Inflammatory Arthritis, Autoimmune Disease, and Hearing Loss

In the United States, 24% of all adults—or 58.5 million people—have arthritis, a leading cause of work disability. In addition to the pain and mobility issues posed by arthritis, some forms of arthritis are linked to hearing loss.

More than 100 types of arthritis exist, but the two most common are osteoarthritis and rheumatoid arthritis (RA), the latter being a type of inflammatory arthritis and autoimmune disease that affects some 1.3 million Americans. IA can affect multiple organs and cause widespread symptoms. In this article, HearingTracker looks at the connections between certain types of arthritis and hearing loss, why they might be related, and how you might better manage both your arthritic pain and hearing health.

What is Inflammatory Arthritis (IA)?

To understand the condition of inflammatory arthritis (IA), it is helpful to first know a little about the immune system and autoimmune disease.

Our immune system protects us against bacteria and viruses. Normally, the immune system can tell the difference between foreign cells and your own cells. But, for people with autoimmune disease, their immune system is overactive and misidentifies their body tissues as foreign cells or harmful germs and attacks them. The result is inflammation and swelling in the body.

IA is a long-lasting or chronic disease that causes inflammation of the affected tissues in and around joints. Inflammatory arthritis conditions are referred to as systemic diseases because they can affect the entire body and often involve multiple joints.

Common symptoms of IA include joint pain and stiffness, weakness, swelling, and decreased range of motion.

Types of IA and links to hearing loss

There are various types of IA, including at least three that researchers have linked with hearing loss:

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune and inflammatory disease. Unlike osteoarthritis, which commonly affects people in later life, RA can begin at any age.

Typically, it affects the joints in the hands, wrists, and knees and can attack many joints simultaneously. RA affects the lining of the joints, causing chronic pain, inflammation, and permanent damage to the joint tissue.

In some people, RA affects the joints and causes damage to other tissues in the body, including the lungs, eyes, heart, and blood vessels. This, in turn, may negatively affect organs associated with your hearing ability.

Psoriatic arthritis

Psoriatic Arthritis (PsA) is a type of arthritis that affects some people with the chronic skin condition psoriasis. Psoriasis causes bumpy red patches of skin covered with white scales and thick fingernails. Like RA, PsA causes joint swelling, stiffness, and pain and has been linked in studies to hearing loss.

Gout

Gout is a common and complex type of IA that can affect anyone. It causes severe attacks of pain, swelling, redness, and tenderness in one or more joints, usually affecting the big toe. Attacks of gout can happen suddenly and can cause people to wake in the middle of the night with the feeling that the affected joint is on fire.

Although there may be less evidence linking hearing loss with gout than for RA or PsA, researchers have suggested higher levels of uric acid in the blood (which can lead to gout) are associated with hearing loss, especially in older adults.

There is no cure for arthritis. However, treatment for IA usually involves a combination of self-management strategies and medications that can help alleviate symptoms, preserve joint function, and slow its progression.

What is autoimmune inner ear disease?

Sometimes, people with autoimmune diseases such as IA can also develop a condition called autoimmune inner ear disease (AIED). For people with AIED, the immune system attacks the cochlea and other structures of the inner ear, causing sensorineural hearing loss (SNHL).

AIED is rare, accounting for only about 1% of all cases of hearing loss. AIED may happen on its own, but in 15-30% of cases, those affected have another autoimmune disease such as RA. Symptoms of hearing loss due to AIED usually develop over several weeks or months and include dizziness and tinnitus.

What types of hearing loss are linked to IA?

Though IA has been linked to conductive and mixed hearing loss, the most common type of hearing loss linked to the disease is SNHL.

SNHL is permanent and happens when the tiny hearing hair cells in the inner ear or the auditory nerve—that transmits balance and hearing information to the brain—become damaged.

Symptoms of SNHL include muffled hearing, difficulty understanding speech, tinnitus (ringing in the ear), and a plugged feeling in the affected ear.

What does the research say about the link between hearing loss and IA?

Most of the research on the link between IA and hearing loss focuses on people living with RA. However, this doesn’t necessarily mean that other types of IA don't share a connection with hearing loss, just that RA has been studied more.

In 2020, while working as an ENT resident at a general military hospital in Athens, Greece, Charalampos Festas, MD, and his team carried out a review and analysis of multiple scientific studies that investigated if RA is associated with specific types of hearing loss. They found that people with RA are 4 times more likely to develop SNHL compared to those without the condition.

An earlier 2001 study found that sensorineural hearing loss affected both ears in 60% of participants with RA, compared with 34.29% of those without the condition.

The 2016 study “Is hearing impairment associated with rheumatoid arthritis: A review,” aimed to explore the possible link between hearing impairment and RA. The researchers found that patients with long RA disease duration were at higher risk of hearing loss compared to people without the disease.

There is further research that explores other IA conditions. For example, a study published in January 2019 examined information about people with Psoriasis with Arthritis (PsA). They found that PsA is independently associated with a significantly increased risk of hearing loss.

