Otologic Manifestations of Psoriasis: A Systematic Review and Meta-Analysis

Psoriatic skin lesions are often seen in the auricle and external auditory canal, but middle ear and inner ear manifestations are not easily identified. Several studies have indicated hearing loss and vestibular dysfunction with psoriasis, but the extent of association has not been well defined.

A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies described audiometric or vestibular assessment of psoriasis patients. Meta-analysis was represented with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals.

A total of 13 studies with 589 psoriasis patients and 617 healthy controls were included. Age did not significantly differ between psoriasis patients (47.1 [12.4] yr) and healthy controls (45.4 [11.2] yr). Psoriasis area and severity index score was 9.9 (8.4), and body surface area scores was 7.9 (14.7). Pure-tone audiometry analysis showed higher mean hearing thresholds in psoriasis patients compared with healthy controls across all frequencies, with the greatest difference at 4000 Hz (MD, 7.70 [4.46-10.94]; p < 0.00001). Speech reception thresholds were worse with psoriasis (MD, 3.53 [1.56-5.49]; p < 0.0001). Abnormal stapedial reflex was more common in psoriasis (OR, 5.19 [1.68-15.99]; p = 0.004). Abnormal vestibular testing was more common in psoriasis for caloric testing (OR, 13.12 [2.88-59.84]; p < 0.0001). Two additional studies of 41,681 psoriasis patients and 80,273 healthy controls found that psoriasis patients were at higher risk for sudden sensorineural hearing loss (OR, 1.50 [1.25-1.80]; p < 0.0001).

Our study shows that psoriasis is associated with hearing loss and vestibular dysfunction, but clinical significance remains undefined. The trends noted in our study require more investigation, and the pathophysiologic mechanisms need to be defined.