Restless Legs Syndrome Does Not Cause Hearing Distortion
No, Restless Legs Syndrome (RLS) cannot cause hearing distortion or impair speech comprehension. RLS is exclusively a sensorimotor disorder affecting the limbs, with no established connection to auditory processing or hearing function.
Core Clinical Features of RLS
The diagnostic criteria for RLS are highly specific and do not include any auditory symptoms 1:
- An urge to move the legs usually accompanied by uncomfortable sensations in the legs
- Symptoms worsen with rest or inactivity such as lying down or sitting
- Relief with movement such as walking or stretching
- Circadian pattern with symptoms worse in evening/night than during the day
- No other medical condition accounts for the symptoms 1
Why This Patient Needs Alternative Evaluation
If your patient is experiencing hearing distortion severe enough to impair speech comprehension, you must evaluate for actual auditory pathology, not RLS. This symptom warrants urgent assessment for sudden sensorineural hearing loss (SSNHL) or other otologic conditions 1.
Critical Differential Diagnosis
The hearing distortion described requires immediate consideration of:
- Sudden sensorineural hearing loss - This is a medical emergency requiring evaluation within 2 weeks of symptom onset, with audiometry as the essential diagnostic test 1
- Tinnitus - While nearly universal in SSNHL, tinnitus presents as ringing or buzzing, not speech distortion that impairs comprehension 1
- Vestibular schwannoma - Can cause progressive hearing loss and may require MRI screening 1
RLS-Associated Symptoms Are Limited
RLS causes significant morbidity, but exclusively through:
- Sleep disruption from the need to move legs or walk at night 2, 3
- Periodic limb movements during sleep in roughly 90% of patients 2, 4
- Secondary effects including poor quality of life, depression, anxiety, and cardiovascular disease risk 5, 3
None of these mechanisms involve auditory processing or hearing distortion 6, 4, 7.
Common Clinical Pitfall
The most important caveat here is not to attribute unrelated symptoms to a known diagnosis. RLS mimics include leg cramps, positional discomfort, arthritis, and neuropathy - all musculoskeletal or neurological conditions affecting the limbs 1. Hearing distortion has never been described as a mimic, associated symptom, or comorbidity of RLS in any validated diagnostic instrument 1.
What to Do Instead
Obtain audiometry immediately if the patient reports hearing distortion affecting speech comprehension 1. The American Academy of Otolaryngology-Head and Neck Surgery recommends that sudden hearing loss be evaluated as quickly as possible, as approximately one-third to two-thirds of patients may recover hearing within 2 weeks, but those with minimal change in the first 2 weeks are unlikely to show significant recovery 1.
If the patient has both confirmed RLS and new-onset hearing symptoms, these are separate, unrelated conditions requiring independent evaluation and management 1, 3.