Clinical Rheumatology

, Volume 38, Issue 3, pp 683–689 | Cite as

Increased risk of sudden sensory neural hearing loss in patients with rheumatoid arthritis: a longitudinal follow-up study using a national sample cohort

  • Sang-Yeon Lee
  • Il Gyu Kong
  • Dong Jun Oh
  • Hyo Geun ChoiEmail author
Original Article


To evaluate the association between sudden sensorineural hearing loss (SSNHL) and rheumatoid arthritis (RA) among a national sample cohort from Korea. Data were collected from 2002 through 2013 for individuals aged ≥ 20 years in the Korean National Health Insurance Service (NHIS)-National Sample Cohort. We extracted the data from RA patients (n = 7619) and 1:4-matched controls (n = 30,476) and analyzed the occurrence of SSNHL. Matching was performed based on age, sex, income, region of residence, and medical history. RA was diagnosed based on International Classification of Disease-10 (ICD-10) codes (M05 or M06) and prescriptions for the antirheumatic drugs. SSNHL was diagnosed based on the relevant ICD-10 code (H912). Among the SSNHL participants, we included only those who had undergone an audiometry exam (claim codes: E6931–E6937, F6341–F6348) and received treatment with steroids. The crude and adjusted hazard ratios (HRs) were calculated using Cox-proportional hazard models, and the 95% confidence intervals (CIs) were determined. Subgroup analyses based on age and sex were also performed. The rate of SSNHL in the RA group (0.8% [62/7619]) was higher than that in the control group (0.6% [177/30,476], P = 0.021). The crude and adjusted HRs for SSNHL were 1.40 (95% CI = 1.05–1.87) and 1.39 (95% CI = 1.04–1.86), respectively, in the RA group (each P < 0.05). The relationship between RA and SSNHL was observed primarily in patients aged ≥ 50 years and men. The risk of SSNHL is higher in patients with RA.


Cohort study Comorbidity Rheumatoid arthritis Sudden sensorineural hearing loss 



The manuscript was edited for proper English language, grammar, punctuation, spelling, and overall style by the highly qualified native English-speaking editors at American Journal Experts (E288-00CA-4EB3-15B0-EA2P).

Funding information

This work was supported in part by a research grant (NRF-2015-R1D1A1A01060860) from the National Research Foundation (NRF) of Korea.

Compliance with ethical standards



Supplementary material

10067_2018_4333_MOESM1_ESM.docx (15 kb)
Table S1 (DOCX 15 kb)


