© Borgis - New Medicine 3/1999, s. 59-60
Elżbieta Reroń, Piotr Muszyński, Robert Przeklasa, Katarzyna Zajdel
Middle ear functional activity in juvenile chronic arthritis: initial information
Audiometric Laboratory, ENT Department, Jagiellonian University Hospital, Cracow
Head of Department: Prof. Eugeniusz Olszewski, M.D.
Intraphalangeal joints are synovial joints with a cartilaginous joint surface, and as such they can be affected by rheumatoid changes, similar to these observed in other articulations in the body. The aim of our study was a comprehensive audiometric assessment of middle ear functional activity and hearing acuity in 38 children aged 4-16 years with juvenile chronic arthritis (JCA). The evaluation of the hearing organ was performed using pure tone audiometry (PTA), verbal audiometry, tympanometry, high frequency audiometry (HFA) and evoked otoacousic emissions (EOAEs). The initial analysis of these tests revealed abnormal tympanograms in the majority of children with JCA, which indicate diminished compliance in organs transmitting acoustic energy. These pathological changes are not sufficient to cause a conductive hearing loss but they can markedly reduce the defensive mechanisms of the middle ear.
One of many basic conditions ensuring the normal function of the mechanism transmitting acoustic energy through the middle ear is an effectively working chain of acoustic bones having an uninterrupted sequence and correct mobility of the incudomalleolar joint, incudostapedial joint and tympanostapedial junction.
Both the incudomalleolar and incudostapedial joints are synovial articulations with a cartilaginous joint surface and therefore they, like other joints in the body, may be affected by arthritis (2, 4, 5).
Since Copeman (3) in 1963 first described three cases of acute arthritis accompanied by transient hearing loss of a conductive nature called, which he `oto-arthritis´, attention has been focused on conductive hearing impairment as a result of rheumatoid changes in the joints between the acoustic bones in the middle ear (3, 10, 12).
Although Gussen (6) in 1977 in autopsies of persons affected by chronic arthritis reported rheumatoid changes on the surface of joints in the chain of acoustic bones, which impaired the conductive activity of the middle ear, conductive hearing loss associated with acute arthritis has been controversial until now (1, 7).
According to many authors (2, 4, 5) dealing with hearing problems in the course of rheumatoid arthritis in adults, sensory-nervous hearing loss has been observed in 26-47% of cases (1), whereas conductive hearing loss has been infrequently reported, that is, in 4.8-13% of cases these being mainly in adults with chronic arthritis of a few dozen years duration (1).
Juvenile chronic arthritis (JCA) is a chronic, inflammatory, systemic disease of the connective tissue. The main symptom is progressive inflammation manifested by pain, oedema, stiffness and restriction of the mobility of the joints, leading to their deformation and destruction. In consequence, the functional effectiveness of the osteoarticular system is impaired. Chronic arthritis can be accompanied by rheumatoid nodules, pericarditis and/or myocarditis, lesions in the lungs, kidneys and eyes, occurring with various frequencies and indicating the systemic nature of the disease (12). There are considerable discrepancies in the morbidity rate of juvenile chronic arthritis in the literature. It is based mainly on observation of patients treated in general hospitals and children´s hospitals as well as rheumatoid diseases out-patient departments. The morbidity rate in Poland ranges between 0.5-0.1 per 100000 children.
Aim of study
The aim of our study was:
1. Comprehensive audiological evaluation of middle ear activity and hearing acuity in children 4-16 years of age suffering from juvenile chronic arthritis.
2. Correlation of the lesions in the hearing organ with the type, activity and duration of arthritis on the basis of clinical and laboratory examinations, such as complete blood count, Biernacki reaction, presence or lack of reactive factor (RF), the level of C-reactive protein (CRP), and seromucoid and antinuclear antibodies (ANA).
Material and methods
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