J Rheum Dis.  2022 Apr;29(2):116-122. 10.4078/jrd.2022.29.2.116.

Idiopathic Inflammatory Arthritis in the Auditory Canal in a Patient With Hearing Impairment: A Case Report and Literature Review

• Nam SH
• Kim GH
• Park HJ
• Kim YG

• KMID: 2527551
• DOI: http://doi.org/10.4078/jrd.2022.29.2.116

Abstract

Inflammatory arthritis can affect the auditory system during the disease course. Although most cases show asymptomatic hearing impairment, it can result in hearing loss. Here we describe the case of a 70-year-old female with hearing impairment associated with idiopathic inflammatory arthritis in her auditory system. She had suffered from hearing difficulties for decades; however, the causes of her hearing impairment had not been evaluated. Pure tone audiometry showed severe sensorineural hearing loss requiring a cochlear implant. The workup for the cochlear implant revealed erosive changes in the incudomalleolar and incudostapedial joints with soft tissue swelling on temporal bone computed tomography. Bone pathology revealed plasmacytic infiltration and granulomatous inflammation. Laboratory examinations showed elevated levels of inflammatory markers; otherwise, she had negative results for all autoantibodies. In patients with idiopathic hearing loss, inflammatory arthritis of the middle ear without peripheral arthritis can provide a clue regarding the cause of the hearing loss.

Keyword

Arthritis; Middle ear; Hearing loss; Cochlear implantation

Figure

• 

  Fig. 1 Pure-tone audiometry. (A) Before cochlear implant, severe sensorineural hearing loss of both ears observed. (B) Two months after cochlear implant, aided audiogram showed a 30 dB threshold through all frequencies.

• 

  Fig. 2 Pathology slides demon-strating chronic osteitis in the left incus (H&E, ×400). (A) Lymphoplasmacytic infiltration (triangles). (B) Granulomatous inflammation (arrow).

• 

  Fig. 3 CT findings of the temporal bone. CT scan of the right middle ear cavity of a 70-year-old female with hearing loss. The arrows indicate the erosive change and deformity of the incudomalleolar joints with soft tissue infiltration (A, C) in the axial plane and soft tissue infiltration at the stapes in the stenvers plane (B). CT: computed tomography.

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