Audiological Abnormalities in Vitiligo Patients: A Hospital-Based Cross-Sectional Study

THIEME Original Research Audiological Abnormalities in Vitiligo Patients: A Hospital-Based Cross-Sectional Study Neel Prabha1 Ripudaman Arora2 Namrata Chhabra1 1 Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India 2 Department of ENT & HNS, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India Monalisa Jati2 Nitin M. Nagarkar2 Address for correspondence Dr Ripudaman Arora, MBBS, MS, All India Institute of Medical Sciences, GE Rd, Tatibandh, Raipur, Chhattisgarh, India (e-mail: ). Int Arch Otorhinolaryngol 2020;24(2):e155–e159. Abstract Keywords ► vitiligo ► sensorineural hearing loss ► audiological functions Introduction There are some discrepancies in the literature about the influence of vitiligo on auditory functions. According to some authors, vitiligo influences hearing, whereas others question such influence. Therefore, we conducted a study to evaluate audiological functions in vitiligo patients. Objectives To determine the effect of vitiligo on auditory functions. Methods A hospital-based observational study was done from January 2017 to July 2017. Clinically diagnosed cases of vitiligo were enrolled for the study. A complete otological examination was conducted in all patients. Results Fifty-two patients (male: female 28:24) were included in the study. Ten patients (19.2%) had sensorineural hearing loss (SNHL). Seven patients (13.5%) had bilateral and 3 (5.7%) had unilateral SNHL. High frequency loss was seen in 17 out of 20 ears (10 affected patients), 6 ears had both low and high-frequency hearing loss. Of 12 ears with speech frequency involvement, mild hearing loss was seen in 5 and moderate to severe in 1 ear. Most cases of SNHL were detected in the age group 41 to 60 years old (63.6%), which was statistically significant (p-value 0.00). Conclusion The results of this study suggest that vitiligo patients require routine monitoring for auditory functions for early identification of SNHL. Older subjects with vitiligo might be at a higher risk for audiological abnormalities. These patients should also be informed regarding the associated risk with noise and ototoxic drug exposure. Introduction Vitiligo is an acquired discoloration of skin caused by loss or damage of epidermal melanocyte and characterized by well-defined depigmented macules. It occurs worldwide with an overall prevalence of1%.1 In a study from India, the point prevalence was 9.982 from four zones of India namely North, South, East and West on 20 November 2012.2 Adults and children of both genders are equally affected, and the greater number of reports among females could be explained by the social consequences to females affected by vitiligo.1 Almost 50% of vitiligo patients present with received December 18, 2018 accepted July 1, 2019 published online November 4, 2019 DOI https://doi.org/ 10.1055/s-0039-1696700. ISSN 1809-9777. symptoms before 20 years of age and nearly 70 to 80% before 30 years of age.1 The exact etiology of vitiligo is not known. However, genetic, neural, immunological and self-destructive pathomechanisms are said to be involved. Autoantibodies are directed against the antigens of melanocytes, which lead to the destruction of melanocytes. Melanocytes are located in the epidermis, hair bulbs, uveal tract, retinal pigmented epithelium, leptomeninges, and inner ear. Hence, the mechanisms responsible for the destruction of melanocyte in the skin affect melanocytes in other locations as Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 155 156 Audiological Abnormalities in Vitiligo Patients Prabha et al. well. There are some discrepancies in the literature about the influence of vitiligo on auditory functions. According to some authors, vitiligo influences hearing,3–9 whereas others question such influence.10–13 Accordingly, this study was designed to evaluate the audiological functions in vitiligo patients. Materials and Methods A hospital-based prospective observational study was done from January 2017 to July 2017 after obtaining permission from the institutional ethics committee. After obtaining a written informed consent, clinically diagnosed cases of vitiligo patients were enrolled for the study. The demographic profile, duration and evolution of vitiligo, personal and family history, medical history, cutaneous and otological examination were recorded in a predesigned proforma. Pregnant females, history or evidence of otological disease, documented hearing loss, familial hearing loss, ototoxic drug intake, chronic exposure to noise, neurological, vascular, or systemic diseases, such as diabetes and hypertension, were excluded. A complete otological examination was conducted in all patients by an otorhinolaryngologist. Otological examination included external examination, tuning fork and pure tone audiometry. Audiological evaluation was performed in a sound-treated room using a single-channeled audiometer. The audiometer, which was used for threshold estimation, was Triveni-TAM-500ME (Andheri, Mumbai, India). Both airconduction thresholds and bone-conduction thresholds were measured. The thresholds (minimum level of hearing) for air conduction were estimated using standard headphone TDH39 (770 Park Ave, Huntington, NY11743, US), from frequency range 250 Hz to 8 KHz, with intensity level
10 dBHL to 120 dBHL, and the pure tone average was measured using an average of three frequencies, that is, 500 Hz, 1 KHz, and 2 KHz. Bone conduction was tested with test frequencies from 250 Hz to 4 KHz, with intensity level from
10 dBHL to 70 dBHL (with standard bone conductor B71, Radio ear, Audiometer alle1, 5500 Middelfart, Denmark). For measuring hearing thresholds at higher frequencies above 8 KHz, MAICO MA 42 (Sicklinggenstr. 70–71, 10553 Berlin, Germany), a dual channel audiometer was used. The MAICO MA42 audiometer delivers test frequencies from 125 Hz to 20 KHz, with intensity levels from
10 dBHL to 120 dBHL. For degree of hearing loss, the following scale was used: minimal > 16 to 25 dB; mild > 25 to 40 dB; moderate > 40 to 55 dB; moderate to severe > 55 to 70 dB; severe > 70 to 90 dB; and profound > 90 dB hearing loss The data analysis was done with the help of the statistical software SPSS version 25 (IBM Corp., Armonk, NY, USA). The data was summarized using descriptive statistics, frequencies, and percentage. Statistical differences between categorical variables were assessed using the Chi-square test. A p-value < 0.05 was considered statistically significant. Results Fifty-two patients (male: female 28:24) were included in the study. The clinico-epidemiological profile of vitiligo International Archives of Otorhinolaryngology Vol. 24 No. 2/2020 Table 1 Sensorineural hearing loss in relation to age, age of onset, gender, vitiligo type and site of onset Age group Number of cases with SNHL (%) Number of cases without SNHL (%) 1–20 years 1 (5. (...truncated)