  1. 1.
    Gibofsky A (2012) Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care 18(13 Suppl):S295–S302PubMedGoogle Scholar
  2. 2.
    Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M, Scott D, Silman A (2002) The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford) 41(7):793–800CrossRefGoogle Scholar
  3. 3.
    Jeong H, Chang YS, Baek SY, Kim SW, Eun YH, Kim IY, Lee J, Koh EM, Cha HS (2016) Evaluation of audiometric test results to determine hearing impairment in patients with rheumatoid arthritis: analysis of data from the Korean National Health and Nutrition Examination Survey. PLoS One 11(10):e0164591. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    McInnes IB, Schett G (2011) The pathogenesis of rheumatoid arthritis. N Engl J Med 365(23):2205–2219. CrossRefPubMedGoogle Scholar
  5. 5.
    Emamifar A, Bjoerndal K, Hansen IM (2016) Is hearing impairment associated with rheumatoid arthritis? A review. Open Rheumatol J 10:26–32. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Melikoglu MA, Senel K (2013) Sudden hearing loss in a patient with rheumatoid arthritis; a case report and review of the literature. Acta Reumatol Port 38(2):138–139PubMedGoogle Scholar
  7. 7.
    Huang CM, Chen HJ, Huang PH, Tsay GJ, Lan JL, Sung FC (2018) Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data. BMJ Open 8(1):e018134. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rauch SD (2008) Idiopathic sudden sensorineural hearing loss. N Engl J Med 359(8):833–840CrossRefPubMedGoogle Scholar
  9. 9.
    Kim SY, Sim S, Kim H-J, Choi HG (2018) Sudden sensory neural hearing loss is not predictive of myocardial infarction: a longitudinal follow-up study using a national sample cohort. Sci Rep 8(1):946CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Greco A, Fusconi M, Gallo A, Marinelli C, Macri GF, De Vincentiis M (2011) Sudden sensorineural hearing loss: an autoimmune disease? Autoimmun Rev 10(12):756–761. CrossRefPubMedGoogle Scholar
  11. 11.
    Rossini BAA, Penido NO, Munhoz MSL, Bogaz EA, Curi RS (2017) Sudden sensorioneural hearing loss and autoimmune systemic diseases. Int Arch Otorhinolaryngol 21(3):213–223CrossRefPubMedGoogle Scholar
  12. 12.
    Oh JH, Park K, Lee SJ, Shin YR, Choung YH (2007) Bilateral versus unilateral sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 136(1):87–91. CrossRefPubMedGoogle Scholar
  13. 13.
    Lin H-C, Chao P-Z, Lee H-C (2008) Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Stroke 39(10):2744–2748CrossRefPubMedGoogle Scholar
  14. 14.
    Lin CF, Lee KJ, Yu SS, Lin YS (2016) Effect of comorbid diabetes and hypercholesterolemia on the prognosis of idiopathic sudden sensorineural hearing loss. Laryngoscope 126(1):142–149CrossRefPubMedGoogle Scholar
  15. 15.
    Lin C, Lin SW, Lin YS, Weng SF, Lee TM (2013a) Sudden sensorineural hearing loss is correlated with an increased risk of acute myocardial infarction: a population-based cohort study. Laryngoscope 123(9):2254–2258CrossRefPubMedGoogle Scholar
  16. 16.
    Hisashi K, Komune S, Taira T, Uemura T, Sadoshima S, Tsuda H (1993) Anticardiolipin antibody-induced sudden profound sensorineural hearing loss. Am J Otolaryngol 14(4):275–277CrossRefPubMedGoogle Scholar
  17. 17.
    Atturo F, Colangeli R, Bandiera G, Barbara M, Monini S (2017) Can unilateral, progressive or sudden hearing loss be immune-mediated in origin? Acta Otolaryngol 137(8):823–828CrossRefPubMedGoogle Scholar
  18. 18.
    Sung YK, Cho SK, Choi CB, Bae SC (2013) Prevalence and incidence of rheumatoid arthritis in South Korea. Rheumatol Int 33(6):1525–1532. CrossRefPubMedGoogle Scholar
  19. 19.
    Cho SK, Sung YK, Choi CB, Kwon JM, Lee EK, Bae SC (2013) Development of an algorithm for identifying rheumatoid arthritis in the Korean National Health Insurance claims database. Rheumatol Int 33(12):2985–2992. CrossRefPubMedGoogle Scholar
  20. 20.
    Lin C, Lin S-W, Weng S-F, Lin Y-S (2013b) Risk of sudden sensorineural hearing loss in patients with systemic lupus erythematosus: a population-based cohort study. Audiol Neurotology 18(2):95–100CrossRefGoogle Scholar
  21. 21.
    Yen Y-C, Lin Y-S, Weng S-F, Lai F-J (2015) Risk of sudden sensorineural hearing loss in patients with psoriasis: a retrospective cohort study. Am J Clin Dermatol 16(3):213–220CrossRefPubMedGoogle Scholar
  22. 22.
    Lee JM, Kim JY, Bok J, Kim K-S, Choi JY, Kim SH (2017) Identification of evidence for autoimmune pathology of bilateral sudden sensorineural hearing loss using proteomic analysis. Clin Immunol 183:24–35CrossRefPubMedGoogle Scholar
