Oto-laryngeal involvement in rheumatoid arthritis

Abstract EN

Objective: To study the effect of rheumatoid arthritis (RA) on the larynx, middle ear conducting system and the inner ear transmitting system.

Rationale: Joints of the middle ear (incudomalleolar, incudostapedial) and larynx (cricoarytenoid) are synovial joints and therefore are subject to be affected by rheumatoid arthritis.

Extra-articular manifestations of the disease (rheumatoid nodular vasculitis) can affect the inner ear.

Methodology: Thirty rheumatoid arthritis patients (18 females and 12 males) and 20 controls constituted the material of this study.

They were subjected to: a) Clinical assessment including musculoskeletal examination.

b) Audiological evaluation (pure tone air and bone conduction, speech reception and discrimination thresholds, threshold bone decay, tympanometry, acoustic reflex, auditory brain stem response audiometry “ABR” ).

c) Complete laryngeal examination (indirect laryngoscopy, fibroptic direct laryngoscopy, stroboscopy).

d) Laboratory investigations (ESR, complete blood picture, rheumatoid factor).

e) Radiological examination of both hands.

Results: A significant increase in pure tone average, speech receptor threshold and acoustic reflex threshold was observed in the patients’ group.

Audiologically 43.33% of RA patients had sensorineural hearing loss of the cochlear type, 13.33% had conductive deafness and 43.33% had normal hearing.

Laryngeal evaluation revealed that 50% of RA patients had laryngeal symptoms (symptomatic group), and 20% of them showed signs of laryngeal affection with indirect and fibroptic laryngoscopy.

Stroposcopic study showed positive findings in both symptomatic and asymptomatic groups.

There was a significant relation between laryngeal affection and the presence of subcutaneous nodules.

Conclusion: Rheumatoid arthritis could affect middle ear and/ or inner ear as well as the larynx.