Skip to main content

Audiovestibular findings in autoimmune diseases



Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms.


This study is designed to evaluate the audiovestibular manifestations in patients with different autoimmune diseases especially asymptomatic cases.

Subjects and Methods

This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz).


patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases).


Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.


  1. 1

    von Mühlen CA, Tan EM. Autoantibodies in the diagnosis of systemic rheumatic diseases. Semin Arthritis Rheum 1995; 24:323–358.

    Article  Google Scholar 

  2. 2

    Lockshin MD. Sex differences in autoimmune disease handbook of systemic autoimmune diseases. Lupus 2005; 4:3–10.

    Google Scholar 

  3. 3

    Invernizzi P, Miozzo M, Selmi C, Persani L, Battezzati PM, Zuin M, et al. Chromosome monosomy: a common mechanism for autoimmune diseases. J Immunol 2005; 175:575–578.

    CAS  Article  Google Scholar 

  4. 4

    Özcan M, Karakus MF¸, Gündüz OH, Tuncel U, Sahin H. Hearing loss and middle ear involvement in rheumatoid arthritis. Rheumatol Int 2002; 22:16–19.

    Article  Google Scholar 

  5. 5

    Farah S, Al-Shubaili A, Montaser A. Behçet’s syndrome: a report of 41 patients with emphasis on neurological manifestations. J Neurol Neurosurg Psychiatry 1998; 64:382–384.

    CAS  Article  Google Scholar 

  6. 6

    Kidd D, Steuer A, Denman AM, Rudge P. Neurological complications of Behçet’s syndrome. Brain 1999; 122:2183–2194.

    Article  Google Scholar 

  7. 7

    Tunc R, Saip S, Siva A, Yazici H. Cerebral venous thrombosis is associated with major vessel disease in Behçet’s syndrome. Ann Rheum Dis 2004; 63:1693–1694.

    CAS  Article  Google Scholar 

  8. 8

    Kastanioudakis I, Skevas A, Danielidis V, Tsiakou E, Drosos A, Moustopoulos H. Ear involvement in systemic lupus erythematosus patients: a comparative study. J Laryngol Otol 1995; 116:103–107.

    Google Scholar 

  9. 9

    Salvinelli F, Cancilleri F, Casale M, Luccarelli V, Di Peco V, D’Ascanio L, De Martino A, Denaro V. Hearing thresholds in patients affected by rheumatoid arthritis. Clin Otolaryngol 2004; 29:75–79.

    CAS  Article  Google Scholar 

  10. 10

    Liening D, Larouere M. Relief of sensorineural hearing loss due to rheumatoid arthritis by endolymphatic sac decompression. J Otolaryngol 1997; 26:281–283.

    CAS  PubMed  Google Scholar 

  11. 11

    Ozcan A, Yalcin S, Kaygusuz I, Sahin S, Gok U, Karlidag T, Ardicoglu O. High frequency hearing loss and middle ear involvement in rheumatoid arthritis. Am J Otolaryngol 2004; 25:411–417.

    Article  Google Scholar 

  12. 12

    Jacobson GP, Shepard NT. Balance functional assessment and management. 2nd ed. San Diego, CA: Plural Publishing; 2015.

    Google Scholar 

  13. 13

    Desmond A. Vestibular function: evaluation and treatment. New York, NY: Thieme Medical Publishers; 2004. 65–111

    Google Scholar 

  14. 14

    Kaplan DM, Marais J, Ogawa T, Kraus M, Rutka JA, Bance ML. Does high-frequency pseudo-random rotational chair testing increase the diagnostic yield of the ENG caloric test in detecting bilateral vestibular loss in the dizzy patient? Laryngoscope 2001; 111:959–963.

    CAS  Article  Google Scholar 

  15. 15

    Arriaga MA, Chen DA, Cenci KA. Rotational chair (ROTO) instead of electronystagmography (ENG) as the primary vestibular test. Otolaryngol Head Neck Surg 2005; 133:329–333.

    Article  Google Scholar 

  16. 16

    Hamid MA. Clinical value of sinusoidal harmonic acceleration test results. Site of lesion and side of lesion. Neurol Clin 1990; 8:287–295.

    CAS  PubMed  Google Scholar 

  17. 17

    Wall C III. The sinusoidal harmonic acceleration rotary chair test. Theoretical and clinical basis. Neurol Clin 1990; 8:269–285.

    Article  Google Scholar 

  18. 18

    Reiter D, Konkle DF, Myers AR, Schimmer B, Sugar SO. Middle ear immittance in rheumatoid arthritis. Arch Otolaryngol 1980; 106:114–117.

    CAS  Article  Google Scholar 

  19. 19

    Coletti V, Fiorino FG, Bruni L, Biasi D. Middle ear mechanics in subjects with rheumatoid arthritis. Audiology 1997; 36:136–146.

    Article  Google Scholar 

  20. 20

    Mokbel AN, Hassan SZ, Zohdi MI, ElShennawy AM. Auditory disorders in patients with systemic lupus erythematosus: relation to clinical parameters. Egypt Rheumatol 2014; 36:117–124.

    Article  Google Scholar 

  21. 21

    Koç A, Emre IE. Audiovestibular manifestations in patients with ankylosing spondylitis – a case report and review of the literature. J Int Adv Otol 2015; 11:176–178.

    Article  Google Scholar 

  22. 22

    Andonopoulus A, Naxakis S, Goumas P. Sensorineural hearing disorders in systemic lupus erythematosus: a controlled study. Clin Exp Rheumatol 1995; 13: 137–141.

    Google Scholar 

  23. 23

    Maciaszczyk K, Durko T, Waszczykowska E, Erkiert-Polguj A, Pajor A. Auditory function in patients with systemic lupus erythematosus. Auris Nasus Larynx 2011; 38:26–32.

    Article  Google Scholar 

  24. 24

    Magaro M, Zoli A, Altomonte L, Mirone L, Corvino G, Di Girolamo S, et al. Sensorineural hearing loss in rheumatoid arthritis. Clin Exp Rheumatol 1990; 8:487–490.

    CAS  PubMed  Google Scholar 

  25. 25

    Batuecas-Caletrío A, del Pino-Montes J, Cordero-Civantos C, Calle-Cabanillas MI, Lopez-Escamez JA. Hearing and vestibular disorders in patients with systemic lupus erythematosus. Lupus 2013; 22:437–442.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Takwa A. Gabr MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gabr, T.A., Kotait, M.A. & Abdel Noor, R.A. Audiovestibular findings in autoimmune diseases. Egypt J Otolaryngol 35, 71–78 (2019).

Download citation


  • Autoimmune diseases
  • hearing loss
  • sinusoidal harmonic acceleration (SHA)