Audiometric evaluation of bone conduction thresholds reveals subclinical sensorineural hearing loss in patients with ankylosing spondylitis and psoriatic arthritis

• Bone conduction thresholds were higher in AS and PsA vs. healthy controls. • Hearing loss may indicate subclinical cochlear involvement in SpA. • No significant difference was found between AS and PsA thresholds. • No consistent link between hearing thresholds and disease activity was seen. • Routine hearing tests may be needed in SpA, even without symptoms. Hearing Loss (HL) has been increasingly recognized as a potential extra-articular manifestation in systemic autoimmune diseases, yet data on audiological involvement in Spondyloarthritis (SpA), particularly Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA), remain limited. This study aimed to evaluate bone conduction hearing thresholds in patients with AS and PsA compared to Healthy Controls (HC) and to investigate associations with clinical and inflammatory parameters. In this retrospective cross-sectional study, Pure Tone Audiometry (PTA) was used to assess bone conduction thresholds in 53 patients with AS, 53 with PsA, and 53 age- and sex-matched HCs. Associations between hearing thresholds and clinical features, disease activity indices, comorbidities, and HLA-B27 status were analyzed. Mean bone conduction thresholds were significantly higher in AS (14.85 ± 3.78 dB) and PsA (15.53 ± 9.37 dB) groups compared to controls (9.23 ± 3.42 dB, p < 0.001). In the overall cohort, hearing thresholds correlated with patient global assessment (rho = 0.307, p = 0.001), physician global assessment (rho = 0.280, p = 0.002), BASDAI (rho = 0.222, p = 0.017), ASQoL (rho = 0.304, p = 0.001), disease onset age (rho = 0.216, p = 0.020), and BMI (rho = 0.246, p = 0.008). Within disease groups, no consistent correlation was found between hearing thresholds and conventional disease activity scores. Subclinical sensorineural hearing impairment may be an underrecognized extra-articular feature of AS and PsA. Routine audiological assessment should be considered, especially in patients with long-standing disease, metabolic comorbidities, or subjective auditory complaints. 3.