbilt University in Nashville, Tennessee.

What can you do?

If you have recently been diagnosed with an autoimmune disease, keep in mind that your hearing may be affected. If you feel like you can’t hear well, take a hearing test to find out. And if you experience sudden or new changes in your hearing, tell your doctor right away.

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