Conductive Hearing Loss in Association With Urate Deposits in the Middle Ear

Hearing loss due to urate deposition in the middle ear: A case report and literature review

Gout is the most common cause of monoarthritis in men occurring classically in the great toe and the knee. Extra-articular gout manifestations are rare. Only a few cases of head and neck urate crystals deposits have been described in the literature. Precipitations in the middle ear cause conductive hearing loss with common otoscopic anomalies and difficult imaging diagnosis.

We report a case of a healthy 58-years-old man with a middle ear urate deposit causing a progressive hearing loss as the very first symptom of gout. The nature of the deposit was unsure on computer tomography (CT) due to atypical density. The final diagnosis was revealed after surgical procedure and histologic examination.

A review of the literature is also presented. Seven cases of middle ear urate deposit as the first symptom of gout were found and compared.

Progressive conductive hearing loss in middle-aged patients with abnormal otoscopy and middle ear atypical density mass on CT scan must lead to a minimal surgical procedure with a histologic examination to exclude urate crystals deposits.

Middle ear urate deposit can be the very first symptom of gout.

Middle ear deposition causes conductive hearing loss with abnormal otoscopy.

Computer tomography shows an abnormal density mass.

Minimal surgical procedure with histologic examination makes the final diagnosis.

Only seven similar cases have been described.

Beyond Medical Treatment: Surgical Treatment of Gout

PURPOSE OF REVIEW

Medical treatment with urate-lowering therapy (ULT) is efficacious. A recent publication suggested that surgery in gout is more prevalent than previously reported. This revelation led us to review what is known about surgical treatment of gout.

RECENT FINDINGS

The Google Scholar database (January 1, 2014-January 1, 2020) found 104 publications with a total of 169 gout patients, with an average disease duration of 6.7 years. Most (68%) were not on ULT. The mean pre-operative serum urate levels were 9.19 mg/dL. One hundred thirteen patients underwent tophi excision, while in 33 patients, tophi were found during surgery. The majority of the surgeries were performed in Asia and Europe. Most patients were not taking ULT at the time of surgery, leading to hyperuricemia. This can result in tophi reformation post-surgery. The role of surgery should be a last-line treatment and until recently has only been demonstrated through case reports.

Gout and hearing impairment in the elderly: a retrospective cohort study using the US Medicare claims data

OBJECTIVES

To evaluate whether gout is associated with a higher risk of hearing loss in older adults.

DESIGN

Retrospective cohort study.

SETTING

USA.

PARTICIPANTS

5% random sample of US Medicare claims 2006-2012, representative of US adults aged 65 years or older.

PRIMARY AND SECONDARY OUTCOMES

Incident (new) hearing loss identified by the presence of at least two claims at least 4 weeks apart with an International Classification of Diseases, Ninth Revision, 389.xx, with no respective claim in the baseline 1-year observation period.

RESULTS

Among the 1.71 million eligible people, 89 409 developed incident hearing impairment. The crude incidence rates of incident hearing impairment in people with versus without gout were 16.9 vs. 8.7 per 1000 person-years. Using Cox regression analyses adjusted for demographics, medical comorbidity and common cardiovascular and gout medications, we found that gout was associated with a significantly higher HR of incident hearing impairment, HR was 1.44 (95% CI 1.40 to 1.49, p<0.0001). Findings were confirmed in sensitivity analyses that substituted continuous Charlson-Romano Index with categorical variable or all comorbidities and additionally cardiovascular risk factors, with minimal attenuation of HR.

CONCLUSIONS

Gout is associated with a higher risk of development of hearing loss in older adults. Future studies need to assess the underlying mechanisms of this association.