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