Rheumatoid arthritis can cause hearing loss, and it does so more often than most people realize. Studies estimate that hearing loss in some form affects more than 60% of RA patients, with some research placing the number as high as 71%. The most common type is sensorineural hearing loss, meaning it originates in the inner ear rather than the ear canal or eardrum, and it tends to affect higher-pitched sounds first.
How RA Damages the Inner Ear
The same inflammatory process that attacks your joints can reach your ears through two distinct pathways, each causing a different type of hearing loss.
The first and more common pathway involves the inner ear, specifically the cochlea. In RA, the immune system produces inflammatory molecules, particularly ones called TNF-alpha and IL-1 beta, that circulate throughout the body. When these reach the inner ear, they trigger an influx of inflammatory cells that enter the cochlea through tiny blood vessels. This creates a cascade of damage to the delicate structures that convert sound vibrations into nerve signals. The result is sensorineural hearing loss, which accounts for 25% to 80% of hearing impairment in RA patients depending on the study. Because the inner ear’s high-frequency sensing cells are especially vulnerable, you may first notice difficulty hearing higher-pitched voices or sounds.
The second pathway involves the middle ear, where three tiny bones (the malleus, incus, and stapes) are connected by small joints. These joints are true synovial joints, the same type RA targets in your fingers and knees. Research using high-resolution imaging in animal models has shown that RA-related inflammation narrows the joint space between the incus and stapes by more than half. It also creates hundreds of tiny pores in the stapes bone itself, occupying about 12% of the bone’s volume compared to less than 1% in healthy ears. This structural damage interferes with the bones’ ability to transmit sound vibrations from the eardrum to the inner ear, producing conductive hearing loss. This type is less common but can occur alongside sensorineural loss, resulting in mixed hearing loss.
What It Feels Like
RA-related hearing loss usually develops gradually, which makes it easy to overlook or attribute to aging. The earliest signs often include difficulty following conversations in noisy environments, needing to turn the TV volume higher than usual, or a sense of muffled sound. Tinnitus, a persistent ringing or buzzing in the ears, is another common early symptom. Some people also describe a feeling of fullness or pressure in the ear.
In rare cases, the onset can be sudden. Case reports document RA patients experiencing rapid sensorineural hearing loss accompanied by tinnitus, sometimes in one ear, sometimes both. Sudden hearing changes like these are worth treating as urgent, since early intervention with anti-inflammatory treatment can sometimes reverse the damage before it becomes permanent.
The Role of RA Medications
This is where things get complicated: some RA medications may contribute to hearing problems, while others may actually protect against them.
High-dose aspirin and other NSAIDs, commonly used for RA pain, can cause mild to moderate temporary hearing loss at high doses, typically affecting higher frequencies and often accompanied by tinnitus. This effect is generally reversible once the dose is lowered or the medication is stopped.
Hydroxychloroquine, a widely used disease-modifying drug, has been linked to reversible sensorineural hearing loss in at least one documented case, where a 34-year-old woman developed hearing changes after five months of treatment. The related drug chloroquine has a more established record of ototoxicity. That said, conclusive evidence on the hearing risks of most RA medications remains limited.
On the other side of the equation, some biologic therapies appear to help. Infliximab, a TNF blocker, does not appear to harm inner-ear function in RA patients and has shown benefits for hearing in autoimmune hearing loss. Adalimumab, another anti-TNF drug, has demonstrated effectiveness in managing sensorineural hearing loss that didn’t respond to steroids. Etanercept has shown improvements in hearing function and tinnitus in patients with immune-related inner ear disorders. The logic is straightforward: if inflammation is driving the hearing loss, then medications that effectively suppress that inflammation may slow or even partially reverse the damage.
Why Hearing Tests Matter for RA Patients
Because RA-related hearing loss tends to creep in gradually and primarily affects high frequencies first, many people don’t notice it until it has progressed significantly. A baseline hearing test (audiogram) at the time of RA diagnosis gives you and your care team a reference point for tracking changes over time. This is especially useful for distinguishing between hearing loss caused by the disease itself and hearing loss that might be a side effect of medication.
If you have RA and notice any changes in your hearing, even subtle ones like increased difficulty with phone conversations or new tinnitus, an audiological evaluation can identify the type of hearing loss involved. Sensorineural, conductive, and mixed hearing loss each point to different underlying causes and respond to different approaches. Catching changes early gives you the widest range of options, from adjusting medications to hearing aids to more targeted anti-inflammatory treatment.
Managing RA-Related Hearing Loss
The most effective strategy is keeping RA inflammation well controlled. Poorly managed disease activity means more systemic inflammation reaching the inner and middle ear. Patients whose RA is in remission or low disease activity generally have better hearing outcomes than those with active, uncontrolled inflammation.
For hearing loss driven by the autoimmune process itself, biologic therapies that target TNF-alpha have shown the most promise. These drugs reduce the inflammatory signaling that damages cochlear structures, and several studies suggest they can stabilize or improve hearing when used at adequate doses.
If medication-related ototoxicity is suspected, the fix is often straightforward. High-dose NSAID-related hearing changes are typically temporary and resolve with dose adjustment. Hydroxychloroquine-related hearing loss in the documented case was also reversible after stopping the drug. Monitoring hearing during treatment helps catch these effects before they become entrenched.
For hearing loss that has already become permanent, hearing aids remain effective. The high-frequency pattern typical of RA-related sensorineural loss responds well to modern hearing aids that can be programmed to amplify specific frequency ranges where your loss is greatest.