Hearing Loss and Ankylosing Spondylitis

Last updated: March 2020

People with ankylosing spondylitis (AS) may develop extra-articular (beyond the joint) manifestations or complications from the chronic inflammatory condition that can affect different parts of the body. One of these extra-articular manifestations is hearing loss.

How common is hearing loss among people with AS?

Hearing loss is common among people with AS. The prevalence of hearing loss in people with AS has varied among different research studies, ranging from 35 percent to 71 percent of subjects. Most hearing loss is mild. There are different types of hearing loss, and while people with AS can have either or both types, conductive hearing loss is more common.1

Types of hearing loss

There are two types of hearing loss, conductive and sensorineural. In addition, some people have a combination of these two, which can be called mixed hearing loss. In conductive hearing loss, there are problems with the ear canal, ear drum, or middle ear (where the ear bones - the malleus, incus, and stapes - are located). Sensorineural hearing loss caused by nerve problems in the inner ear.2

How does AS cause hearing loss?

The exact way AS can cause hearing loss isn't fully understood. Researchers have several theories on how this may occur: the tissue and blood vessels in the inner ear may suffer from the autoimmune mechanisms, the ear bones may develop stiffness and impaired mobility, or hearing loss may develop as a side effect of medications used to treat AS.3

What else causes hearing loss?

There are many different causes of hearing loss. Conductive hearing loss can be caused by a malformation of the ear structures, fluid in the middle ear due to colds, ear infections, allergies, perforated eardrum, impacted earwax, or a foreign object in the ear. Sensorineural hearing loss can be caused by exposure to loud noise, aging, trauma to the head, virus or diseases, autoimmune inner ear disease, malformation of the inner ear, or Meniere's disease.2

What are common symptoms of hearing loss?

Hearing loss can progress slowly over time. People with hearing loss may notice that they2:

  • Have to ask others to repeat what they are saying
  • Have difficulty following conversations in groups
  • Believe others are mumbling
  • Frequently turn up the sound on televisions or radios
  • Have difficulty on the telephone
  • Avoid noisy restaurants or parties
  • Have trouble understanding dialogue at movies
  • Oversleep because they don't hear the alarm clock

Because hearing loss can be subtle and progress gradually, family and friends may notice these changes before the individual does.

How is hearing loss diagnosed?

Hearing loss is diagnosed based on symptoms, history, and a hearing test.2 There is a variety of hearing tests, and the tests used are based on the age of the individual and other factors. Tests may include:4

  • Pure-tone testing, which tests the quietest sound a person can hear at different pitches or frequencies
  • Speech testing, in which the individual repeats words heard through headphones that are spoken at different levels
  • Otoacoustic Emissions (OAEs), which measures how well the inner ear works using a small earphone placed in the ear

How is hearing loss treated?

Most hearing loss can be treated, and treatment may include hearing aids or surgically implanted cochlear implants. It is important to treat hearing loss because hearing loss has been linked to increased risks of heart disease, dementia, depression, high blood pressure, diabetes, falls, isolation, and loneliness.2

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