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Eh? What’s That You Say?

I bet I know a set of joints you’ve never heard of before: the ossicular joints.

They’re synovial joints, like the joints in your knees, elbows, shoulders, and knuckles (among others). Synovial joints are the hinge- or ball-and-socket joints that allow us to move: walk; bend at the hip and pick things up with our fingers; shrug a sweater on or off, play tennis or chase a 3-year-old. Synovial joints mean we can swing our arms or run races or do jumping jacks.

When it comes to rheumatoid disease, though, synovial joints are special in a darker way. RD tricks the body’s deadly serious, protective immune system into siccing confused-but-valiant soldier-antibodies on them. Misguided and lethal, the antibodies perceive the synovial tissues (which lubricate, cushion, and protect the joints) as enemies that must be destroyed at all costs.

You know what that means: if they’re not stopped, the antibodies cause inflammation, pain, and the eventual destruction and sometimes, deformity of the joint. More pain–and often, permanent disability–follows.

How … delightful. But back to the ossicular joints. Where are they, anyway?

They’re in your ears. Yes, you heard that right. (Forgive me, please?) There are three tiny bones in the inner ear, lying directly behind the eardrum: the malleus (“hammer”), the incus (“anvil”), and the stapes (“stirrup”). Together they’re known as the middle ear ossicles, and without them, you can’t hear a dang thing.

The hammer connects to the eardrum; its other end connects, hinge-like, to the anvil. The anvil and stirrup bones hinge as well. Finally, the stirrup’s flat end connects to an oval opening in the cochlea, the horn-like, fluid-filled portion of the inner ear.

When a sound hits the amazingly sensitive eardrum, it vibrates and moves the middle ear ossicles. Like miniature levers, they cause the flat end of the stirrup to pump against the cochlea, sending waves of sound spiraling through to the brain.

The connecting “hinges” between the hammer, anvil, and stirrup bones are actually miniscule synovial joints. As odd as it sounds, RD may attack even these, the smallest joints in the human body.

This misguided, self-destructive attack on the ossicular joints causes inflammation and swelling. It can also thicken the synovial fluid into a hard substance called pannus, causing deformity. All of this interferes with the free movement of those tiny ossicular hinges, keeping them from conducting sound as well as they should. Tinnitus (a constant ringing, hissing, or roaring sound in the ears), reduced or impaired hearing, or even deafness can result.

Fortunately, ear RD is rare, affecting only about 1 percent of patients. Studies show that in some patients, the auditory symptoms track right along with the course of their RD; they’re worse when it flares and get better when it abates.

Treatment for symptoms of hearing loss related to RA is the same as for all the other synovial joints: treat the underlying disease with non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate or Plaquenil, and biologic DMARDs, such as Humira.

As someone who’s endlessly curious, discovering that I have joints in my ears (!) delights me. That my RD can mess them up like it does my fingers, knees, and elbows is sobering, though. It never stops surprising me.

 

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. How Do the Hammer, Anvil, and Stirrup Bones Amplify Sound Into the Inner Ear? from http://www.scientificamerican.com/article/experts-how-do-the-hammer-anvil-a/
  2. What is Autoimmunity? How is it Connected to Vestibular Disorders? from http://vestibular.org/autoimmune-inner-ear-disease-aied
  3. Autoimmune Inner Ear Disease, from  http://american-hearing.org/disorders/autoimmune-inner-ear-disease-aied/

Comments

  • Cari
    3 years ago

    I wore hearing aides for eight years because the stirrup in both ears ‘froze’ in place due to RA.. About 18 months ago I had surgery on both ears and they put a prosthetic bone in it’s place. My hearing has improved a lot and I currently am not wearing hearing aids at all. I recommend looking into this procedure if you are having trouble hearing because of your RA. It’s wonderful to be able to hear again.

  • pinpinny
    3 years ago

    I have RD of the Inner Ear. This is devastating disease. The progression of this disease can be quick and bilateral. I woke up one morning with sudden hearing loss. The destruction is not just limited to bones and joints but also the vestibular system. This is the part of the body responsible for balance and equilibrium. The disease robs you the ability to walk. In some cases it progresses to the eyes. When the head moved the eyes continue to move. Suddenly I find myself totally deaf in one ear, needing a walker, and lacking eye acquity. Not to mention the pain. Welcome to my world.

  • Nanci Burns
    4 years ago

    When I tell people I have a rheumatoid disease, they look at my hands, & some even say “Well, you must have a mild case, your hands aren’t twisted”. They just don’t understand how many joints we have that they can’t see.

  • Lisa Butcher
    4 years ago

    Exactly!

  • Mariah Z. Leach moderator
    4 years ago

    Wow, Wren. Thanks for sharing this! Seeing as I have literally made a career out of arthritis advocacy it always surprises me when I still learn something new!

  • Wren moderator author
    4 years ago

    It’s a never-ending journey, isn’t it. Fortunately, ear-RA is rare. But it does make me wonder about the tinnitus I’ve had for years, you know?

    Glad to hear from you, Mariah! I hope you’re feeling well and that those three boys–the two littles and the one big–aren’t running you off your feet. Happy Halloween! 😉

  • jan curtice
    4 years ago

    Ohhhh … ouch! There is an inner ear condition called Meniere’s Disease that has similar symptoms to the ones you just described. It affects the semicircular canals creating problems with balance, hearing, vertigo. ENT gives the diagnosis; my rheumy treats it since it uses the same meds as the RA. There is also a joint in voice box. It controls the flow of air, swallowing food, and speech. It can also get nodules on it. Some signs to watch for are unexplained hoarseness, tightness in the throat, “choking” feeling, wheezing, etc. My ENT diagnosed this condition. Once again my rheumy treats it because it uses the same meds as my RA. I’ve also learned the joints in my ribcage can be real bogger-bears … especially when the asthma is acting up. Who would have ever thought we had joints in all these places? =^^=

  • mary owens
    4 years ago

    I started loosing my hearing 2-3 years ago. My Rheumatologists nor the people who fitted me for hearing aids told me about this ,both have attributed to “growing older”. For me it is a loss because music sounds “off and tinny” I used to love just listening to music.

  • Lisa Butcher
    4 years ago

    I agree. They all have hurt me at one time or another, including my ears,

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