Hearing Loss

Hearing loss is common as we get older and is a natural part of aging. However, it is more common in people with rheumatoid arthritis (RA) and other autoimmune conditions.

How is RA linked to hearing loss?

It is unclear exactly why people with RA have an increased risk of hearing loss. Experts have suggested many possible causes including:1-3

  • RA-related inflammation of the joints between the small bones of the ear
  • Inflammation of the blood vessels (called vasculitis) supplying the cells that process sounds
  • Development of rheumatoid nodules in the ear that physically block sound
  • Side effects of some drugs used to treat RA like NSAIDs, aspirin, hydroxychloroquine, and some disease-modifying anti-rheumatic drugs (DMARDs)
  • Collections of immune system-related proteins called antibody-antigen complexes that deposit in the inner ear and cause damage

Types of hearing loss

The most common types of hearing loss are sensorineural and conductive hearing loss.4

In sensorineural hearing loss, there is a problem with the cells in the inner ear that detect sound. It also includes issues with the nerves that carry information about sounds we are hearing to the brain.4

People with conductive hearing loss have something blocking sound from getting into their inner ear in the first place. An example of conductive hearing loss is a buildup of earwax that physically blocks the ear canal. It is also possible to have mixed sensorineural and conductive hearing loss.4

Hearing loss can range from mild to severe or profound. With profound hearing loss, a person cannot hear regular speech and may only hear some, if any, loud noises. Hearing loss can affect one ear or both ears. If it affects both ears, there may be differences in the hearing that is lost from side to side. Some types of hearing loss come on suddenly, while others slowly develop over time.4

Common type of hearing loss in RA

The most common type of hearing loss in RA is sensorineural hearing loss. However, it is still possible to have conductive hearing loss or both sensorineural and conductive hearing loss together.1-3

There is a specific type of sensorineural hearing loss called autoimmune inner ear disease (AIED) that can happen in people with RA. In AIED, the body mistakenly attacks the inner ear, similar to how RA affects the joints. AIED in the general population is very rare, but the risk is increased for those with more than 1 autoimmune condition.1-3

Symptoms

It can be hard to realize a person is losing their hearing, especially if the hearing loss is developing over a long period of time. Common signs of hearing loss include:5

  • Ringing in the ears
  • Muffled sounds
  • Needing to turn the volume louder on music or TV
  • Difficulty understanding speech, especially when there is loud background noise
  • Feeling like there is a blockage or stuffiness in the ear

Diagnosis

Some experts recommend people with RA have a hearing test when they are diagnosed and regularly after that. However, this does not always happen. An audiologist is a professional who can test a person’s hearing.1-3

There are several different types of tests for hearing loss. These include extended high-frequency audiometry and pure tone audiometry, among others. Your doctor will also directly look in your ears if you are having trouble hearing. This can help identify physical blockages like earwax that may be interfering with hearing.1-3

Treatment

In some cases, treatment may be simple and involve removing earwax or adjusting medicines that can impact hearing. It may also be helpful to increase other drugs used to control RA and suppress inflammation to prevent further damage. Steroids are also often used to treat hearing loss.1-3

Other treatment options include:1-3

  • Hearing aid
  • Cochlear implants
  • Surgery
  • Injections of steroids into the ear

Sudden hearing loss requires immediate medical attention. The sooner a person is treated for sudden hearing loss, the better the chances of recovery.1-3

Prevention

Some causes of hearing loss cannot be prevented, such as aging. However, there are several steps you can take to reduce your risk of hearing loss, such as:1-3

  • Seeing a doctor immediately if you notice sudden hearing loss
  • Avoiding loud noises or wearing earplugs or protective headphones if around loud machinery or speakers
  • Adjusting potential hearing-impacting drugs with your doctor’s help
  • Quitting smoking, since nicotine can impact blood flow to the tiny vessels in the ear and cause damage
  • Avoiding alcohol or other substances that can impact how we process sounds
  • Managing other conditions that impact blood flow, such as high blood pressure, diabetes, high cholesterol, and heart disease.

Talk to your doctor about your risk of hearing loss and ways you can prevent it.

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Written by: Casey Hribar | Last reviewed: March 2021