  23. 23.
    Stewart OG, Simmons IG, Martin MF, Morrell AJ (2001) Bilateral facial nerve palsy associated with p-ANCA positive vasculitis in a patient with rheumatoid arthritis. Br J Ophthalmol 85(10):1266–1267CrossRefPubMedGoogle Scholar
  24. 24.
    Lobo FS, Dossi MO, Batista L, Shinzato MM (2016) Hearing impairment in patients with rheumatoid arthritis: association with anti-citrullinated protein antibodies. Clin Rheumatol 35(9):2327–2332CrossRefPubMedGoogle Scholar
  25. 25.
    Lukasik ZM, Makowski M, Makowska JS (2018) From blood coagulation to innate and adaptive immunity: the role of platelets in the physiology and pathology of autoimmune disorders. Rheumatol Int 38:959–974. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Knijff-Dutmer E, Koerts J, Nieuwland R, Kalsbeek-Batenburg E, Van De Laar M (2002) Elevated levels of platelet microparticles are associated with disease activity in rheumatoid arthritis. Arthritis Rheumatol 46(6):1498–1503CrossRefGoogle Scholar
  27. 27.
    Habets KL, Trouw LA, Levarht EN, Korporaal SJ, Habets PA, de Groot P, Huizinga TW, Toes RE (2015) Anti-citrullinated protein antibodies contribute to platelet activation in rheumatoid arthritis. Arthritis Res Ther 17(1):209CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Takatsu M, Higaki M, Kinoshita H, Mizushima Y, Koizuka I (2005) Ear involvement in patients with rheumatoid arthritis. Otol Neurotol 26(4):755–761CrossRefPubMedGoogle Scholar
  29. 29.
    Jung TT, Rhee CK, Lee CS, Park YS, Choi DC (1993) Ototoxicity of salicylate, nonsteroidal antiinflammatory drugs, and quinine. Otolaryngol Clin North Am 26(5):791–810PubMedGoogle Scholar
  30. 30.
    Seckin U, Ozoran K, Ikinciogullari A, Borman P, Bostan EE (2000) Hydroxychloroquine ototoxicity in a patient with rheumatoid arthritis. Rheumatol Int 19(5):203–204CrossRefPubMedGoogle Scholar
  31. 31.
    Alvarez-Lafuente R, Fernández-Gutiérrez eB, De Miguel S, Jover J, Rollin R, Loza E, Clemente D, Lamas J (2005) Potential relationship between herpes viruses and rheumatoid arthritis: analysis with quantitative real time polymerase chain reaction. Ann Rheum Dis 64(9):1357–1359CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Urata Y, Uesato R, Tanaka D, Kowatari K, Nitobe T, Nakamura Y, Motomura S (2011) Prevalence of reactivation of hepatitis B virus replication in rheumatoid arthritis patients. Mod Rheumatol 21(1):16–23CrossRefPubMedGoogle Scholar
  33. 33.
    Hultcrantz M, Sylvén L, Borg E (1994) Ear and hearing problems in 44 middle-aged women with Turner’s syndrome. Hear Res 76(1–2):127–132CrossRefPubMedGoogle Scholar
  34. 34.
    Choi HG, Park B, Sim S, Ahn SH (2016) Tonsillectomy does not reduce upper respiratory infections: a National Cohort Study. PLoS One 11(12):e0169264. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kim SY, Kim HJ, Park EK, Joe J, Sim S, Choi HG (2017a) Severe hearing impairment and risk of depression: a national cohort study. PLoS One 12(6):e0179973. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kim MS, Kim SY, Kim JH, Park B, Choi HG (2017b) Depression in breast cancer patients who have undergone mastectomy: a national cohort study. PLoS One 12(4):e0175395. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Lee WH, Kim J-W, Lim J-S, Kong IG, Choi HG (2018) Chronic rhinosinusitis increases the risk of hemorrhagic and ischemic stroke: a longitudinal follow-up study using a national sample cohort. PLoS One 13(3):e0193886CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kuhn M, Heman-Ackah SE, Shaikh JA, Roehm PC (2011) Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis. Trends Amplif 15(3):91–105. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Rabinowitz PM (2000) Noise-induced hearing loss. Am Fam Physician 61(9):2759–2760Google Scholar
  40. 40.
    Lin RJ, Krall R, Westerberg BD, Chadha NK, Chau JK (2012) Systematic review and meta-analysis of the risk factors for sudden sensorineural hearing loss in adults. Laryngoscope 122(3):624–635CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Sang-Yeon Lee
    • 1
  • Il Gyu Kong
    • 2
  • Dong Jun Oh
    • 3
  • Hyo Geun Choi
    • 2
    • 4
    Email author
  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Laboratory MedicineHallym University College of MedicineAnyangKorea
  3. 3.Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  4. 4.Department of Otorhinolaryngology-Head & Neck SurgeryHallym University Sacred Heart HospitalAnyang-siRepublic of Korea

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