Psoriasis and Hearing Loss

There is now evidence that those with psoriasis are more likely to develop a mild sudden sensori-neural hearing loss (SSNHL). According to a Taiwanese ps2study by Yen and colleagues (2015) at Chi Mei Medical Center in Tainan, sudden sensori-neural hearing lossps3 (SSNHL) might be a manifestation of systemic vascular involvement in autoimmune disease, possibly changing the overall treatment of this disorder. Their study may have discovered a connection between psoriasis and sudden sensori-neural hearing loss (SSNHL), as they found the incidence of SSNHL to be 1.51 times higher among those with psoriasis than in the general population, especially when hearing loss is already present.

What is Psoriasis?

 

Psoriasis is a chronic (long-lasting) skin disease of scaling and inflammation whose prevalence varies considerably. In the USA, approximately 2% of the population is affected. High rates of psoriasis have been reported in people of the Faroe islands, where one study found 2.8% of the population to be affected. The prevalence of psoriasis is low in certain ethnic groups such as the Japanese, and may be absent in aboriginal Australians and Indians from South America.  Signs and symptoms vary from person to person but, according to the Mayo Clinic (2016), may include one or more of the following:

  • Red patches of skin covered with silvery scales
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed
  • Itching, burning or soreness
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints

psPsoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.  Psoriasis occurs when skin cells quickly rise from their origin below the surface of the skin and pile up on the surface before they have a chance to mature. Usually this movement, often called “turnover”, takes about a month, but in psoriasis it may occur in only a few days.  Mayo Clinic (2016) also indicates that there are various types of psoriasis, some more severe than others.  These include:

  • Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. .
  • Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration.
  • Scalp psoriasis. Psoriasis on the scalp appears as red, itchy areas with silvery-white scales.
  • Guttate psoriasis. This primarily affects young adults and children and triggered by a bacterial infection such as strep throat.
  • Inverse psoriasis. Mainly affecting the skin in the armpits, in the groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin.
  • Pustular psoriasis. This uncommon form of psoriasis can occur in diffuse or localized areas on hands, feet or fingertips.
  • Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
  • Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis.

What Causes Psoriasis?

 

Psoriasis is a skin disorder driven by the immune system and genetics that involves a type of white blood cell called a T cell. Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become sops4 active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells.  T-Cells are essential for human immunity as evidenced by the lack of a type of T-cell in HIV/AIDS.

 The several types of T-Cells can be divided into two general types, Killers and Helpers.  Killer cells hunt down and destroy cells that are infected or may have become cancerous. Helper cells set up immune responses to various types of threats to the body. The thought is that the relationship among the these types of T cells is disrupted somehow.  Researchers suggest that there is often a family history of psoriasis in those who have psoriasis, and they have identified genes that are linked to the disease.  People with psoriasis often have “flare ups” when their skin worsens, then improves. There are conditions cause these “flares” such as infections, stress, and changes in climate that dry the skin as well as certain medicines that may trigger an outbreak or worsen the disease. At times people who have psoriasis notice that lesions will appear where the skin has experienced trauma from a cut, scratch, sunburn, or infection.  It often affects elbows, knees, scalp and other areas.

 

Sudden Sensori-Neural Hearing Loss & Psoriasis

 

Worldwide estimates claim there are over 15,000 cases of sudden sensori-neural hearing loss each year and 4,000 cases are seen in the United States.  Most of these cases are individuals that are 50-60 years of age but some cases occur in 20-30 year-olds.   Sudden sensori-neural hearing loss is defined as a loss greater than 30 dBHTL in three contiguous frequencies occurring over a period of less than three days.  Traditionally sudden sensori-neural hearing losses are often idiopathic but can be associated with head trauma (such as a car accident), acoustic trauma (such as being too close to a gun or airbag when it explodes), viral infections, tumors, ps1decreased circulation to the inner ear, membrane breaks, medication for erectile dysfunction or ototoxic drug exposure.  While many of these cases of SSNHL rectify themselves in a short time there are others that linger for quite some time.Most of the time, however, the cause for SSNHL is listed as “idiopathic” or unknown.   

Gender of people who have Psoriasis and experience Hearing Loss:

  • female: 60.61 %
  • male: 39.39 %

Age of people who have Psoriasis and experience Hearing Loss:

  • 0-1: 0.0 %
  • 2-9: 2.13 %
  • 10-19: 0.0 %
  • 20-29: 8.51 %
  • 30-39: 12.77 %
  • 40-49: 14.89 %
  • 50-59: 27.66 %
  • 60+: 34.04 %
The review of psoriasis cases and their correlation with hearing impairment certainly requires further study, but the idea that this impairment is associated with psoriasis is innovative, plausible, and interesting.  Other recent studies are also suggesting that psoriasis may also be involved in vestibular disorders.  While the Taiwan study and its results will undoubtedly spawn other investigations of the correlation of psoriasis with sudden sensori-neural hearing loss at this point “the jury is still out as to if psoriasis has a connection to this form of mild sensori-neural hearing loss.”

References:

eHealthMe (2016).  Would you have hearing loss when you have psoriasis?  Retrieved August 1, 2016.

Mayo clinic Staff (2016). Diseases and Conditions:  Psoriasis.  Retrieved August 2, 2016.

National Institute on Arthritis and Musculoskeletal and Skin Disease (2016). What Causes Psoriasis?  Retrieved August 2, 2016.

Yen YC, Lin YS, Weng SF, Lai FJ. (2015). Risk of sudden sensorineural hearing loss in patients with psoriasis: a retrospective cohort study.  Am J Clin Dermatol. 2015 Jun;16(3):213-20. Retrieved August 1, 2016.

Images:

Brind’Amour, K. & Krucik, G. (2013). Scalp Psoriasis Photos. Healthline.  Retrieved August 2, 2016. 

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About Robert Traynor

Robert M. Traynor is a board certified audiologist with 45 years of clinical practice in audiology. He is a hearing industry consultant, trainer, professor, conference speaker, practice manager, and author. He has 45 years experience teaching courses and training clinicians within the field of audiology with specific emphasis in hearing and tinnitus rehabilitation. Currently, he is an adjunct professor in various university audiology programs.

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