E016 Erosive psoriatic arthritis causing deafness
Authors: Coulton Alice K , Gubbins William R , Young-Min Steven 
Published: April 2023

Abstract

Background/Aims
Hearing loss from systemic psoriatic disease is rare, and cases reported in the literature have been reported with sensorineural deficits. Conductive hearing loss due to psoriatic arthritis has not been specifically reported in the literature, and this is believed to be the first reported case of erosive psoriatic arthritis causing conductive hearing loss. Presented is an illustrated case of a patient complaining of worsening bilateral hearing loss who underwent investigations under otolaryngology and audiology, and subsequent CT imaging which identified erosion of the temporal bone, posterior to the left temporomandibular joint, resulting in subluxation into the external auditory canal leading to complete occlusion of the canal.

Methods
58yo female with psoriatic arthritis, psoriasis, and Raynaud’s phenomenon presenting with an 18-month history of hearing loss, worst on the left, but with some improvement on mouth opening. Treatment of her psoriatic arthritis has been with Ixekizumab since July 2021 with good overall disease control. Previous DMARD therapy includes methotrexate, sulfasalazine, and hydroxychloroquine, and previous biologic therapy of adalimumab and secukinumab. She had undergone bilateral reshaping of the mandibular condyle & fossa 20 years ago for presumed degenerative arthropathy that was non-responsive to conservative management; further details of the surgery will be presented.

Results
Patient was referred to audiology and otolaryngology who noted significant narrowing of both ear canals on examination. Audiological investigations revealed a right sided sensorineural hearing loss, and mixed pattern of hearing loss on the left. The patient proceeded to have skull vault imaging to assess for a structural cause of her left sided hearing loss. The finding of the CT petrous bones revealed soft tissue swelling associated with erosion of the anterior wall of the temporal and mandibular bones, causing subluxation and mass effect into the external auditory canal with no other cause for left-sided hearing loss demonstrated. Interestingly her hearing improved slightly with jaw opening and dynamic MRI may be indicated if surgical intervention is an option.

Conclusion
Our patient has a mixed hearing loss. The specific cause of the sensorineural component in our patient is not known but sensorineural loss has been reported in patients with psoriatic disease. The pathogenesis of psoriasis associated sensorineural hearing loss remains unclear however emerging evidence may implicate the downregulation of gap junction beta-2 protein encoding connexin 26 an integral cell signalling gap protein. We believe this is the first reported case where conductive hearing loss has resulted from a direct result of psoriatic arthritis from erosive temporomandibular joint disease leading to mass effect on the audio vestibular anatomy. It is a stark reminder of the consequences of erosive disease and the importance of surveillance of temporomandibular joint function in psoriatic arthritis patients given this rare but potential complication.
Disclosure
A.K. Coulton: None. W.R. Gubbins: None. S. Young-Min: None.