title: Hearing impairment in a tertiary-care-level population of Mexican rheumatoid arthritis patients.
abstract: OBJECTIVE
  The objectives of this study were to assess characteristics of hearing impairment (HI) in Mexican Mestizo patients with rheumatoid arthritis.
  
  
  METHODS
  One hundred thirteen consecutive patients (101 women, aged 43.3 ± 13.1 years) without previously identified HI diagnosis had a structured interview and complete rheumatic and audiologic evaluations, which included at least a pure-tone audiometry and standard and high-frequency tympanometry. Hearing impairment was defined if the average thresholds for at least 1 of low-, mid-, or high-frequency ranges were 25-dB hearing level or greater in 1 ear (unilateral) or both ears (bilateral). Hearing impairment was classified as mild or moderate/severe. Appropriate statistics, multivariate analysis, and receiver operating characteristic curves were used.
  
  
  RESULTS
  Hearing impairment was detected in 27 patients (24%), was sensorineural-type HI in 25 (93%), bilateral in 14 (52%), and mild in 20 of them (74%). Normal tympanograms (type A) were found in 93 patients (82%), although high-frequency tympanometry was abnormal in 80 patients (71.4%). Patients with HI were significantly older (51.8 ± 14.1 vs. 40.7 ± 11.7 years, P ≤ 0.001), had more frequent rheumatoid nodules (37% vs. 12.8%, P = 0.001), and had more (median [range]) comorbidities per patient (2 [1-2] vs. 1 [0-2], P = 0.03). Multivariate analysis showed that HI was significantly associated to age (odds ratio, 1.1; 95% confidence interval, 1.03-1.15; P ≤ 0.001). The best cutoff level for HI was 50 years of age and increased to 59 years for moderate/severe HI.
  
  
  CONCLUSIONS
  A significant proportion of Mexican Mestizo outpatients with rheumatoid arthritis had previously undiagnosed HI, mainly of sensorineural type, of mild severity, and bilateral. Older age was the only prognosticator of HI.
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México. virtichu@gmail.com
authors.forename: Virginia
authors.initials: V
authors.lastname: Pascual-Ramos
authors.forename: Irazú
authors.initials: I
authors.lastname: Contreras-Yáñez
authors.forename: Lorena
authors.initials: L
authors.lastname: Enríquez
authors.forename: Samantha
authors.initials: S
authors.lastname: Valdés
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ramírez-Anguiano
mesh_terms: D000158:Acoustic Impedance Tests; D000328:Adult; D000367:Age Factors; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D005260:Female; D034381:Hearing Loss / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013063:Speech Discrimination Tests
chemical_list: D002097:C-Reactive Protein