Vitiligo is known to be associated with sensorineural hearing loss (SNHL) in adults older than 50, and periorbital vitiligo has also been associated with ocular manifestations in this population. However, little was known about sensory abnormalities in pediatric vitiligo until now.

New research links pediatric vitiligo to SNHL and mixed hearing loss but not with ocular conditions, according to a study that appears in JAMA Dermatology.

For the study, researchers analyzed data from the TriNetX Research Network, which comprises electronic health records from 89 healthcare organizations in the United States. The study included 21,833 pediatric patients with vitiligo who had a mean age of diagnosis of 9.6. When compared with matched controls, patients with vitiligo had significantly higher risks of both SNHL and mixed hearing loss. There was no significant difference observed for conductive hearing loss between the groups.

SNHL risk increased after the first year of follow-up, while mixed hearing loss risk was elevated exclusively during the first year, the study showed.

Patients with vitiligo had an elevated risk of retinal and choroidal disorders (including chorioretinal inflammation, chorioretinal degeneration, retinal detachments and breaks, and other disorders of choroid and retina), but this significance disappeared during the sensitivity and time-stratified analyses. There were no significant differences found in risks of vision impairment, dry eye disease, uveitis, or glaucoma between pediatric vitiligo patients and controls.

Study author Anna Cristina Garza-Mayers, MD, PhD, a Pediatric Dermatologist at Seattle Children’s Hospital and an Assistant Professor at the University of Washington in Seattle, WA, talked to TDD about the new findings and their potential implications for practice.

TDD: What is the study’s main takeaway message?

Anna Cristina Garza-Mayers, MD, PhD: “Other studies have shown that vitiligo is associated with hearing loss in adults. This is a large retrospective cohort study across many institutions that found that pediatric vitiligo is associated with increased risks of sensorineural and mixed hearing loss. This study also examined ocular disorders and did not find an increased risk of vision impairment.”

TDD: How may pediatric vitiligo increase the risks of SNHL and mixed hearing loss?

Dr. Garza-Mayers: “Vitiligo is a disorder of depigmentation due to the loss of melanocytes that is thought to be autoimmune. Melanocytes are mostly found in the skin but are also located in the inner ear and in the eye. There is data to suggest that melanocytes in the ear regulate ion channels needed for hearing.”

TDD: What is the next step research-wise?

Dr. Garza-Mayers: “It will be important to validate these findings in other populations, for instance, in a prospective study.”

TDD: Should pediatric vitiligo patients have hearing evaluations?

Dr. Garza-Mayers: “Clinicians should maintain a high level of suspicion with a low threshold for referral for formal audiologic assessment in pediatric patients with vitiligo. There is no data to suggest when testing is most helpful; further study will be needed to determine this.”