Hearing Assessment in Patients with Allergic Rhinitis: A Hospital-Based Study of Auditory Dysfunction and Its Reversibility after Eight Weeks of Standard Pharmacotherapy

Abstract

Background: Allergic rhinitis (AR) is an IgE-mediated inflammatory disorder of the nasal mucosa. The anatomical and functional continuity between the nasal cavity, nasopharynx, Eustachian tube and middle ear provides a plausible route by which nasal inflammation may compromise auditory function, yet hearing is seldom assessed during routine management of AR.

Objectives: To characterise auditory function in adults with AR, to examine whether nasal symptom severity and disease duration relate to audiological abnormality, and to determine whether audiological measures change after eight weeks of standard pharmacotherapy.

Methods: A hospital-based, prospective, single-arm observational study enrolled 150 adults aged 18–65 years with AR diagnosed according to ARIA criteria. Baseline assessment comprised history, otorhinolaryngological examination, otoscopy, tuning fork tests, pure tone audiometry (PTA) at 0.5–8 kHz, 226 Hz tympanometry and distortion product otoacoustic emissions (DPOAE). Symptom burden was quantified with the Total Nasal Symptom Score (TNSS) and disease control with the Rhinitis Control Assessment Test (RCAT). All participants received an intranasal corticosteroid, an oral antihistamine and a leukotriene receptor antagonist for eight weeks, after which every assessment was repeated. Paired t-tests, McNemar and McNemar–Bowker tests, the chi-square test and Pearson correlation were applied, with p < 0.05 taken as significant.

Results: Mean age was 31.8 ± 9.3 years, 56.7% were male, 64.0% had persistent AR and mean TNSS was 8.7 ± 1.9. At baseline, some degree of hearing loss was present in 58/150 (38.7%) right and 62/150 (41.3%) left ears; conductive loss predominated (22.7% and 25.3%), with sensorineural loss in 12.0% and 13.3%. Type C tympanograms were recorded in 23.3% of ears in each side and type B in 13.3% and 14.7%. After treatment, the proportion of ears with normal thresholds rose from 61.3% to 80.7% on the right and from 58.7% to 78.0% on the left (p = 0.01). Threshold gains were largest at 500 Hz (6.1 dB right, 6.2 dB left; p = 0.01) and absent at 8 kHz (1.1 dB; p = 0.17 and 0.19). Type A tympanograms increased to 75.3% and 72.7%, and DPOAE pass rates rose from 67.3% to 80.7% (p = 0.02) and from 64.7% to 78.7% (p = 0.03). The reduction in TNSS correlated modestly with PTA improvement (r = +0.39, p = 0.02 right; r = +0.36, p = 0.03 left). Baseline hearing loss increased with AR duration (p = 0.03 right, p = 0.04 left).

Conclusion: Approximately two in five ears of adults with AR showed measurable hearing loss, predominantly conductive and frequency-weighted towards the lower frequencies, and largely reversible with eight weeks of anti-inflammatory therapy. A smaller, high-frequency component persisted. Audiological screening is warranted in patients with persistent or long-standing AR, and the absence of a control arm means that the observed improvement should be confirmed in a controlled study.