Sudden hearing loss in a patient with rheumatoid arthritis; a case report and review of the literature.

Dear Sir, There is considerable evidence suggesting a relation ship between autoimmune diseases and hearing impairment. As a specific entity, autoimmune sensorineural hearing loss (ASHL) has been reported to occur in association with autoimmune diseases such as rheumatoid arthritis (RA). We wanted to draw attention to this relationship by a case with RA presented sudden hearing loss. Our case was a 37-year-old woman with a 12-year history of seropositive RA who had good response to methotrexate. Bilateral sudden sensorineural hearing loss developed in the follow-up of the patient. Her past medical history was unremarkable, she had no history of vertigo or ocular problems. On physical examination, systemic evaluation was normal except from mild limitations in the extention of right elbow and wrists bilaterally. Neurological examination was unremarkable and in particular there were no cerebellar or vestibular findings. Otoscopic examination was also normal. A magnetic resonance image of her brain revealed no pa tho logic findings. The audiogram showed symmetric sensorineural hearing loss predominantly for the high frequencies. ASHL was considered as a diagnosis based on bilateral rapidly progressive sensorineural hearing loss and the presence of RA. Prednisone 1 mg/kg per day was administered to the patient in the otorhinolaryngology review and she responded well with a subtotal recovery. AISH is a well-described clinical entity that has a relationship with a number of systemic autoimmune disorders. It was defined by McCabe in a case series with sudden sensorineural hearing loss who responded to corticosteroids and/or cyclophosphamide. This favorable response to corticosteroids suggested that hearing loss in these patients was caused by an autoimmune mechanism in spite of its uncertain etiopathogeMeltem Alkan Melikoglu1, Kazim Senel1