Hearing Loss and Inflammatory Arthritis

Inflammatory arthritis conditions affect more than the joints. Among the complications faced by people living with these conditions are heart disease, osteoporosis, kidney problems, and hearing loss.

Hearing loss is an important concern for people living with inflammatory arthritis conditions. The auditory system—the body system responsible for hearing—is affected by inflammation in the same way other body systems are. Medications used to treat inflammatory arthritis are another reason people with these conditions are at a higher risk for hearing loss, as are lifestyle and environmental factors.

Here is what you need to know about the increased risk of hearing loss with inflammatory arthritis.

What Is Inflammatory Arthritis?

Inflammation is the body’s natural response to an illness or injury. This process allows white blood cells to release inflammatory chemicals in the bloodstream and affected tissues to protect and heal the body. The chemical response that follows promotes blood flow in the affected areas of the body, which is why you see redness and feel warmth in these areas. The swelling in inflammation is from increased blood vessel permeability, which allows fluid to migrate from the circulation into tissues. This protective process can also cause pain because it stimulates nerves.

With some diseases—especially inflammatory arthritis—the inflammation process is triggered even when the body has not been attacked by foreign substances such as bacteria or viruses. In these instances, the body’s immune system (which would normally protect you) mistakenly attacks healthy tissues through the inflammatory process. With inflammatory arthritis, inflammation attacks the joints. Often, multiple joints throughout the body are affected.

Inflammatory arthritis conditions, such as rheumatoid arthritis, psoriatic arthritis, and gout, are also called systemic diseases because they are known for affecting the entire body.

Rheumatoid arthritis (RA) is a type of inflammatory arthritis that affects the joints of the hands, feet, elbows, wrists, ankles, and knees. RA is a systemic disease, so it also affects several body systems, including the cardiovascular and respiratory systems. Systemic symptoms are more common in people who have a more severe form of the disease. These symptoms may affect the eyes, lungs, heart, blood vessels, nerves, and muscles.

Psoriatic arthritis (PsA) is a type of inflammatory arthritis affecting people with the skin condition psoriasis. Psoriasis causes skin cells to multiply faster than normal. The result is a buildup of plaques, or bumpy red patches covered with white scales that can grow anywhere on the body.

Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint, usually in a big toe. It is caused by excess uric acid in the bloodstream.

Anyone of any age can develop an inflammatory arthritis condition, and these diseases are incurable. Fortunately, these conditions are treatable, and, for most people, the outlook can be good due to advances in diagnosis and treatment. Healthcare providers can start effective treatment early, and with so many options out there, most people are lucky enough to experience less joint damage and few or no complications.

Connection: Inflammatory Arthritis and Hearing Loss

Much of the research on the connection between inflammatory arthritis and hearing loss is on people living with RA. That is not to say that other types of inflammatory arthritis don’t also increase the risk for hearing loss; it just means a connection to RA has been more commonly studied.

Overactive Immune System

One 2014 report in the journal Frontiers in Pharmacology confirms the growing evidence related to a connection between inner ear problems and inflammatory and immune system conditions. Autoimmune inner ear disease is sensorineural hearing loss caused by an overactive immune system response, but hearing loss can be caused by other issues not related to the immune system. In 15 percent to 30 percent of cases, autoimmune inner ear disease occurs in the context of a systemic autoimmune disease.

Rheumatoid Arthritis

In a review of clinical reports published in The Open Rheumatology Journal in 2016, researchers report that patients with RA are at a higher risk for hearing loss in comparison to others in the general population. Hearing loss in people with RA has numerous causes and risk factors, which may include but are not limited to disease severity and duration as well as lifestyle.

The Open Rheumatology Journal review finds the most common hearing impairment in people with RA is sensorineural hearing loss (SNHL), affecting up 72 percent of people with RA. Sensorineural hearing loss results from damage to the inner ear, the auditory nerve (the nerve that runs from the ear to the brain), or in the brain.

A newer and larger study from Korea published in 2019 found that people with RA—especially those over age 50—were 40 percent more likely to develop SNHL than others without the condition. The researchers observed this connection and determined the risk was more common in men who were age 50 and up. Further, they noted their findings were confirmation that SNHL risk was higher in people with RA than others in the general population.

Psoriatic Arthritis

PsA can also be associated with hearing loss. One study reported by the Journal of Rheumatology in 2019 found that 31.7 percent of study participants with PsA were experiencing hearing loss, in comparison to 6.7 percent of healthy participants who were also experiencing hearing loss. Additionally, 23.3 percent of the people with PsA experienced impaired balance. Inner ear damage was to blame for hearing and balance issues in up to 26.7 percent of the PsA study participants. None of the healthy study participants showed this type of damage.

Gout

People with gout also experience hearing loss, and risk seems to increase with age. One 2018 report published in BMJ Open finds elderly people with gout are more likely to develop hearing loss over six years in comparison to those without gout. The researchers suspect hearing loss and gout may share some of the same processes as hearing loss, including hyperuricemia-related (excess uric acid in the blood), inflammation, and oxidative stress (imbalance between free radicals and antioxidants in the body).

Causes

Causes of hearing loss in people with inflammatory arthritis may include the disease itself, the medications used to treat the disease, and various lifestyle and environmental factors.

