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Hearing Loss in Systemic Lupus Erythematosus: a Systematic Review
Yara Hanna1, Mohamad Tlais1, Dania Natour2
1Faculty of Medicine, University of Balamand, Beirut, Lebanon.
Maedica
|April 14, 2026
Summary
Systemic lupus erythematosus (SLE) often causes hearing loss through autoimmune issues, vascular problems, or medication side effects. Early detection and management are key to preventing permanent hearing impairment in SLE patients.
Area of Science:
- Rheumatology
- Otolaryngology
- Pathology
Background:
- Hearing loss is an underrecognized complication of systemic lupus erythematosus (SLE).
- Potential causes include autoimmune inner ear damage, antiphospholipid syndrome (APS)-related vascular occlusion, and medication ototoxicity (e.g., hydroxychloroquine).
- The full extent and clinical impact of hearing loss in SLE remain unclear.
Purpose of the Study:
- To systematically review and synthesize the current evidence on the prevalence, clinical presentation, pathophysiology, and management of hearing loss in patients with SLE.
Main Methods:
- A comprehensive systematic review of multiple databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library) was performed up to September 2025, adhering to PRISMA guidelines.
- Included studies encompassed various designs: cohort, case-control, cross-sectional, case series, case reports, and temporal bone analyses.
- Data extraction focused on auditory outcomes, prevalence, clinical features, underlying mechanisms, and treatment strategies, with rigorous risk of bias assessment.
Main Results:
- Ten studies were included, revealing a significant prevalence of sensorineural hearing loss in SLE patients, ranging from approximately 27% to 56% with advanced audiometry.
- Pathological findings in SLE patients included vasculitis, stria vascularis atrophy, and hair cell loss.
- Sudden hearing loss was frequently associated with antiphospholipid antibodies, suggesting a vascular mechanism, while hydroxychloroquine ototoxicity was less consistently observed in larger studies.
Conclusions:
- Hearing loss in SLE is multifactorial and more common than in the general population.
- Prompt diagnosis and individualized treatment, including corticosteroids, anticoagulation for APS, and drug review, can improve patient outcomes.
- Regular audiological monitoring is recommended to mitigate the risk of irreversible hearing loss and disability.
