2034: Hidden Burden in Rheumatology: Cross-Sectional Study of Hearing Loss in Systemic Autoimmune Diseases

Background/Purpose: Autoimmune inner ear disease is a progressive sensorineural hearing loss of autoimmune origin, often underdiagnosed due to the lack of specific criteria, and requires further research to improve its detection and treatment. To determine the prevalence of hearing loss in adult patients with a confirmed diagnosis of systemic autoimmune rheumatic disease, seen at a Rheumatology Department in Bogotá, Colombia.

Methods: Cross-sectional observational study including 147 patients (18-60 years), selected through non-probabilistic consecutive sampling. Cases of hearing loss attributable to non-autoimmune causes were excluded. Each participant underwent pure tone audiometry (PTA) and a structured clinical interview to assess otovestibular symptoms. Demographic, clinical, audiological, and immunological variables were collected. Statistical analysis was performed using Stata® v17 with descriptive statistics and tests for comparison of proportions and ranks, considering p < 0.05 as the significance level.

Results: Only 4.76% (n = 7) of patients had a previously confirmed diagnosis of hearing loss; however, 46.9% (n = 69) were found to have hearing loss confirmed through PTA, of which 91.3% were sensorineural, 81.2% fluctuating, and mostly mild (69.6%) with a descending pattern (87.5%). Hearing loss rates were higher in SSc (75%) and rheumatoid arthritis (RA) (60.6%). Antinuclear antibodies were positive in 70.4% of patients, and 65.9% had received corticosteroids. A significant association was found between hearing loss and systemic sclerosis (SSc) (p = 0.042). When analyzing the pure tone average thresholds in both ears by autoimmune disease (Fig. 1 and 2), it was noted that in RA patients – Left Ear, the curve remained relatively stable between 250–2000 Hz, with a noticeable increase (worsening threshold) from 4000 Hz onward, indicating high-frequency hearing loss. In contrast, in SSc – Right Ear, thresholds were elevated across all frequencies, especially from 4000 Hz onwards, showing a consistently worse hearing profile with marked high-frequency hearing impairment. Anti-Ro antibodies were positive in 46.7% of patients without hearing loss and in 20.4% of those with hearing loss (p = 0.0078).

Conclusion: This study reveals a marked underdiagnosis of hearing loss in patients with systemic autoimmune rheumatic diseases, with only 4.76% previously identified versus 46.9% confirmed through audiological assessment during the study. The predominance of sensorineural, mild, and descending-pattern hearing loss—particularly in conditions such as SSc and RA—highlights the need for systematic auditory evaluation in this population. An inverse association was found between Anti-Ro positivity and hearing loss, which may reflect a lower rate of auditory involvement among patients with Sjögren’s syndrome within the cohort. As one of the few studies to comprehensively assess hearing loss across a broad spectrum of autoimmune diseases, our findings underscore the importance of increased clinical awareness and early detection strategies in rheumatologic care.