CLINICAL REPORT
655 ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Auditory System Involvement in Psoriasis
Francesco BORGIA 1, Francesco CIODARO 2, Fabrizio GUARNERI 1, Annunziata BARTOLOTTA 1, Valeria PAPAIANNI 1, Claudio GUARNERI 1, Natalia CATALANO 2, Francesco GALLETTI 2 and Serafinella P. CANNAVÒ 1
1
Department of Clinical and Experimental Medicine – Section of Dermatology, 2 Department of Adulthood and Childhood Human Pathology“ G. Barresi” – Otorhinolaryngology and Auditory Microsurgery Unit, University of Messina, Messina, Italy
Psoriasis is a systemic inflammatory disorder associated with many other chronic and progressive diseases. There are few studies on the association of psoriasis with alterations in auditory function. A clinical and instrumental pilot study of auditory function was performed with 77 psoriatic patients and 77 age- and sexmatched healthy controls. The main results were:( i) hearing loss, mostly of sensorineural type, was significantly more frequent in patients than in controls;( ii) conductive and mixed hearing loss were more frequent in arthropathic than in non-arthropathic psoriatic patients;( iii) duration of psoriasis > 10 years or smoking were associated with higher frequency of hearing loss;( iv) psoriasis was more severe in patients with hearing loss than in those without hearing loss. Tympanogram abnormalities were found in patients more often than in controls. These data expand the list of extracutaneous conditions associated with psoriasis, and support the need for further basic and clinical research in this field.
Key words: psoriasis; ear involvement; hypoacusis; metabolic syndrome; psoriatic arthropathy; sensorineural hearing loss.
Accepted Apr 12, 2018; Epub ahead of print Apr 12, 2018 Acta Derm Venereol 2018; 98: 655 – 659.
Corr: Francesco Borgia, Department of Clinical and Experimental Medicine – Section of Dermatology, University Hospital“ G. Martino”, via Consolare Valeria n ° 1, IT-98125 Messina, Italy. E-mail: fborgia @ unime. it
Psoriasis, which for a long time was considered exclusively cutaneous, is now recognized as a systemic inflammatory disorder that shares pathogenic pathways with many chronic and progressive diseases( 1). The constantly updated list of these conditions includes psoriatic arthritis, metabolic syndrome or single components of the syndrome, cardiovascular diseases, inflammatory bowel diseases, uveitis, obstructive sleep apnoea, nonalcoholic fatty liver disease, and psychiatric disturbances( 2 – 5). The external ear is commonly involved in psoriasis( 6), with typical psoriatic lesions usually present at the conchal bowl as intensely itching, well-demarcated, erythematous plaques with a silvery scale. Ear psoriasis may sometimes appear as non-specific erythematous, dry, and scaly skin; nevertheless, diagnosis is easy when typical lesions are detectable in other areas of the body( 7, 8). Interestingly, despite the high prevalence of clinical manifestations involving both the auricle and the external auditory canal, the potential impact of psoriasis on
SIGNIFICANCE
Psoriasis is a systemic inflammatory disorder associated with many chronic and progressive diseases. This study investigated auditory function in 77 psoriatic patients and 77 age- and sex-matched healthy controls. Overall, hearing loss and alterations of tympanogram are more frequent among psoriatic patients. Patients with psoriatic arthropathy suffer from hearing loss more often than non-arthropatic ones. Hearing loss is also more frequent when psoriasis lasts for more than 10 years and among smokers. Finally, psoriasis is generally more severe in patients with hearing loss. These data expand the list of extracutaneous conditions associated with psoriasis.
the function of the auditory system has, until now, been little studied. Only 2 cases of sudden-onset autoimmune sensorineural hearing loss have been reported in patients affected by psoriatic arthritis, and there is a lack of data about possible morpho-functional alterations of the external and middle ear and hearing impairment( 9, 10). This pilot study aimed to assess the possible presence of hearing loss in a population of psoriatic patients. In addition, a qualitative and quantitative evaluation of clinical manifestations and functional impairment of the external auditory canal and / or tympanic membrane was performed in these patients, via examination and instrumental measurements.
METHODS
A case-control study was performed on out-patients aged 18 years or over, who attended our dermatological centre for observation due to psoriasis. None of the patients had been treated with systemic drugs for psoriasis in the last 3 months( topical treatments were allowed), and none had a history of otological diseases( genetic hearing loss, head injuries, otological surgery, exposure to ototoxic agents, acoustic traumas or professional / particular noise exposure, chronic external otitis, recurrent middle ear infections requiring otological surgery). As a control group, we considered an equal number of sex- and age-matched subjects with negative personal and family history of dermatological diseases, and without any possible concurrent causes of auditory impairment, as listed above. Severe cardiovascular problems, namely class 3 or 4 heart failure according to the New York Heart Association( NYHA) classification, were exclusion criteria for psoriatic patients and controls. None of the subjects included in the study used hearing aids.
After obtaining approval from our institutional review board and written informed consent from participants, for each patient a dermatologist recorded the duration of psoriasis, smoking and alcohol intake, Psoriasis Area and Severity Index( PASI) score,
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2937 Acta Derm Venereol 2018; 98: 655 – 659