Hearing Loss With Rheumatoid Arthritisby Marianna Paulson, B.Ed., B.P.E.-O.R. Patient Advocate
Does rheumatoid arthritis (RA) affect hearing? The data is contradictory. A review of studies on hearing loss in people with RA found that they are at a higher risk of hearing impairment. "In spite of wide diversity regarding published results, it is obvious that hearing impairment in RA is a multifactorial disease, since it can be affected by environmental factors (e.g. smoking), and disease characteristics (e.g. rheumatoid nodule), as well as patients’ characteristic (e.g. age).”
Signs of hearing loss
Hearing loss is debilitating, isolating, and exhausting. You may have hearing loss if:
- You often think people are mumbling.
- You often ask people to repeat what they said.
- You no longer clearly hear the sound of running water, the refrigerator, or your dog's claws on the floor.
- Certain sounds seem especially loud.
- Noisy environments drain you.
- You can't make out what people are saying if they are not looking directly at you.
Your doctor may refer you to an ear, nose, and throat specialist to rule out any medical concerns, an audiologist, or a hearing clinic for evaluation. Be prepared for questions about your concerns, family history of hearing loss, and the types of hearing environments you've been in (classroom, construction, etc.). Most hearing tests take place in a sound-proof booth, so let the clinician know if you're claustrophobic. The clinician will choose from any number of tests to evaluate your hearing.
Types of hearing loss
Sensorineural hearing loss is the most common finding in patients with RA. This occurs when the tiny hairs in the inner ear are damaged, or the nerve pathways to the brain are compromised. In conductive hearing loss, sound is unable to be conducted from the external ear in to the middle and inner ear. Some people with RA have mixed hearing loss, involving both types. My former rheumatologist believed that diminished functioning of the ossicles — the tiny bones in the ears — could potentially affect hearing in people with RA.
The middle ear transmits sound from the outer ear to the inner ear. It is made up of three bones (ossicles) called the malleus (hammer), incus (anvil), and stapes (stirrup). Unfortunately, RA can also affect these bones, either through a discontinuity of sound, or an increase of stiffness in the ossicular system. Researchers concluded that “rheumatoid arthritis reduces vascularity of auditory ossicles and causes degeneration of articular surfaces.”
Tinnitus is often described as ringing in the ears, but people may also hear clicks, whistles, and other unusual sounds on a temporary or permanent basis. There is no cure, but you can get used to it. People who are severely impacted by tinnitus may benefit from tinnitus retraining therapy. People who have Sjogren's syndrome, a comorbidity of RA, may develop tinnitus as a result. Let your doctor know if you experience tinnitus.
Medication can cause hearing loss
Many of the drugs RA patients take have been proven to be ototoxic, meaning they can damage hearing, bring on tinnitus, and cause vertigo. Non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, some disease-modifying anti-inflammatory drugs (DMARDs), and salicylates have been implicated in hearing loss. My audiologist wisely reminded me that the fear of hearing loss should not preclude using antibiotics and NSAIDs when needed.
Isolation, fatigue, and noise sensitivity
In my experience, hearing loss is far more isolating that RA. At least with RA, you can retreat to your home and lose yourself in a movie or a TV program, or have a quiet chat, either in person or on the phone. That's not the case with hearing loss. Anything I watch on TV requires subtitles, so you end up missing some of the action. Conversations that you once took for granted are challenging. A lot of energy is used in order to distinguish sounds and filter out background noises, which can be very draining.
When purchasing hearing aids, it pays to shop around, as prices can vary. Not every hearing aid works for every person. The skill level of the person adjusting your hearing aids can have a big influence on how well your hearing aids work for you. You may require several adjustments to have them work well for you. When making this big-ticket purchase, which is only good for five to seven years, clarify the return policy. If you find that after several adjustments they don't work for you, you want to get a 100-percent refund.
Advice worth hearing
There's an even more compelling reason to purchase hearing aids. Researchers have linked hearing loss to dementia and Alzheimer's. A hearing- impaired listener expends a great deal of effort and energy to comprehend speech, thus drawing resources away from the act of encoding the speech content in memory. There is a tendency to isolate when hearing is difficult, which leads to less mental stimulation. Loneliness and depression are not uncommon.
What you can do to improve your hearing odds
First, get a base-line hearing test. If you smoke, stop. Smoking is associated with an increased risk of hearing loss. There is also evidence that smoking can make your RA worse. It’s also wise to limit your alcohol consumption. Cochlear (inner ear) function is impacted by long-term alcohol use. Also, our world is becoming excessively noisy. Guard your hearing as you would your wallet. Sounds at or above 80 decibels can cause hearing loss. Upload a decibel meter app such as Decibel X to your device.
Education and adaptation
You may have to educate people about how to interact with you or people you love who have hearing loss. Believe it or not, I've had to remind receptionists at hearing clinics to look directly at the client and speak clearly and slowly. Finding ways to adapt how you get through your day can also help. When you go to restaurants, ask to be seated away from the speakers and sit with your back to the room. Explain that you have hearing loss and politely ask if the music can be turned down.