Evaluation of middle and inner ear functions in rheumatoid arthritis patients

Rheumatoid arthritis (RA) is an autoimmune disease which is characterized by the passage of primarily CD4 (+) T cells and monocytes into the intravenous inflamed synovial tissue and synovial fluid. The aim of our work was to examine middle ear, inner ear and efferent auditory system by using multifrequency tympanometry, transient evoked otoacoustic emission (TEOAE) and contralateral suppression test in detail. A total of 75 subjects; 35 patients with rheumatoid arthritis and 40 healthy subjects participated in the study. Immitansmetric measurements of participants were performed, and then their hearing levels were measured applying pure tone audiometry. The evaluation of each group with otoacoustic emission test was performed in two stages: before giving contralateral acoustic stimulation (CAS) and during 70 dB narrow band contralateral acoustic stimulation. Mean age of patients with rheumatoid arthritis was 44,31±10,4, mean age of control group was 41,48±12,5 and the difference between groups was not statistically significant (p=0,293). By comparison pure tone hearing levels between rheumatoid arthritis and control group at 125Hz-16000 Hz frequency, pure tone hearing levels of rheumatoid arthritis patients at all frequencies were higher. These differences were found statistically significant except for 2000 Hz, 14000 Hz and 16000 Hz in right ear, 16000 Hz in left ear (p<0,05). Tympanogram results in all of the subjects were within normal limits. The value of the resonant frequency of the patient and control group were respectively for right ear 748,86 ± 188,06 ; 830,00 ± 122,37, for left ear 772,86 ±157,80; 847,50 ± 140,94 Hz. The difference was statistically significant (p<0,05). When compared two groups' TEOAE results, emission results obtained from rheumatoid arthritis patients were statistically significantly lower than control group at 1000Hz, 2000Hz, 2800Hz and 4000Hz frequencies (p<0,05). When TEOAE measurement before and during contralateral acoustic stimulation (CAS) were compared to evaluate the contralateral suppression level, it was detected that there was decline in emission values except for 2800 and 4000 Hz at all frequencies in study group and there was decline in emissions values all frequencies control group (p<0,001).There was no statistically significant difference between contralateral suppression levels in both groups (p>0,05). As a result, our findings indicate the presence of auditory dysfunction in rheumatoid arthritis. When the rheumatoid arthritis is diagnosed, the patients should be undergo audiologic evaluation and informed about possible pathological involvement. Future studies should continue about middle and inner ear condition in rheumatoid arthritis patients and potential interactions that may be associated with disease characteristics.