**Author details**

*An Overview and Management of Multiple Chronic Conditions*

risk factor for sudden SNHL in psoriasis patients by Yen et al. [12]. In addition, it has been suggested that the correlation between high PASI scores and hearing loss at medium and high frequencies may be related to the increase of the mediators responsible for psoriatic disease to high levels in exacerbation periods [14, 22, 25]. However, in most studies, no relationship was found between the duration of psoriatic disease, clinical patterns of psoriasis, medical treatments and patient age, and hearing loss and/or audiovestibular dysfunction [14–17, 19, 21, 24, 25]. In studies demonstrating significant hearing loss in psoriasis patients, accompanying joint involvement was observed in 5.8% to 51.9% of them [14, 21, 22]. It has been mentioned that the presence of joint involvement in patients with psoriasis may lead to a more chronic inflammatory process and so adversely affect hearing [25]. Indeed, studies evaluating the hearing of psoriasis patients have different results, but it has been reported that hearing was adversely affected in all studies examining patients with PsA [15, 16, 18, 20]. It has been stated that PsA, which condition facilitates additional bone formation, can disrupt outer hair cell integrity through the forma-

tion of autoimmune-mediated fibro-osseous deposits in the cochlea [16].

The main treatment for autoimmune inner ear disease is by corticosteroids, and significant improvement of hearing impairment has also been reported in previous PsA cases following steroid administration [27–29]. Moreover, promising advances have been performed in the treatment of immune-mediated inner ear disease with various TNF-α inhibitors (etanercept, infliximab, golimumab; as used in other underlying autoimmune diseases or as form of local intratimpanic infusion), demonstrating them to be effective in reducing inflammation and hearing loss in cochlear diseases [44, 51]. Nonetheless, if hearing loss still occurs, cochlear implantation is a safe and effective method for the auditory rehabilitation of severe SNHL [44, 52]. However, flap complications are more common in cases such as psoriasis, where the risk of surgical site infection is higher than normal patients. It has been beneficial to add perioperative antipsoriatic topical agents and/or UVB phototherapy to standard infection prophylaxis in terms of reducing postoperative

The relationship between psoriasis/PsA and audiovestibular dysfunction supports the need for further studies aimed at better identification of the underlying pathogenic mechanisms, and accordingly to update diagnostic and even treatment approaches. It is well known by most dermatologists that psoriasis is a lifelong multisystemic chronic inflammatory disease rather than just a skin and/or joint condition. It should also be remembered that psoriatic disease, which has become the target of modern biological treatments today, is often accompanied by certain comorbidities such as metabolic syndrome, cardiovascular disease and obesity. For this reason, psoriasis and its associations should be approached in an integrated manner as well as related physicians should be in regular coordination with specialists in a special multidisciplinary team. However, it is obvious that physicians, especially dermatologists and rheumatologists, need to be more aware of the prevalence of hearing loss in psoriasis patients. It should be kept in mind that subclinical SNHL is a neglected but an important comorbidity in patients with psoriasis and PsA. Psoriatic patients, particularly with severe clinical symptoms, arthropathy, obesity, hypertension and metabolic syndrome, should be followed up with regular audiometric tests even if there is no subjective hearing complaint. In fact, regardless of clinical severity or type of psoriasis, evaluation of all psoriatic patients for the audiovestibular perspective would be more useful for the future quality of life

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infection and sequelae [52].

**4. Conclusion**

Sevgi Akarsu Department of Dermatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

\*Address all correspondence to: sevgi.akarsu@deu.edu.tr

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