Furthermore, a 2018 report found that older adults with gout are more likely to develop hearing loss over 6 years in comparison to those without gout.

RA and risk of sudden sensorineural hearing loss

A 2019 Korean study found that people (mainly aged 50+ years old) with RA were 40% more likely to experience a sudden sensorineural hearing loss (SSNHL)—a sudden or rapid loss of hearing in one or both ears, which can occur immediately or over a few days—compared to those without the condition.

Note that if you think you have experienced SSNHL, be sure to seek immediate medical attention from an ENT physician and audiologist, as early treatment can help save your hearing.

How is hearing loss linked to IA?

Regarding the link between hearing loss and IA, “The pathophysiology [the study of abnormal functions in the body and how disease processes work] is very complicated,” explains Dr. Festas. “It depends on what inflammatory disease someone has and the intensity of the disease.”

He notes the effects of IA on hearing differ for each affected individual. “There isn't a general rule for whether someone with IA will develop hearing loss, or if so, to what degree,” explains Festas. “There is still a lot of research to be done in this area.”

Though the connection between IA and hearing loss is not yet fully understood, there are some potential explanations for the causes of hearing loss in people with IA, including the following:

Ear damage related to autoimmune disease

For people with autoimmune diseases such as IA, their body’s immune system may attack the bone, cartilage, or joints between the tiny bones in the ear, causing damage to their hearing. Also, Inflammation of blood vessels (vasculitis), a serious complication of IA, can damage the parts of the ear responsible for sending sound information to the auditory nerve and brain.

Rheumatoid nodules

Up to 20% of patients with RA develop rheumatoid nodules, which are firm lumps that range from the size of a pea to a walnut and develop under the skin. “Rheumatoid nodules are mostly seen in the hands, or even the feet or ears of patients with rheumatoid arthritis,” according to Dr. Festas. If rheumatoid nodules develop in the ear, they may cause damage to the middle and outer ear, making it difficult for sound to travel through the ear.

Lifestyle, environment, and age

Various studies have identified smoking as a risk factor for IA. For example, the authors of the 2016 study note that hearing loss in people with RA could be associated with many factors, including environmental and lifestyle factors such as noise, smoking, and alcohol consumption. And, of course, older age means there could be a cumulative effect of all factors associated with hearing loss.

IA medications

Different medications are used to manage IA conditions, both prescription and over-the-counter (OTC). Some common ones are general pain relievers, such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs, which include ibuprofen), and corticosteroids. Some medications, such as ibuprofen, have been linked to hearing loss.

HearingTracker spoke with New Jersey audiologist Robert M. DiSogra, AuD, who writes and lectures on a variety of hearing loss topics and is an expert on ototoxicity (ear-damaging medication), to find out more.

DiSogra referred to a 2017 study that investigated the relationship between the duration of analgesic (painkillers) use and self-reported hearing loss. “A recent study of over 55,000 women showed a 10% risk of hearing loss with regular use of acetaminophen over a 10-year period,” he told HearingTracker. Those who used aspirin did not show similar problems with hearing.

Furthermore, another examining data from nearly 27,000 men found that regular aspirin use increased the chances of hearing loss by 50%. Men under age 50 who regularly used NSAIDs increased their risk of hearing loss by 61%. And, for regular users of acetaminophen, the risk of hearing loss was doubled.

Researchers suspect that the reason for the link between certain pain relievers and hearing loss is that they may reduce blood flow to the ears. If this is the case, the long-term use of some pain relievers may damage hearing in some people.

DiSogra created the following table which lists the medications and any auditory or vestibular side effects of medications used to manage autoimmune disease:

A note on herbal therapies to relieve pain

DiSogra also mentioned the use of complementary and alternative medicine, including herbal therapies, to manage IA and other autoimmune diseases. Despite extensive use, these products are not subject to the same governmental quality control standards as conventional medicine, and there is a lack of reliable clinical data assessing their safety and effectiveness in treating pain.

Taking care of your hearing 

In addition to healthy eating and regular exercise, you can help to prevent or minimize future hearing loss in the following ways:

• Avoid loud noise: To prevent noise-induced hearing loss, be mindful of how loud you listen to music and avoid extended exposure to loud noise. Use hearing protection such as earplugs or protective earmuffs if you work in a loud environment or are attending any social activity that involves loud noise, such as concerts or sporting events. 
• Quit smoking and avoid second-hand smoke. Nicotine constricts blood vessels, meaning the hearing hair cells in your inner ears receive less oxygen, which can lead to hearing damage.
• Avoid or cut back alcohol: Alcohol can damage hearing hair cells in the inner ears. Excessive drinking may also cause damage to your brain and affect the way your brain processes sound. 

Final note

Being aware of the association between IA and hearing loss can help you to manage your pain and protect your hearing. If you are living with IA and you or a loved one feel you are having difficulties with your hearing, or you start to experience tinnitus, be sure to speak to your healthcare provider. They can explain any risks of medications you are taking to manage your IA and may recommend changing to a more ear-friendly alternative to help preserve your hearing.