Sensorineural Hearing Loss in Sjögren’s Syndrome

Recommendations on neurologic, cognitive, and psychiatric manifestations in patients with Sjögren's disease by the Brazilian Society of Rheumatology

BACKGROUND

Neurological and psychiatric manifestations occur in patients with primary Sjogren's disease (SjD) with a wide-ranging clinical presentation, affecting quality of life, social participation, and prognosis. Despite this, neither central nor peripheral neurological symptoms are systematically evaluated in the context of autoimmunity or identified as manifestations of SjD. The EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) covers only part of them in the neurological domain.

METHODS

We performed a systematic review of the diagnosis and prevalence of central, peripheral, and autonomic nervous system manifestations in primary SjD, following the recommendations proposed by the Cochrane Collaboration Handbook. Observational studies were included when their main issue was the diagnosis and the prevalence of the manifestations individually. We employed a generalized linear mixed model (GLMM) method with a random-effects model, and the results were computed using logit transformation, implemented through the 'meta' and 'metafor' packages in the R software (version 3.6.1). To present these recommendations, agreement among experts was investigated using the Delphi method in in-person meetings.

RESULTS

We propose ten recommendations regarding the investigation and management of neurological involvement in SjD that had 100% agreement among participants.

CONCLUSION

These recommendations add to the literature on the clinical care of patients with SjD.

Prevalence and Intriguing Clinical Profiles of Autoimmune Inner Ear Diseases in Sudden Sensorineural Hearing Loss

INTRODUCTION

Sudden sensorineural hearing loss (SSNHL) is idiopathic in 70-90% of cases with 10-30% linked to vascular injuries, viral infections, or autoimmune inner ear disease (AIED). AIED contributes to less than 1% of all hearing losses, categorized into primary, affecting only the inner ear, and secondary, associated with systemic autoimmune diseases (SAID). This study examines the prevalence and features of AIED in SSNHL in a tertiary referral center.

MATERIALS AND METHODS

We conducted a prospective study from November 2021 to December 2022 including SSNHL patients who exhibited symptoms like hearing loss or tinnitus. Evaluations included tympanometry, pure tone audiometry, and blood tests, with suspected AIED cases further assessed by rheumatologists using Lobo's diagnostic criteria. Treatment responses were monitored through regular audiometry updates.

RESULTS

Out of 694 SSNHL patients, 43 (6.2%) were diagnosed with AIED, of which 36 (83.7%) had primary AIED and 7 (16.3%) had secondary AIED linked to conditions like Sjögren's syndrome and systemic lupus erythematosus. Treatment response was seen in 19.4% of primary and 42.9% of secondary AIED cases.

CONCLUSION

The prevalence of AIED in SSNHL patients was found to be 6.2%, with a notable fraction also suffering from SAID. Responses to treatment were positive in about a third of these cases, highlighting the importance of interdisciplinary management for this rare yet significant cause of SSNHL.

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.