Gout with hearing loss
Rheumatology and Immunology Research
Gout is regarded as an autoinflammatory disease induced by the deposition of monosodium urate crystals in the synovial fluid and periarticular tissues. It is characterized by joint symptoms and uric acid nephropathy, as well as other organs involved due to inflammation. Here, we presented a rare case of gout with hearing loss. A 26-year-old Chinese man presented to the Otolaryngology Department with a 1-year history of bilateral ears hearing loss. He had no history of ear injury, fever, rash,
... adache, nasitis, red eyes, hypertension, and diabetes, and denied exposure to loud noise or ototoxic drugs. Otoscopic examination showed that eardrums were normal. Enhanced magnetic resonance imaging (MRI) scanning detected no abnormalities of inner acoustic meatus or intracranial space-occupying lesion. Auditory brainstem responses (ABR) indicated that the right threshold was increased to 50, and the latency of left V wave and left I-V waves interval were slightly prolonged. Pure tone audiometry (PTA) demonstrated elevated thresholds of 35 dB at 8 kHz in the left ear, while 75 dB and 55 dB at 4 kHz and 8 kHz in the right ear, respectively. Testing for distortion product otoacoustic emissions (DPOAE) found abnormal otoacoustic emissions in the 6-8 kHz frequency of the left ear, and in the 4 kHz and 6-8 kHz frequency of the right ear. He was diagnosed with nerve deafness by the otolaryngologist. Meanwhile, we learned that he had a 3-year history of gout. The right first metatarsophalangeal joint was hurt once; the symptom alleviated voluntarily. Annual follow up showed that serum uric acid increased but without any treatment. Physical examination showed no joint swelling and tenderness, and no ectopic tophus. Laboratory findings showed an increased serum uric acid of 730 mmol/L. Complete blood count, liver and kidney function, C-reactive protein, and erythrocyte sedimentation rate were normal, while anti-nuclear antibodies and antineutrophil cytoplasmic antibodies were negative, and renal ultrasound showed no abnormality. Based on the clinical manifestations and laboratory results, he was diagnosed as gout complicated with nerve deafness. After 3 months of allopurinol monotherapy (100 mg, thrice a day), he had no arthritis and the serum uric acid level was decreased to 362 mmol/L. Intriguingly, his symptom of hearing loss was obviously relieved. Meanwhile, the results of ABR followup was improved with normalization of waves, but PTA and DPOAE results showed no remarkable changes.