It is well known that psoriasis can involve the ear, with scaling, crusting, and itching involving both the external ear and the ear canal. This can be very unpleasant, especially if you are a psoriasis sufferer who uses ‘in the canal’ hearing aids. What is less well known, is that psoriasis is associated with an increased risk of sudden sensorineural hearing loss – (SSHL). This is a condition in which the nerve carrying sound information to the brain, undergoes a sudden deterioration, resulting in the rapid onset of deafness in one ear. People with SSHL often discover the hearing loss upon waking up in the morning. Others may first notice it when they attempt to use the damaged ear during a telephone call. Other symptoms of SSHL include a feeling of fullness in the ear, dizziness, and/or a ringing in the ears (tinnitus).
SSHL is an uncommon condition, with an estimated annual incidence of 5-20/100,000 people - though the true incidence is certainly higher due to under-reporting. It occurs mainly in people aged 30-60 years. It is not known what causes SSHL, but some researchers have suggested that it may be an immune response, with circulating antibodies causing an inflammatory response, which then damages the inner ear. SSHL is a medical emergency and requires urgent treatment with steroids to prevent permanent hearing loss.
Given that psoriasis is an autoimmune condition, this Korean study sought to establish the risk of SSHL in patients with psoriasis, using data from the Korean Health Insurance Review.
A total of 12,864 patients with psoriasis were matched with 51, 456 controls and followed for up to 12-years. Over this period a total of 69 (0.54%) psoriatic patients developed SSHL, compared with 185 (0.36%) in the control group. Overall, patients with psoriasis were 50% more likely to develop SSHL when compared with non-psoriatic controls.
Comment
This study is consistent with other reports which have shown an increased risk of SSHL in patients with psoriasis. The mechanism is unclear but is likely to be immune-related. Whilst SSHL is uncommon, the consequences of a delayed diagnosis are potentially very serious. Conversely, with prompt diagnosis and treatment, a considerable proportion of patients can make a good recovery. Patients with psoriasis who experience a sudden deterioration in their hearing should seek medical attention as a matter of urgency and healthcare providers should be alert to the need for immediate treatment.
Reference
Hyo Geun Choi, Bumjung Park, et al. Psoriasis Increases the Risk of Sudden Sensorineural Hearing Loss: A Longitudinal Follow Up Study Using a National Sample Cohort; 2020, 17: 9310.