Audiovestibular symptoms in systemic sclerosis: a systematic review and meta-analysis

Purpose Answer the following PICO question: Are patients diagnosed with systemic sclerosis (SSc) (Population) who are evaluated clinically and audiometrically (Intervention), have a higher prevalence of audiovestibular pathology when compared with non-SSc patients (Comparison), and how do they present symptomatically and on testing audiovestibular symptomatology and testing modalities (Outcome)? Methods A systematic review and meta-analysis was performed. PubMed, Scopus, CINAHL, and Cochrane Library databases were searched from inception to November 27, 2023. Studies of patients diagnosed with SSc and audiologic and vestibular symptoms were selected for review. Studies of non-SSc pathologies, studies without audiovestibular outcomes, and case reports (fewer than four patients) were excluded. A meta-analysis of proportions and comparison of weighted proportions was performed in MedCalc 20.217. Results Thirteen studies with 414 SSc patients and 390 control patients were included. The mean +/- SD symptom duration was 108.5 +/- 71.8 (range: 6-600) months for SSc patients. Comparison of proportions showed patients with SSc were significantly more burdened with symptoms of tinnitus (Delta 34.1% [95% CI, 27.6-40.5]; p < 0.0001), vertigo (Delta 32.4% [95% CI, 24.8-40.3]; p < 0.0001), and subjective hearing loss (Delta 26.0% [95% CI, 20.8-31.3]; p < 0.0001) compared to control patients. Findings regarding vestibular testing were not meta-analyzable because of incomplete data and lack of standard reporting. Conclusion SSc patients showed statistically significant, yet not clinically significant, worse hearing than controls. These differences, along with increased reports of subjective audiological and vestibular symptoms in patients with SSc, emphasize interdisciplinary collaboration and assessment of SSc for audiovestibular pathologies in the appropriate clinical context.