Chronic otitis media and ankylosing spondylitis: an HLA association?

Mean platelet volume, red cell distribution width, platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in patients with ankylosing spondylitis and their relationships with high-frequency hearing thresholds

The mean platelet volume (MPV), red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) comprise laboratory markers in ankylosing spondylitis (AS). There is a controversy in the literature regarding which type of ear involvement is characteristic of AS. The aim of this study was to simultaneously investigate the MPV, RDW, platelet to lymphocyte (PLR) and NLR in patients with AS and their relationships with high-frequency hearing thresholds. Thirty patients with AS and 35 age-matched healthy subjects were included. Each subject was tested with low- (250, 500, 1000 and 2000 Hz) and high- (4000, 8000, 10,000, 12,000, 14,000 and 16,000 Hz) frequency audiometry. Additionally, the case and control groups were evaluated regarding the average hearing thresholds in bone conduction. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured. The RDW, MPV, neutrophils, lymphocytes and platelet counts were evaluated with the complete blood count. Furthermore, the NLR and PLR were calculated. The complete blood count, platelet numbers, ESR, CRP and NLR levels were significantly increased in the AS patients compared with the healthy controls (p < 0.001, p = 0.007, p < 0.001, p < 0.001 and p = 0.047, respectively). There was no statistically significant difference in the RDW, PLR or MPV levels (p > 0.05) in the AS patients compared with the healthy controls. The BASDAI score and disease duration were not correlated with the ESR, CRP levels, MPV, PLR, RDW or NLR in patients with AS (all; p > 0.05). The AS patients had increased average measurement values for the hearing threshold in both ears at frequencies of 250, 500, 1000 and 2000 Hz; however, there was no statistically significant difference (p > 0.05). The average values of the hearing threshold in both ears at the high frequencies of 4000, 6000, 8000, 10,000, 12,000 and 14,000 Hz were significantly increased in the case group; however, it was not significantly increased at 16,000 Hz. The current study is the first to investigate the PLR, NLR, MPV and RDW levels in acute AS. We identified a significantly increased NLR, leukocyte count, ESR and CRP in AS patients. Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may represent an extra-articular feature of the disease. The combined use of NLR with the leukocyte count and other clinical assessments may facilitate the diagnostic process of ankylosing spondylitis.

High-frequency sensorineural hearing loss in patients with ankylosing spondylitis: is it an extrarticuler feature of disease?

OBJECTIVE

The aim of this study was to investigate the ear involvement, especially at extended higher frequencies than those previously studied, in patients with ankylosing spondylitis (AS).

PATIENTS AND METHODS

We prospectively evaluated 45 consecutive patients with AS. All patients underwent a complete physical examination of the ear, nose, and throat and an audiologic evaluation that included pure-tone audiometry at conventional and extended high frequencies, the determination of a speech discrimination score and the uncomfortable loudness level, and impedance audiometry. Thirty healthy volunteers were included as controls.

RESULTS

The mean age of the patients was 39.6 +/- 9.1 years (range 19-63 years) and that of the controls was 10.6 +/- 8.1 years (range 1-30 years). There was no statistically significant difference between the two groups with respect to conventional frequency air conduction threshold and bone conduction threshold. There was a statistically significant difference at 14,000-16,000 Hz at extended high frequencies in 32 patients with AS (71.1%) versus 12 controls (40%). At 14,000-16,000 Hz, eight patients demonstrated a sensorineural hearing loss caused by extraspinal involvement. There was a significant difference between the patients with or without extraspinal involvement, and a positive correlation was noted between the duration of disease and the hearing level at 10,000-16,000 Hz.

CONCLUSION

Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may be an extra-articular feature of that disease. A long duration of disease and extraspinal involvement are important parameters for ear involvement in patients with AS.

Chronic otitis media: a new extra-articular manifestation in ankylosing spondylitis?

Following a study reporting a fourfold increase in the occurrence of chronic otitis media in patients with ankylosing spondylitis, this prospective study examines this association with respect to severity, duration of disease, and acute phase in ankylosing spondylitis. Forty two consecutive patients with classical ankylosing spondylitis seen at the rheumatology clinic of a teaching hospital where the features of ankylosing spondylitis were recorded had an otological examination by an otolaryngologist. The occurrence of chronic otitis media (all categories) was 12/42 (29%). The acute phase serum markers (C reactive protein and IgG) were increased in patients with active or inactive chronic otitis media. Extra-articular manifestations were significantly more common in the chronic otitis media group than in those with no history of chronic otitis media. The results of this study suggest that chronic otitis media may be another extra-articular manifestation of ankylosing spondylitis. Alternative explanations, however, include similar aetiological factors for the two conditions or a previously unrecognised increased occurrence of HLA-B27 in patients with chronic otitis media.