Disease: The same inflammatory process that affects the joints can also affect the tiny joint, bone, and cartilage structures in the ears. Further, the more severe a person’s inflammatory arthritis is, the more likely the disease may affect the small structures of the ear. Additionally, inflammation of blood vessels (vasculitis), a very serious complication of inflammatory arthritis, can lead to damage in parts of the ear that are responsible for sending information to the auditory nerve and brain.

Medication: Some of the medications used to treat inflammatory arthritis conditions may also be responsible for hearing loss. For example, one study reported in 2012 in the American Journal of Epidemiology found women who took ibuprofen or acetaminophen two or more days a week had an increased risk for developing hearing loss. Ibuprofen is often used to manage inflammation and pain, while acetaminophen can manage arthritis-related pain.

Lifestyle: Certain lifestyle habits may play a part in the development of hearing loss in people with RA and other types of inflammatory arthritis. The authors of the 2016 Open Rheumatology Journal report note that hearing loss in people with RA has to do with many factors, including environmental and lifestyle factors such as noise, cigarette smoking, and alcohol consumption. They further state that quitting smoking, reducing alcohol consumption, and incorporating steroid medications and disease-modifying treatments in an RA treatment plan can reduce the risk of hearing loss.

Autoimmune inner ear disease (AIED): AIED describes hearing loss related to autoimmunity—the misdirected immune system response that causes it to go awry and attack its healthy tissues. In AIED, the cochlea—the spiral-shaped cavity of the inner ear that produces nerve impulses in response to sound vibration—and other inner ear structures are the target of the body’s overactive immune system. AIED may appear on its own, but in about 15 percent to 30 percent of causes, AIED is related to a systemic inflammatory disease. Symptoms of AIED include dizziness and ringing in the ears, which typically develop over several weeks or months.

Hearing Loss Symptoms

The symptoms of hearing loss are not always obvious. For most people, it is their families and friends who first notice a problem when a loved one doesn’t respond, misunderstands what is being said, or because the loved one with hearing loss sets the volume on the radio or TV higher than they normally would.

Common symptoms of hearing loss an affected person may notice include:

• Speech that sounds muffled
• Trouble carrying on a conversation when there is background noise, such as in a restaurant
• Ringing or noise inside the ears
• Trouble hearing consonants (constant letter sounds)
• Frequently asking others to repeat things or speak slower, louder, or clearer
• Withdrawal from conversations and avoidance of social activities

People with inflammatory arthritis should be aware of the symptoms of hearing loss. That way if any symptoms develop, they can seek out medical help and prompt treatment.

Diagnosis

Having an inflammatory arthritis condition doesn’t change the way you are evaluated and diagnosed.

Testing can help with diagnosing ear problems related to inflammatory arthritis. Blood work includes anti-cochlear antibody testing that looks for specific inflammation-producing proteins that attack cochlear cells, and lymphocyte transformation assay testing to determine if a person has a type of white blood cell that may negatively affect immune system responses.

Various hearing tests may include:

• Brainstem auditory evoked response (BAER) test (also called a brainstem auditory evoked potentials [BAEP] test): measures how your brain responds to clicks and other audio tones
• Otoacoustic emissions (OAE) tests: records sound vibrations the ear produces in response to what is heard. People with normal hearing will produce normal OAE vibrations, but people with hearing loss do not usually produce these or produce much fewer.
• Electrocochleography: uses an electrode placed in the ear canal to record electrical potentials generated in the inner ear and auditory system in response to sounds

Treatment

Treatments for hearing loss depend on the location and source of the problem. For people with inflammatory arthritis, treatment using corticosteroids and methotrexate can be effective, according to one 2014 report in the Greek medical journal Hippokratia. Oral steroids can improve hearing by up to 60.5 percent, while intratympanic application (directly in the ear—using an injection or ear drops) can improve hearing by up 68.6 percent in some people. Methotrexate does not offer as high of a response, but it can improve hearing loss in up to 11.1 percent of people.

If you have SNHL related to medication use, your healthcare provider may adjust or change your medications. Some people may need a hearing aid to help them hear better and/or restore hearing.

Prevention

You can prevent hearing loss related to inflammatory arthritis or at least reduce the effects it may have on your hearing.

Ways to prevent or reduce the effects of hearing loss include:

• Letting your healthcare provider know about any over-the-counter pain relievers you are taking
• Letting your healthcare provider know if you experience symptoms or ringing or roaring in your ears or dizziness
• Avoiding long exposure to loud noise, as loud noise can promote the development of SNHL, especially in people with inflammatory arthritis
• Wearing ear protection when around loud noise or noisy equipment (i.e., a lawnmower)
• Keeping the volume down when listening to music with earbuds
• Quitting smoking and avoiding secondhand smoke
• Avoiding or cutting back on alcohol

A Word From Verywell

Anyone who lives with inflammatory arthritis who starts to notice ringing in their ears or finds it is getting harder to hear or understand conversations should talk to their healthcare provider. In many cases, hearing loss can be reversed, or the solution could be as easy as reducing a medication dosage or finding a treatment alternative.

Of course, you shouldn’t stop taking any medication without first talking to your healthcare provider. It is also is a good idea to learn about and understand the risks of some of the medications you take to manage inflammatory arthritis so you can talk to your practitioner if you think you are having problems with your hearing.