An Expert Weighs in on PsA Hearing Loss

While psoriatic arthritis is often associated with pain and swelling in the joints, many patients also experience other related health issues, called comorbidities, which can affect the eyes, liver, heart and other organs.

This is in addition to psoriasis. According to the Arthritis Foundation, more than half of psoriatic arthritis patients have at least one other medical condition and 40 percent have three or more.¹ I happen to have chronic dry eye in addition to psoriasis and psoriatic arthritis<. Add me to the lucky 50 percent category. As if that’s not enough, the National Psoriasis Foundation (NPF) reports that psoriatic arthritis patients also need to keep a lookout for hearing loss and balance issues. In one study, 26.7 percent of psoriatic arthritis patients had inner ear damage, which can cause hearing and balance impairment.²

Getting expert advice

We tend to put off dealing with symptoms, and we convince ourselves that the symptoms just aren’t a big deal, that we can deal with them in our own bubble, and that any treatments will be too difficult. Sometimes, the scariest part of dealing with unusual health issues is getting answers that you don’t want to know. But like so many other things in life, procrastination usually doesn’t end well, and this is true for hearing loss.

I interviewed Diana R. Dinkin, M.A., CCC-A, FADA, director of audiology at Ear Center Audiology in Warren, Michigan. I wanted to find out exactly how psoriatic arthritis can affect hearing because having expert advice can ease fears of the unknown and might make patients more apt to get tested if they feel their disease has affected their hearing.

Key terms when it comes to your ears

To make it a bit easier to understand, here are a few key terms to know, as defined by the National Center for Biotechnology Information, U.S. National Library of Medicine.³

• Audiologist: A health care professional who is trained to evaluate hearing loss and related disorders, including balance (vestibular) disorders and tinnitus, and to rehabilitate individuals with hearing loss and related disorders. An audiologist uses a variety of tests and procedures to assess hearing and balance function and to fit and dispense hearing aids and other assistive devices for hearing.
• Cochlea: Snail-shaped structure in the inner ear that contains the organ of hearing.
• Conductive hearing loss: Hearing loss caused by a problem of the outer or middle ear, resulting in the inability of sound to be conducted to the inner ear.
• Inner ear: Part of the ear that contains both the organ of hearing (the cochlea, containing the organ of Corti) and the organ of balance (the labyrinth, containing the cristae and the maculae).
• Sensorineural hearing loss: Hearing loss caused by damage to the sensory cells or nerve fibers (or both) of the inner ear.

Breaking it down with Diana

I have psoriasis and psoriatic arthritis, both of which are chronic autoimmune diseases that have widespread inflammation throughout the body. According to articles published by NPF, there is a significant increase in hearing loss among patients with psoriatic disease.⁴ Can you explain how inflammation in the ear could affect hearing loss in patients with psoriatic disease?

Following an inflammatory injury, an accumulation of leucocytes [a cell that is involved in fighting foreign substances and disease] and immunoglobulins [proteins present in the immune system which function as antibodies] within the cochlea creates an inflammatory reaction that causes destruction within the inner ear, and ultimately results in sensorineural hearing loss. Hearing loss in psoriasis patients can happen when an excess buildup of old skin cells can also cause a temporary conductive loss.

What are the types of hearing loss associated with psoriatic arthritis?

Conductive loss; sudden sensorineural hearing loss (SSNHL), which is a rapid loss of hearing within 72 hours; and sensorineural hearing loss.

Can inflammation in the ear be treated? If so, how?

Treatment options include manual extraction of old skin scales blocking the ear canal, topical non-steroidal medication, steroids, and immunosuppressant agents.

If inflammation decreases in the ear, is it possible to restore full hearing or is hearing loss permanent?

If a conductive loss, it requires removal of the excess skin debris that is blocking the ear canal to reverse hearing loss. If a SSNHL, there is a potential chance of partial or full recovery if treated with steroids within 24-72 hours of onset. Permanent hearing loss can occur when a condition is left untreated or goes beyond the small window of treatment opportunity.

If a patient is concerned about possible hearing loss, what should he/she do? What steps should he/she take?

Seek audiologist or medical consultation for an objective evaluation and appropriate treatment. If the hearing loss is sudden in nature, be sure to convey the urgency and necessity for an emergency appointment within 72 hours - the sooner, the better.

Part of treating psoriasis and psoriatic arthritis is to try to keep an otherwise healthy body: eating right, exercise, get enough sleep, regular physicals, etc. What can patients do to keep their ears (and hearing) healthy to help avoid other complications with hearing loss?

Have your ears and hearing checked on a routine basis, usually every one to two years, or sooner, as needed. Use prescription medicines, creams, shampoos, and ear drops to less the actions of the immune system and minimize debris build-up from psoriasis.

Is there anything else you would like to mention?

Unfortunately, there is no cure for psoriatic disease. However, with a proactive approach towards care and treatment, progression of the disease and its symptoms may be minimized or stopped.

Hearing loss has no age limit. If you or someone you know suspects hearing loss, are over the age of 40 years, or have a medical condition [like psoriasis or psoriatic arthritis] that increases your risk for hearing loss, you should have your hearing tested.

Untreated hearing loss increases the chance of cognitive decline, developing dementia, risk of falling, phonemic regression (the disproportionate inability to process and understand speech in relation to the individual’s degree of hearing loss), and is known to contribute to depression and social isolation. It is important to pursue amplification as soon as a hearing loss is identified to avoid these issues.