Sensorineural hearing loss as the first manifestation of Sjögren's syndrome

Increased prevalence of hearing loss, tinnitus and sudden deafness among patients with Sjögren's syndrome

BACKGROUND

This study aimed to provide an updated prevalence of hearing loss, tinnitus, vertigo and sudden deafness on patients with Sjögren's syndrome and matched comparison patients.

METHODS

Data for this study were retrieved from the Taiwan Longitudinal Health Insurance Database and Taiwan's registered catastrophic illness dataset. This study included 20 266 patients with Sjögren's syndrome as the study group and 60 798 propensity score-matched comparison patients as the comparison group. We used multivariable logistic regressions to estimate the ORs and 95% CI for tinnitus, hearing loss, vertigo and sudden deafness among Sjögren's syndrome patients versus comparison patients.

RESULTS

χ2 tests showed there were statistically significant differences between the study group and comparison group in the prevalence of tinnitus (10.1% vs 6.3%, p<0.001), hearing loss (5.6% vs 3.3%, p<0.001), vertigo (4.6% vs 3.2%, p<0.001) and sudden deafness (0.8% vs 0.6%, p<0.001). Multiple logistic regression revealed that patients with Sjögren's syndrome had a greater tendency to have tinnitus (OR=1.690, 95% CI 1.596-1.788), sudden deafness (OR=1.368, 95% CI 1.137-1.647), hearing loss (OR=1.724, 95% CI 1.598-1.859) and vertigo (OR=1.473, 95% CI 1.360-1.597) relative to comparison patients after adjusting for age, income, geographic location, residential urbanisation level, diabetes, hypertension, hyperlipidaemia and rheumatoid arthritis.

CONCLUSIONS

We found higher prevalence of hearing loss, vertigo, tinnitus and sudden deafness among patients with Sjögren's syndrome relative to comparison patients. Findings may provide guidance to physicians in counselling patients with Sjögren's syndrome regarding a higher risk of hearing loss, tinnitus, sudden deafness and vertigo.

Sensorineural Hearing Loss in Sjögren’s Syndrome

Sjögren’s syndrome is a chronic autoimmune disease characterized by systemic dysfunction of exocrine glands, mainly the salivary and lachrymal glands. Sjögren’s syndrome consists of two forms: primary Sjögren’s syndrome, which is characterized by dry eyes and dry mouth without autoimmune diseases; and secondary Sjögren’s syndrome, which is characterized by symptoms associated with other autoimmune diseases, such as systemic lupus erythematosus. Disease severities vary considerably from mild glandular dryness to severe glandular involvement with numerous extraglandular and systemic features. Sensorineural hearing loss is sometimes observed in both primary and secondary Sjögren’s syndrome. This review article consists of (1) Pathology of Sjögren’s syndrome, (2) Clinical manifestation of Sjögren’s syndrome, (3) Autoimmune inner ear disease, (4) Histoanatomical features of the inner ear, (5) Immunological characteristics of the inner ear, (6) Pathophysiology of autoimmune inner ear disease, (7) Treatment for sensorineural hearing loss in Sjögren’s syndrome, and (8) Future direction. Finally, we introduce a recently developed disease model of salivary gland inflammation and discuss future expectations for the treatment of sensorineural hearing loss in Sjögren’s syndrome.

Unilateral Sensorineural Hearing Loss in Children Associated With Sjögren's Syndrome

The occurrence of unilateral sensorineural hearing loss (SNHL) during school age is relatively rare and accounts for approximately 6% of all deafness in childhood. We present two cases involving children who were diagnosed with SNHL associated with Sjögren's syndrome (SS). Case 1: An eight-year-old girl with an approximately two-year clinical history of gradual hearing loss was diagnosed with SNHL associated with SS based on histological findings of inflammation in the salivary glands and the presence of serum anti-Sjögren's syndrome-A antibody. Case 2: An eight-year-old boy with acute idiopathic thrombocytopenic purpura in whom unilateral hearing loss, which was not associated with any problems in daily life, was detected during hospitalization and who was finally diagnosed with SNHL and SS. Steroid treatment was ineffective for both patients. The previously unrecognized combination of SNHL with SS should be considered in the diagnosis of unilateral SNHL, even in children.

Brainstem auditory evoked potentials in patients with primary Sjögren's syndrome without central nervous system involvement

OBJECTIVES

Primary Sjögren's syndrome (pSS) is an autoimmune, multisystem exocrinopathy characterized by dysfunction of the exocrine glands. Central nervous system (CNS) involvement is estimated to be present in 10-60% patients with pSS. The present study aimed to evaluate brainstem auditory evoked potentials (BAEP) in pSS patients without central nervous system involvement, and without otolaryngological abnormalities.

METHOD

Thirty-six pSS patients (35 women, 1 man, mean age 48 years old) and 40 healthy volunteers were investigated. BAEP, brain imaging, laboratory parameters, and clinical neurological and otolaryngological examinations were performed.

RESULTS

Abnormal BAEP were recorded in 16.7% patients. The mean wave BAEP I and V latency and mean wave III-V and I-V interpeak latencies were significantly longer in pSS patients than the controls. There were no statistically significant correlations between BAEP parameters and laboratory tests. None of the patients was found having the abnormalities on brain imaging.

CONCLUSIONS

This study confirms that in pSS patients without clinical central nervous system impairment, auditory pathway disturbances could be found. Disorders of brain bioelectrical activity may be a consequence of ongoing autoimmune process. Key Points • BAEP abnormalities confirmed the clinically observed involvement of the central nervous system in patients with pSS. • Brain bioelectrical activity dysfunctions in pSS patients may be a consequence of ongoing inflammatory and/or immunological processes.

Evaluation of medial olivocochlear efferent system and hearing loss in patients with primary Sjögren’s syndrome

Background/aim

Autoimmune diseases are a remarkable issue for researchers due to their adverse effects on the auditory system, but for primary Sjögren’s syndrome (pSS) there is little research on the comprehensive audiological findings in literature. The main objective of this study was to investigate the medial olivocochlear efferent functions of subjects with pSS and to examine the audiological findings.

Materials and methods

The study included 36 subjects with pSS and 36 healthy subjects. All the subjects underwent testing including pure tone, speech, and high frequency audiometry; tympanometry and acoustic reflexes; distortion product otoacoustic emissions (DPOAE); and suppression of DPOAE.

Results

The hearing thresholds of the pSS group were higher than those of the control at all frequencies (P < 0.001). Minimal to mild sensorineural hearing loss was observed in 52.77% of all the subjects with pSS. Additionally, all of the subjects had type A curve tympanograms, but the static compliances of the pSS group were lower and the acoustic reflex thresholds were higher than in the control (P < 0.001). In suppression levels of DPOAE, no statistically significant difference was found between the groups (P > 0.05).

Conclusion

The study indicates that because of obtaining normal suppression levels in DPOAE, the medial olivocochlear efferent system is functional in pSS. However, there is a need for more tests, including auditory brainstem response, to evaluate the afferent auditory system in pSS.