Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton that can also involve extra-articular structures. Chronic inflammation, ossicular fixation, and immune-mediated inner ear injury have all been proposed as mechanisms by which AS may affect hearing, yet audiological involvement often remains subclinical and under-recognised.

Objective: To determine the prevalence, type, and severity of hearing loss among patients with ankylosing spondylitis and to study its distribution with respect to age, sex, and disease duration.

Methods: This cross-sectional study was conducted over one year (June 2021 to May 2022) in the Departments of Rheumatology and Otorhinolaryngology and Head-Neck Surgery of a tertiary care institute. A hundred clinically or radiologically confirmed cases of AS, aged 20 to 60 years, were enrolled after excluding patients with congenital hearing loss, anatomical head-and-neck abnormality, middle-ear disease or surgery, ototoxic drug or radiation exposure, and diabetes mellitus. All patients underwent detailed history taking, otoscopic examination, pure tone audiometry, and tympanometry.

Results: Hearing loss was detected in 43 of 100 patients (43%), comprising 36 of 89 males (40.4%) and 7 of 11 females (63.6%). Sensorineural hearing loss (SNHL) was the predominant type, affecting the majority of involved ears, followed by conductive hearing loss (CHL) and a small proportion of mixed loss. Bilateral involvement (24 patients) was more common than unilateral involvement (19 patients). Hearing loss was mild in the majority of affected patients (34/43), moderate in 7, and severe in 2. Both the prevalence and severity of hearing loss increased with advancing age and with longer duration of AS. Only 29 of the 43 patients with audiometrically confirmed hearing loss reported subjective hearing symptoms.

Conclusion: Nearly half of the patients with ankylosing spondylitis in this cohort had audiometrically detectable hearing loss, predominantly sensorineural, mild in degree, and frequently asymptomatic. These findings support routine audiological screening in patients with AS, particularly those with longer disease duration, to enable early detection and management.

KEYWORDS: Ankylosing Spondylitis, Hearing Loss, Sensorineural Hearing Loss, Audiometry, Extra-articular Manifestation.