Hearing loss and rheumatoid arthritis (RA) often occur together. People with RA have an increased risk of hearing loss, especially sensorineural hearing loss.

Sensorineural hearing loss is hearing loss due to damage in the inner ear. This type of hearing loss affects the ability of the brain to interpret sound signals from the ear. Several different factors may contribute to hearing loss in RA.

For instance, damage to the ear from arthritis medication may happen when a person uses these drugs at high dosages for a prolonged period, as they reduce blood supply to the inner ear. The same inflammation and immune response that attack the joints may also damage the inner ear in some people with arthritis.

In this article, we provide more information about RA and hearing loss, including the causes and treatment options. We also discuss other autoimmune diseases that may affect a person’s hearing.

Can RA Cause Hearing Problems?

RA may increase the risk of both conductive and sensorineural hearing loss.

Conductive hearing loss happens when there is damage to the outer and middle portions of the ear, making it difficult for the ear to conduct sound.

Sensorineural hearing loss refers to damage that is deeper in the ear, affecting the inner ear and nerves. This type of hearing loss disrupts the brain’s ability to interpret sound.

A person can also experience mixed hearing loss, which means that they have both types of hearing impairment.

A 2016 review states that studies have reported various rates of sensorineural hearing loss in people with RA, ranging from 25% to 72%.

An earlier 2001 study compared the rates of this type of hearing loss between people with RA and those without this condition. The researchers found that sensorineural hearing loss affected both ears in 60% of participants with RA, compared with 34.29% of those without RA.

Researchers do not yet fully understand how or why RA might cause hearing loss.

However, some potential explanations include:

Environmental risk factors

Smoking, exposure to loud noises, and alcohol may increase the risk of hearing loss in all people, including those with RA. Smoking is also a risk factor for RA itself.

There is a lack of data assessing whether the effects of alcohol or exposure to loud noises are different in people with RA, so it is unclear how those environmental factors might interact with the disease.

RA medications

Various studies have linked over-the-counter drugs, such as ibuprofen, to hearing loss. For example, a 2012 study that followed 62,261 women who participated in the Nurses’ Health Study II found a correlation between the regular use of ibuprofen or acetaminophen — using it on 2 days or more each week — and hearing loss. There was no correlation between aspirin and hearing loss.

Experts suspect that the reason for this link is that these pain relievers reduce blood flow to the ears. If this is the case, the long-term use of certain pain relievers may damage hearing in some people.

People with RA may also take antibiotics to treat infections, especially when they use immunosuppressants that increase infection risk. Some antibiotics, including streptomycin and neomycin, may also increase hearing loss risk.

RA-related ear damage

As with other autoimmune diseases, RA causes the body to attack healthy tissue. It may damage tissue in the ears or nerves and affect a person’s hearing.

Rheumatoid nodules, which are firm lumps that develop under the skin, may damage the middle and outer portions of the ear, causing conductive hearing loss that makes it difficult for the ear to conduct sound. Chronic inflammation may also damage nerve cells in the inner ear, making it hard for the ear to send signals to the brain or for the brain to interpret these signals.

How to treat hearing problems linked to RA

Although hearing loss is treatable, it is not always curable.

When hearing loss or ringing in the ears occurs as a result of medication, stopping the medication may reverse the hearing loss. However, it is important to weigh the risks and benefits of stopping treatment. It may only be safe to stop treatment if an alternative drug is available. For this reason, a person should not stop taking RA medication without first talking with a doctor.

Other treatment options depend on the cause of the hearing loss, as well as its severity. Some options include:

Steroids: Corticosteroids may help reverse autoimmune hearing loss.
Vasodilators: These drugs dilate the blood vessels, improving blood flow to the ear. They may help reverse damage from RA drugs.
Anti-inflammatory drugs: Drugs to reduce inflammation may prevent further hearing loss, and, in some cases, they may even reverse it.
Lifestyle changes: Limiting alcohol intake and quitting smoking can also reduce the negative effects of these substances on hearing.
Hearing aids: Hearing aids do not reverse hearing loss, but they can help a person hear better, reducing the risk of communication issues, depression, and other consequences of hearing loss.

A 2014 study suggests that hearing loss correlates with a higher risk of depression. While the factors contributing to this depression are complex, and researchers do not fully understand them, it is likely that social isolation and communication difficulties play a role. Treating hearing loss may, therefore, improve both hearing and overall well-being.

Inflammation and hearing loss

Chronic inflammation is common in autoimmune diseases. Several studies suggest that this inflammation may impair hearing by damaging the ears or the nerves that send signals to and from the brain. Inflammation can also damage the blood vessels, changing the flow of blood to the ears and disrupting hearing structures.

Treating inflammation may reduce the risk of hearing loss. In some cases, anti-inflammatory treatments may even reverse hearing loss.

Autoimmune diseases

RA is just one of many autoimmune diseases. Autoimmune diseases cause the body’s immune system to attack healthy cells, which can lead to widespread inflammation, as well as damage throughout the body.

Research on other autoimmune diseases has identified a higher risk of hearing loss among people with autoimmune disorders compared with those without these conditions. For example, 2021 research found that people with systemic lupus erythematosus had significantly higher odds of hearing loss than age-matched controls. Across all the reviewed studies, the average prevalence of hearing loss among people with lupus was 27%.

A rare autoimmune disease called autoimmune inner ear disease primarily targets the inner ear, causing hearing loss. Some people with this condition also experience issues with their vestibular system, which controls balance, leading to dizziness and poor coordination.

People with autoimmune diseases are more vulnerable to additional autoimmune issues. Due to this, people with RA should not assume that this condition is the only possible explanation for any hearing loss. A second autoimmune condition, such as autoimmune inner ear disease, may be causing the hearing issues.

Rheumatoid arthritis can cause hearing loss either directly, if inflammation damages the ears and nerves, or indirectly, such as when medication for RA impairs hearing.

Hearing loss is treatable, and it may sometimes even be possible to reverse it. Finding the right treatment requires a trip to the doctor and a comprehensive exam.

An RA specialist can assess whether RA symptoms have spread to the ear. They can help a person weigh the risks and benefits of medication and refer them to a hearing loss expert if necessary.

Article originally appeared on Medical News Today