Auditory system dysfunction in patients with vitiligo: is it a part of a systemic autoimmune process?

Abstract

Association of vitiligo with ocular and auditory abnormalities and other autoimmune disorders suggests its systemic autoimmune origin. Therefore, this study was carried out in an attempt to evaluate the effect of melanin deficiency in patients with vitiligo, as regards the extent and duration of the disease on the auditory pathway and to study the associated other ocular and systemic abnormalities in them. Forty patients with vitiligo and 20 normal volunteers were examined. Audiological evaluation including pure-tone audiometry, extended high-frequency audiometry, transient evoked otoacoustic emissions, and auditory brainstem response was carried out. Ophthalmic evaluation including visual acuity, intraocular tension, and fundus examination was carried out. Laboratory investigations including hemoglobin level, random blood sugar, liver, kidney, and thyroid function tests, and autoimmune testing (antistreptolysin O titer, erythrocyte sedimentation rate, rheumatoid factor, and antinuclear antibodies) were carried out. Sensorineural hearing loss was found in 15 (37.5%) patients; 10 (66.67%) of them had bilateral hearing loss and at high frequencies (2–8 kHz) sensorineural hearing loss. Transient evoked otoacoustic emissions were absent or decreased in 67.5%. There were no statistically significant differences in all auditory brainstem response parameters in vitiligo patients compared with the control group. One-fourth (25%) of them had decreased visual acuity, 22.5% had anemia, 12.5% had thyroid dysfunction, 10% had raised random blood sugar, 2.5% had raised liver enzymes, 32.5% had raised rheumatoid factor, 20% had raised antinuclear antibody, and 15% had raised erythrocyte sedimentation rate.