Role of Otoacoustic Emission Test in Active Rheumatoid Arthritis Patients

R Bhuvaneswari; R Shanthimalar; V Sumathi

R Bhuvaneswari Madras Medical College, Chennai, Tamil Nadu, India
R Shanthimalar Madras Medical College, Chennai, Tamil Nadu, India
V Sumathi Madras Medical College, Chennai, Tamil Nadu, India,

Keywords: Anticyclic citrullinated protein antibodies, Otoacoustic emissions, PASS, REFER, Rheumatoid arthritis

Abstract

Introduction: Rheumatoid arthritis (RA) is an autoimmune, chronic systemic inflammatory disease affecting the small joints
and also has extra-articular manifestations. The early active stage of RA shows increased titer of anticyclic citrullinated
protein antibodies in serum. Cochlear involvement resulting in Sensorineural hearing loss is one of the extra-articular
manifestations in its active stage which can be identified at its subclinical level by screening with otoacoustic emission
(OAE) test. OAE are sounds produced by healthy hair cells of the cochlea which shows a decrease or disappearance in
active RA.
Materials and Methods: Thirty RA patients in active stage satisfying 2010 American College of Rheumatism/European League
Against Rheumatism and Disease Activity Score IV criteria with normal hearing ability between 25 and 45 years of age and 30
age- and sex-matched controls were subjected to OAE test. Both males and females were included in the study.
Results: Statistical analysis was done using software SPSS version 21. All controls PASSed the test indicating normal hair
cell function in both ears (60 ears). Thirty active stage patients were tested for both ears (60 ears). Out of 60, 19 PASSed the
test and 41 showed REFER indicating subclinical hair cell dysfunction.
Conclusion: Study revealed subclinical hair cell dysfunction in 2/3rd of cases. Thus, OAE has a key role in screening, diagnosing
and in preventing hearing disability in RA patients.

Author Biographies

R Bhuvaneswari, Madras Medical College, Chennai, Tamil Nadu, India

Professor, Institute of Physiology and Experimental Medicine

R Shanthimalar, Madras Medical College, Chennai, Tamil Nadu, India

Associate Professor, Institute of Physiology and Experimental Medicine,

V Sumathi, Madras Medical College, Chennai, Tamil Nadu, India,

Assistant Professor, Institute of Physiology and Experimental Medicine,

References

1. Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extraarticular
disease manifestations in rheumatoid arthritis: Incidence trends
and risk factors over 46 years. Ann Rheum Dis 2003;62:722-7.
2. Goeldner I, Skare TL, de Messias Reason IT, Nisihara RM, Silva MB,
Utiyama SR. Anti-cyclic citrullinated peptide antibodies and rheumatoid
factor in rheumatoid arthritis patients and relatives from Brazil.
Rheumatology (Oxford) 2010;49:1590-3.
3. Takatsu M, Higaki M, Kinoshita H, Mizushima Y, Koizuka I. Ear
involvement in patients with rheumatoid arthritis. Otol Neurotol
2005;26:755-61.
4. Bayindir T, Filiz A, Iraz M, Kaya S, Tan M, Kalcioglu MT. Evaluation
of the protective effect of Beta glucan on amikacin ototoxicity using
distortion product otoacoustic emission measurements in rats. Clin Exp
Otorhinolaryngol 2013;6:1-6.
5. Uribe-Escamilla R, Poblano A, Alfaro-Rodríguez A. Transient evoked
otoacoustic emissions and cochlear dysfunction. Egypt J Ear Nose Throat
Allied Sci 2013;14:195-200.
6. Hall JW, Adlin D, May K, Bantwal A. Pediatricians Guide to Otoacoustic
Emissions (OAEs) and Tympanometry. Vol. 78. MAICO; 2010.
7. Emamifar A, Bjoerndal K, Hansen IM. Is hearing impairment associated
with rheumatoid arthritis? A review. Open Rheumatol J 2016;10:26-32.
8. Murdin L, Patel S, Walmsley J, Yeoh LH. Hearing difficulties are common
in patients with rheumatoid arthritis. Clin Rheumatol 2008;27:637-40.9. Bayazit YA, Yilmaz M, Gunduz B, Altinyay S, Kemaloglu YK, Onder M,
et al. Distortion product otoacoustic emission findings in Behçet’s
disease and rheumatoid arthritis. ORL J Otorhinolaryngol Relat Spec
2007;69:233-8.
10. Dikici O, Muluk NB, Tosun AK, Unlüsoy I. Subjective audiological tests
and transient evoked otoacoustic emissions in patients with rheumatoid
arthritis: Analysis of the factors affecting hearing levels. Eur Arch
Otorhinolaryngol 2009;266:1719-26.
11. Baradaranfar MH, Doosti A. A survey of relationship between rheumatoid
arthritis and hearing disorders. Acta Med Iran 2010;48:371-3.
12. Rohit A, Liao K, Nair R, Ringold S, Costenbader KH. Anti-Citrullinated
peptide antibody (ACPA) assays and their role in the diagnosis of
rheumatoid. Arthritis Arthritis Rheum 2009;61:1472-83.
13. Aletaha D, Ward MM, Machold KP, Nell VP, Stamm T, Smolen JS.
Remission and active disease in rheumatoid arthritis: Defining criteria for
disease activity states Arthritis Rheum 2005;52:2625-36.
14. Pascual-Ramos V, Contreras-Yáñez I, Rivera-Hoyos P, Enríquez L,
Ramírez-Anguiano J. Cumulative disease activity predicts incidental
hearing impairment in patients with rheumatoid arthritis (RA). Clin
Rheumatol 2014;33:315-21.
15. Lakshkar SS, Goyal LK, Saigal R. Anti-citrullinated peptide antibodies
(ACPA): Possible role in determining disease activity and severity in
rheumatoid arthritis of less than one year duration. Sch J Appl Med Sci
2016;4:569-74.
16. Ye Y, Li SL, Xie M, Jiang P, Liu KG, Li YJ. Judging disease activity in
rheumatoid arthritis by serum free kappa and lambda light chain levels.
Kaohsiung J Med Sci 2013;29:547-53.
17. Kumar BN, Walsh RM, Wilson PS, Carlin WV. Sensorineural hearing loss
and ulcerative colitis. J Laryngol Otol 1997;111:277-8.
18. Magaro M, Zoli A, Altomonte L, Mirone L, Corvino G, di Girolamo S, et al.
Sensorineural hearing loss in rheumatoid arthritis. Clin Exp Rheumatol
1990;8:487-90.
19. Martin BL, Whitehead ML, Martin GK. Clinical applications of otoacoustic
emissions. J Speech Hear Res 1991;34:964-81.