Audio-vestibular abnormalities in patients with rosacea: a prospective case-control study

Rosacea is a chronic inflammatory dermatosis characterized by neurovascular dysregulation and systemic inflammatory features that may extend beyond the skin and potentially affect highly vulnerable sensory organs such as the inner ear. To investigate audiologic and vestibular functions in patients with rosacea and to explore whether subclinical alterations may be detected compared with healthy controls.

In this prospective, age- and sex-matched case-control study, 53 patients with rosacea and 58 healthy controls were enrolled. All participants underwent pure-tone audiometry and the Video Head Impulse Test (vHIT). Disease severity, disease duration, sex, Demodex mite count, and rosacea subtypes were recorded. Data were analyzed using appropriate statistical tests.

Compared with controls, patients with rosacea had significantly higher air-conduction thresholds in both ears (left: p < 0.001; right: p < 0.001). In contrast, bone-conduction thresholds did not show clinically meaningful between-group differences; the small numerical difference observed for the left ear was not statistically significant (p = 0.084), and right bone-conduction thresholds were similar between groups (p = 0.331). On vHIT, vestibulo-ocular reflex (VOR) gains were significantly reduced in the left anterior (p < 0.001) and right posterior (p = 0.001) semicircular canals in the rosacea group. No significant associations were identified between vestibular parameters and disease severity, disease duration, Demodex count, rosacea subtype, or sex.

These findings suggest that patients with rosacea may exhibit subtle audiologic and vestibular functional differences compared with healthy individuals. However, given the case-control design and the limited magnitude of the observed differences, these results should be interpreted cautiously, and audiovestibular evaluation may be considered primarily in symptomatic patients or selected subgroups rather than as a routine screening approach.