Sjögren’s & Ear Pain
Patients with Sjögren’s are at increased risk of hearing loss, both conductive (hearing loss occurs due to problems with the ear canal, eardrum, eustachian tube, or ear bones) and sensorineural (nerve deafness) types. Autoimmune hearing loss can occur; this is a type of sensorineural hearing loss that results from one’s antibodies attacking the auditory nervous system. Treatment is similar to other forms of autoimmune hearing loss and centers on oral steroids. Occasionally, other immunosuppressant drugs are used for steroid-sparing effects. Partial return of hearing can occur if treatment is prompt, although progressive deterioration is more common. Other causes of the hearing loss that are treatable must be evaluated prior to a patient being given the diagnosis of Sjögren’s-related autoimmune hearing loss.
Tinnitus, or ringing in the ears, also occurs more frequently in patients with Sjögren’s. In patients with sensorineural hearing loss, tinnitus also frequently occurs. However, even Sjögren’s patients with normal hearing complain of tinnitus. The reason for this in unknown. Tinnitus occurs more often in patients with anxiety and depression; on many occasions, treating the anxiety and depression can improve the patient’s subjective tinnitus. While most patients are able to live with the tinnitus, some patients will suffer so greatly that more aggressive treatment such as tinnitus maskers or biofeedback may be necessary.
Otalgia, or ear pain, can occur in as many as 25% of Sjögren’s patients. The origin of the ear pain is also largely unknown, although many suspect that the dryness in the upper airway can lead to eustachian tube dysfunction. The role of the eustachian tube is to equalize pressure within the middle ear; when the eustachian tube is diseased, the middle ear develops negative pressure, which can lead to pain, hearing loss, fluid accumulation, and even infection. The treatment of eustachian tube dysfunction depends on the severity of the disease; avoiding decongestants and using a nasal steroid and nasal saline to improve function is usually all that is necessary. In severe cases of eustachian tube dysfunction patients may suffer from recurrent fluid buildup in the middle ear and even infections. Patients with this level of disease may benefit from antibiotics or even a myringotomy tube (a tube is placed in the eardrum to drain the middle ear and bypass the defective or diseased eustachian tube).
Ear pain, redness, and swelling may also occur due to relapsing polychondritis. This condition causes autoimmune inflammation of ear cartilage as well as other cartilaginous structures in the head and neck and may occur as an isolated condition or in association with other autoimmune diseases like Sjögren’s. It is usually treated with high-dose oral steroids and other immunosuppressant drugs.
*excerpt taken from “The Sjögren’s Book”, Forth Edition; please contact us if you are interested in a copy of this book