Association Between Psoriasis with Arthritis and Hearing Impairment in US Adults: Data from the National Health and Nutrition Examination Survey

Evaluation of Auditory Functions in Patients with Psoriasis

Our study aims to evaluate the functions of the middle and inner ear and the efferent auditory system in psoriasis. Hearing thresholds, resonance frequency, otoacoustic emission amplitudes with and without contralateral acoustic stimulation, contralateral suppression levels were evaluated in 35 psoriasis patients and 40 controls. The air-conduction hearing thresholds of the patients were significantly higher than the controls at 125, 250, 500, 1000, 2000, 4000, and 12,000 Hz frequencies in the left ear, and 125, 250, 500, 1000, 2000, and 4000 Hz frequencies in the right ear, and the bone-conduction hearing thresholds of the patients were found to be significantly higher than the controls at all frequencies in the left ear, and 250, 500, 1000 and 2000 Hz in the right ear (p < 0.05). The resonance frequencies of patients were found to be significantly lower than the controls (p < 0.001). The emission amplitudes obtained with contralateral acoustic stimulation were significantly lower than without contralateral acoustic stimulation at 1 kHz frequency in both groups (p < 0.01). There was no significant difference in contralateral suppression levels of the two groups (p > 0.05). Our findings indicate that middle ear mechanics can be affected by psoriasis. There was no significant difference between psoriasis patients and healthy controls in terms of efferent auditory functions. There was a significant difference at limited frequency in hearing thresholds and emission amplitudes between the groups.

Association of Psoriasis With Hearing Loss: A Systematic Review and Meta-Analysis

BACKGROUND

The relation between psoriasis and hearing loss has been unclear.

OBJECTIVE

To investigate the association of psoriasis with hearing loss.

METHODS

We searched MEDLINE and Embase on 12th November 2022 for studies on the association between psoriasis and hearing loss. We conducted a random-effects model meta-analysis to calculate pooled mean difference (MD) in the pure tone thresholds, pooled odds ratio for sensorineural hearing loss, and pooled hazard ratio for sudden sensorineural hearing loss related to psoriasis.

RESULTS

We included 12 case-control/cross-sectional and 3 cohort studies with 202,683 subjects. Psoriasis was associated with hearing loss at 500 Hz (pooled MD 2.21, 95% CI (CI) 0.13 to 4.29), 1000 Hz (pooled MD 2.97, 95% CI 1.01 to 4.93), 2000 Hz (pooled MD 5.13, 95% CI 2.45 to 7.82), 4000 Hz (pooled MD 9.3, 95% CI 5.1 to 13.51), and 6000 Hz (pooled MD 11.04, 95% CI 5.05 to 17.03). Patients with psoriasis had increased odds for sensorineural hearing loss (pooled odds ratio 3.85, 95% CI 1.07-13.9) and risk for sudden sensorineural hearing loss (pooled hazard ratio 1.45; 95% CI 1.22-1.71).

CONCLUSION

Psoriasis is associated with hearing loss, especially at high frequencies.

Otologic Manifestations of Psoriasis: A Systematic Review and Meta-Analysis

INTRODUCTION

Psoriatic skin lesions are often seen in the auricle and external auditory canal, but middle ear and inner ear manifestations are not easily identified. Several studies have indicated hearing loss and vestibular dysfunction with psoriasis, but the extent of association has not been well defined.

METHODS

A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies described audiometric or vestibular assessment of psoriasis patients. Meta-analysis was represented with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals.

RESULTS

A total of 13 studies with 589 psoriasis patients and 617 healthy controls were included. Age did not significantly differ between psoriasis patients (47.1 [12.4] yr) and healthy controls (45.4 [11.2] yr). Psoriasis area and severity index score was 9.9 (8.4), and body surface area scores was 7.9 (14.7). Pure-tone audiometry analysis showed higher mean hearing thresholds in psoriasis patients compared with healthy controls across all frequencies, with the greatest difference at 4000 Hz (MD, 7.70 [4.46-10.94]; p < 0.00001). Speech reception thresholds were worse with psoriasis (MD, 3.53 [1.56-5.49]; p < 0.0001). Abnormal stapedial reflex was more common in psoriasis (OR, 5.19 [1.68-15.99]; p = 0.004). Abnormal vestibular testing was more common in psoriasis for caloric testing (OR, 13.12 [2.88-59.84]; p < 0.0001). Two additional studies of 41,681 psoriasis patients and 80,273 healthy controls found that psoriasis patients were at higher risk for sudden sensorineural hearing loss (OR, 1.50 [1.25-1.80]; p < 0.0001).

CONCLUSION

Our study shows that psoriasis is associated with hearing loss and vestibular dysfunction, but clinical significance remains undefined. The trends noted in our study require more investigation, and the pathophysiologic mechanisms need to be defined.