Early detection of auditory dysfunction in rheumatoid arthritis: Bridging the gap between rheumatology and audiology for improved diagnosis and patient outcomes in the African context

Auditory dysfunction, particularly sensorineural hearing loss (SNHL), is increasingly recognized as an extra-articular manifestation of rheumatoid arthritis (RA). However, its early detection and management remain underexplored, especially within African healthcare systems, where interdisciplinary collaboration between audiologists and rheumatologists is limited.

This narrative review synthesizes peer-reviewed evidence on the prevalence, characteristics, and mechanisms of auditory dysfunction in adults with RA, with a focus on applicability to African contexts and similar low- and middle-income countries (LMICs). It advocates for integrating routine audiological screening into RA care to improve diagnostic and patient outcomes.

A narrative review was conducted using 29 peer-reviewed studies published from 2000 onward, identified via PubMed, Scopus, Web of Science, and Google Scholar. Studies focused on adult RA populations and included audiological assessments such as pure tone audiometry, tympanometry, OAEs, and auditory evoked potentials. Data were synthesized thematically across five objectives.

Five interrelated themes emerged from the synthesis: (1) the prevalence and types of auditory dysfunction in RA; (2) audiological assessment methods and patterns of impairment; (3) proposed pathophysiological mechanisms linking RA and hearing loss; (4) relationships between auditory dysfunction, disease activity, duration, and treatment; and (5) implications for early detection and integrated care, particularly within African and LMIC contexts. Sensorineural hearing loss (SNHL) was the most prevalent type, affecting up to 71% of RA patients. Conductive and mixed hearing losses (CHL and MHL) were also reported, often associated with middle ear and ossicular involvement. Mechanisms included immune-mediated cochlear inflammation, vasculitis, and potential ototoxicity. Several studies reported weak or inconsistent associations between RA disease activity and hearing loss, suggesting a need for independent audiological monitoring. African studies reflected similar trends while highlighting systemic barriers to early detection.

Hearing loss is a neglected comorbidity in RA. Integrating audiological services into rheumatology, especially in African and LMIC settings, offers an opportunity for early detection, patient-centered care, prevention of communication and cognitive decline, and improved interdisciplinary patient management.