الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
It is not uncommon to encounter audio-vestibular symptoms in people with systemic autoimmune disorders. Many theories have been proposed in order to get at an appropriate understanding of pathophysiology and mechanisms underlying this presentation. Different tools, such as pure tone audiometry (PTA), speech reception threshold (SRT), acoustic reflex. Different approaches such as, visual head impulse test (VHIT), nystagmography can be used to test the vestibular system.
The aim of our study was to evaluate the audio-vestibular functions in various autoimmune diseases and to reach the relationship between those functions and different diseases parameters.
The current study included forty nine patients (16 with rheumatoid arthritis (RA), 18 with systemic lupus erythematosus (SLE) and 15 with behcet´s disease (BD). To serve as controls, 15 healthy individuals with matched age and gender were recruited to serves as controls.
All patients were subjected to full history taking, clinical examination, pure tone audiometry (PTA), tympanometry, speech reception threshold test (SRT) and examination for acoustic reflex were done for audiological evaluation and visual head impulse test (VHIT) for vestibular assessment.
The present study detected hearing loss in 51.1% of patients of all types and degrees based on PTA and other auditory tools. However, vestibular functions were not found to be affected in patients. Significant statistical difference was found between patients and healthy controls regarding hearing loss and affection through all frequencies.
There was significant correlation between disease duration and high frequency hearing loss (8000 HZ) bilaterally in patients group (P-value=0.049,0.048 in right and left ear respectively).
Among rheumatoid arthritis patients significant positive correlation was found between disease duration and hearing affection at high frequencies 4000, 8000 HZ with (p = 0.048 and 0.020) in right side and at frequency of 2000HZ and 8000HZ (p=0.050 and 0.004) in left side respectively. Significant positive clinical correlation was found between DAS28_ESR with hearing affection at frequency of 250 HZ in right ear (p=0.047) and 8000 HZ in left ear (p= 0.041).
Significant positive clinical correlation was found between ESR levels with hearing affection at frequency of 250,500 and 8000 HZ in right ear (p=0.002,0.009 and 0.008 respectively) and at frequency of 4000 and 8000 HZ in left ear (p= 0.036 and 0.007 respectively). Significant positive clinical correlation was found between CRP levels with hearing affection in left ear at frequency of 250 Hz (p=0.037) in rheumatoid arthritis patients.
Among SLE patients, disease duration was significantly correlated positively with hearing loss bilaterally at frequencies of 1000, 2000 and 8000 HZ (p=0.004, 0.004, 0.052) respectively in right side and at frequency of 4000 HZ (p=0.019). However, there was not any association between hearing loss in SLE patients and any other disease activity indices
Hearing affection did not correlate bilaterally and through all frequencies with all activity domains including ocular, CNS affection, and major vessel affection also with BDCAF score, ESR or Disease duration among behcet´s disease patients.
Linear regression was done to the correlated data and revealed that disease duration is a predictor for occurrence of hearing loss at high frequencies (4000, 8000 HZ) (p=0.014, 0.046 )respectively. Moderate relationship was also found between disease duration and hearing loss at the same level (Adjusted R Square=0.608, 0.300 respectively).
In conclusion, audio-vestibular affection is a commonly associated with different autoimmune diseases which is mostly neglected and can impair patients activities a have a bad impact on his life quality.
We recommend to be alert to early development of auditory and vestibular symptoms and regular follow up with an audiologist to detect early cases and prevent more harm to the patient.