Supervisors info:
Βλασταράκος Πέτρος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαραγκουδάκης Παύλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δελίδης Αλέξανδρος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
INTRODUCTION
Systemic Lupus Erythematosus (SLE) is a chronic, systematic, and autoimmune disease, which can affect multiple body organs and systems and appears with a wide range of clinical manifestations. The inner ear is also affected, but the underlying pathophysiological mechanisms are currently unclear. It is widely speculated that they include the deposition of immune complexes in the stria vascularis, hair cell damage caused by cytokine overproduction, or even the production of autoantibodies against specific inner ear antigens. As a result, patients with SLE often report otologic symptoms, such as hearing loss, sudden hearing loss, tinnitus and aural fullness. The aim of the present study was to investigate whether the auditory disorders associated with SLE may demonstrate any specific clinical features. The presence of such specific pattern could lead to their early diagnosis and better treatment.
METHODS
A literature review was conducted in three different databases (PubMed, Google Scholar and Cochrane Library), in search of original publications that focus on the auditory disorders appearing in patients with SLE, over the last 20 years. The included studies were written in English and presented auditory disorders appearing in adults diagnosed with SLE.
RESULTS
126 research studies were initially retrieved. Duplicate publications were removed, both inclusion and exclusion criteria were applied, and 19 original studies were finally included in the data analysis. With regard to their general research features, four were systematic reviews and/or meta-analyses, 12 observational studies, and three were case reports or case series.
DISCUSSION
Hearing loss is the most common otologic symptom experienced by patients with SLE. All studies report that the prevalence of hearing loss in groups of patients with SLE is higher compared to their counterparts in the control groups. The respective range varies from 6% to 70%, according to the current literature. The research results conclude that the hearing loss in SLE has some particular features; the hearing loss is mainly sensorineural, bilateral, and initially affects the higher frequencies. Moreover, it can present as sudden hearing loss or can be asymptomatic, especially when it affects frequencies over 8kHz. All the other otologic symptoms (tinnitus, hyperacusis, aural fullness) seem to have a direct association with the underlying hearing loss in patients with SLE.
CONCLUSION
The high prevalence of hearing loss in patients with SLE requires a complete audiological evaluation of patients diagnosed with this autoimmune disease. It is recommended that the audiological evaluation includes not only the conventional audiometry, but also the extended high-frequency audiometry (EHFA). In this manner, cases of hearing loss, asymptomatic or not, can be timely diagnosed. Moreover, such bench-point measurements may facilitate hearing loss monitoring, and detect potential audiometric changes in the future, such as threshold deterioration, or a sudden sensorineural hearing loss.
Keywords:
Systemic lupus erythematosus, Auditory disorders, Hearing loss, Sudden hearing loss, Tinnitus
