Importance Vogt-Koyanagi-Harada disease (VKH) is a severe ocular disorder with multi-organ affection including the ear. Few studies have evaluated otolaryngologic manifestations. Current classification criteria of uveitis only includes tinnitus and disacusis.

Objective To describe audiological and vestibular findings of VKH in Chile, and determine correlations with disease activity.

Design Cross sectional study of Chilean patients with VKH.

Setting Patients assessed between 2018 and 2021 with demographics, ophthalmologic, audiological and otolithic evaluations.

Participants Subjects accomplishing VKH diagnostic criteria of the International Nomenclature Committee in Uveitis recruited in a referral academic center in Santiago, Chile.

Main Outcome and Measures Primary outcome was the correlation between VKH activity and neurotologic symptoms. Demographics, symptoms and signs were assessed by structured survey and physical examination. Disability was assessed by DHI and HIIE-S. Neuro-otologic diagnostics tests were cVEMP, audiogram, suprathreshold click ABR, MLAEP, and DPOAE. Complete case correlation analysis was performed.

Results 54 patients were evaluated. 65% reported ear symptoms at disease presentation. 32% of ear symptoms started synchronically and 30% started before eye symptoms. Ear and vestibular symptoms produced predominantly mild disability. The history of nausea, falls or hyperacusis during presentation correlated with disease activity at study evaluation. Hyperacusis at evaluation correlated with active or chronic-recurrent VKH. Neurotologic tests revealed mild ear impairment and few correlations with eye disease.

Conclusions Otolaryngology features are frequent in VKH and may precede eye disease. Hyperacusis at evaluation may indicate current or persistent ocular disease. A broader spectrum of neurotologic symptoms must be considered in current classification of uveitis.

Question Are there characteristic findings in the hearing and otolithic function of patients with Vogt-Koyanagi-Harada disease (VKH), and do they correlate to the eye disease activity?

Findings In a cross sectional study of 54 patients with VKH, a high frequency of neuro-otologic manifestations, and some associations to activity, chronicity and recurrence of VKH were found. Importantly, some of the ear symptoms may precede VKH diagnosis.

Meaning VKH has neurotologic features that can aid diagnosis and staging of the disease. Thus, physicians must be aware of these manifestations.

The authors have declared no competing interest.

This research work was supported by Fundacion Guillermo Puelma to J.M. and P.D., the National Agency for Research and Development of Chile (ANID), FONDECYT 1220607, and ANID - Basal Project AFB240002 to P.D., FONDECYT grants 1212038 to C.U., 11191215 to L.C. and 3220781 to F.V.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Comite de etica asitencial del Hospital Clinico de la Universidad de Chile, Hospital Clinico Universidad de Chile, Facultad de Medicina, Universidad de Chile, approved protocol number 1019/19

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All data produced in the present study are available upon reasonable request to the authors