Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
Otol Neurotol. 2022 Aug 1;43(7):742-752. doi: 10.1097/MAO.0000000000003597.
Psoriatic skin lesions are often seen in the auricle and external auditory canal, but middle ear and inner ear manifestations are not easily identified. Several studies have indicated hearing loss and vestibular dysfunction with psoriasis, but the extent of association has not been well defined.
A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies described audiometric or vestibular assessment of psoriasis patients. Meta-analysis was represented with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals.
A total of 13 studies with 589 psoriasis patients and 617 healthy controls were included. Age did not significantly differ between psoriasis patients (47.1 [12.4] yr) and healthy controls (45.4 [11.2] yr). Psoriasis area and severity index score was 9.9 (8.4), and body surface area scores was 7.9 (14.7). Pure-tone audiometry analysis showed higher mean hearing thresholds in psoriasis patients compared with healthy controls across all frequencies, with the greatest difference at 4000 Hz (MD, 7.70 [4.46-10.94]; p < 0.00001). Speech reception thresholds were worse with psoriasis (MD, 3.53 [1.56-5.49]; p < 0.0001). Abnormal stapedial reflex was more common in psoriasis (OR, 5.19 [1.68-15.99]; p = 0.004). Abnormal vestibular testing was more common in psoriasis for caloric testing (OR, 13.12 [2.88-59.84]; p < 0.0001). Two additional studies of 41,681 psoriasis patients and 80,273 healthy controls found that psoriasis patients were at higher risk for sudden sensorineural hearing loss (OR, 1.50 [1.25-1.80]; p < 0.0001).
Our study shows that psoriasis is associated with hearing loss and vestibular dysfunction, but clinical significance remains undefined. The trends noted in our study require more investigation, and the pathophysiologic mechanisms need to be defined.
银屑病皮损常发生于耳廓和外耳道，但中耳和内耳表现不易识别。几项研究表明银屑病与听力损失和前庭功能障碍有关，但关联程度尚未明确。
按照系统评价和荟萃分析的首选报告项目，对 PubMed、CINAHL、Scopus 和 Cochrane Library 进行了系统检索。纳入的研究描述了对银屑病患者的听力或前庭评估。荟萃分析采用比值比（ORs）或均数差（MD）及其 95%置信区间表示。
共纳入 13 项研究，共纳入 589 例银屑病患者和 617 例健康对照者。银屑病患者（47.1[12.4]岁）与健康对照者（45.4[11.2]岁）的年龄无显著差异。银屑病面积和严重程度指数评分（PASI）为 9.9（8.4），体表面积评分为 7.9（14.7）。纯音听阈分析显示，与健康对照组相比，银屑病患者各频率的平均听力阈值均较高，其中 4000 Hz 的差异最大（MD，7.70[4.46-10.94]；p<0.00001）。银屑病患者的言语接受阈较差（MD，3.53[1.56-5.49]；p<0.0001）。鼓室声反射异常在银屑病患者中更为常见（OR，5.19[1.68-15.99]；p=0.004）。在冷热水试验中，银屑病患者的前庭功能异常更为常见（OR，13.12[2.88-59.84]；p<0.0001）。另外两项对 41681 例银屑病患者和 80273 例健康对照者的研究发现，银屑病患者发生突发性聋的风险更高（OR，1.50[1.25-1.80]；p<0.0001）。
本研究表明，银屑病与听力损失和前庭功能障碍有关，但临床意义尚不清楚。本研究中观察到的趋势需要进一步研究，需要明确其病理生理机制。
