1
|
Padoan R, Cazzador D, Pendolino AL, Felicetti M, De Pascalis S, Zanoletti E, Bovo R, Martini A, Schiavon F. Cogan’s syndrome: new therapeutic approaches in the biological era. Expert Opin Biol Ther 2019; 19:781-788. [DOI: 10.1080/14712598.2019.1611779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Alfonso Luca Pendolino
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Susanna De Pascalis
- Emergency Unit, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Elisabetta Zanoletti
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Roberto Bovo
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Alessandro Martini
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| |
Collapse
|
2
|
Mora P, Calzetti G, Ghirardini S, Rubino P, Gandolfi S, Orsoni J. Cogan's syndrome: State of the art of systemic immunosuppressive treatment in adult and pediatric patients. Autoimmun Rev 2017; 16:385-390. [DOI: 10.1016/j.autrev.2017.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022]
|
3
|
Cochlear implantation in patients with Cogan syndrome: long-term results. Eur Arch Otorhinolaryngol 2014; 272:3201-7. [PMID: 25367706 DOI: 10.1007/s00405-014-3376-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/25/2014] [Indexed: 10/24/2022]
Abstract
The objective of this study was to evaluate the long-term outcomes of patients with Cogan syndrome (CS) who have undergone cochlear implantation. Subjects consisted of 12 cochlear implant users with a typical form of CS. Measures included word and sentence recognition scores. The speech recognition performance was rated before cochlear implantation and at 1 and 5 years after implantation. The speech materials were presented in quiet only condition. The mean 12-month post-operative word and sentence recognition scores were 91.4 and 93.1%, respectively. Five years after implantation, the group means for word and sentence recognition tests were 94 and 96.3%, respectively. No patients in this series experienced flap complication or other local or systemic complications. This long-term study on 12 subjects with CS over 5 years of cochlear implant use reveals that cochlear implantation is safe in the long term and provides excellent and stable hearing results.
Collapse
|
4
|
Reiff A, Kadayifcilar S, Özen S. Rheumatic Inflammatory Eye Diseases of Childhood. Rheum Dis Clin North Am 2013; 39:801-32. [DOI: 10.1016/j.rdc.2013.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
5
|
Zenone T. Syndrome de Cogan. Presse Med 2013; 42:951-60. [DOI: 10.1016/j.lpm.2012.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/12/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022] Open
|
6
|
Pagnini I, Zannin ME, Vittadello F, Sari M, Simonini G, Cimaz R, Zulian F. Clinical features and outcome of Cogan syndrome. J Pediatr 2012; 160:303-307.e1. [PMID: 21920537 DOI: 10.1016/j.jpeds.2011.07.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To review the clinical features of Cogan syndrome, a rare vasculitis characterized by systemic, ocular, and audiovestibular symptoms. STUDY DESIGN Clinical records of patients with Cogan syndrome followed at 2 pediatric rheumatology institutions and those from a database search were reviewed. Data included clinical features at onset and during the disease course, treatments, and outcomes. RESULTS Twenty-three children with Cogan syndrome (15 males; mean age, 11.4 years [range, 4-18 years]) were included in the analysis. Eleven patients (47.8%) exhibited systemic features at disease onset, including fever, arthralgias-arthritis or myalgias, headache, and weight loss. Twenty-one patients (91.3%) had ocular symptoms, due mainly to interstitial keratitis, uveitis, or conjunctivitis/episcleritis. Vestibular symptoms (39.1%) included vertigo, vomiting, and dizziness. Auditory involvement (65.2%) consisted of sensorineural hearing loss, tinnitus, and deafness. Four patients had cardiac valve involvement, and 3 had skin manifestations. After a median 2 years of follow-up, 30.4% of the patients were in clinical remission, but all others had irreversible complications (deafness, 21.7%; sensorineural hearing loss, 13.0%; vestibular dysfunction, 4.3%; ocular complications, 13.0%; cardiac valve damage, 17.4%). CONCLUSION Audiovestibular and ocular involvement have a major impact on prognosis in children with Cogan syndrome.
Collapse
Affiliation(s)
- Ilaria Pagnini
- Department of Pediatrics, University of Florence, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
7
|
|
8
|
Kawamura S, Sakamoto T, Kashio A, Kakigi A, Ito K, Suzuki M, Yamasoba T. Cochlear implantation in a patient with atypical Cogan's syndrome complicated with hypertrophic cranial pachymeningitis. Auris Nasus Larynx 2010; 37:737-41. [DOI: 10.1016/j.anl.2010.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 04/11/2010] [Accepted: 04/20/2010] [Indexed: 11/29/2022]
|
9
|
Zulian F, Sari M, de Filippis C. Otolaryngological manifestations of rheumatic diseases in children. Int J Pediatr Otorhinolaryngol 2009; 73 Suppl 1:S56-60. [PMID: 20114157 DOI: 10.1016/s0165-5876(09)70011-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rheumatic diseases represent a group of autoimmune conditions which primarily affect the musculo-skeletal system but can also involve other internal organs such as the auditory and the respiratory systems. Among the rheumatic diseases of children those which present an otolaryngological involvement at disease onset or during their course are essentially juvenile idiopathic arthritis (JIA), Cogan syndrome (CS), relapsing polycondritis (RPC) and Wegener granulomatosis (WG). In this section, we will review the main characteristics of these conditions with the attempt to propose a few elements for an easy differential diagnosis which might help for an early diagnosis and a more appropriate treatment.
Collapse
|
10
|
Yaginuma A, Sakai T, Kohno H, Mitooka K, Kohzaki K, Tsuneoka H. A case of atypical Cogan’s syndrome with posterior scleritis and uveitis. Jpn J Ophthalmol 2009; 53:659-661. [DOI: 10.1007/s10384-009-0729-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/16/2009] [Indexed: 10/20/2022]
|
11
|
Hautefort C, Loundon N, Montchilova M, Marlin S, Garabedian EN, Ulinski T. Mycophenolate mofetil as a treatment of steroid dependent Cogan's syndrome in childhood. Int J Pediatr Otorhinolaryngol 2009; 73:1477-9. [PMID: 19656580 DOI: 10.1016/j.ijporl.2009.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 06/27/2009] [Indexed: 12/18/2022]
Abstract
Cogan's syndrome is a rare chronic inflammatory disorder which typically associates an ophthalmological and vestibulocochlear involvement, with a risk of systemic symptoms in 50-70% of cases. Autoimmune origin has been consolidated by the recent discoveries of Lunardi as a result of the dysregulation of the response of B and T lymphocytes. We report here a pediatric case of Cogan's syndrome, with long term follow-up and complete vestibulocochlear and ophthalmologic examination. During the acute phase, early steroids treatment (prednisone 1mg/kg per day) was effective on ocular lesions and hearing loss. The patient required high steroid doses to maintain remission, suggesting the necessity for steroid sparing immunosuppressive agents. We introduced mycophenolate mofetil (MMF), an immunosuppressive agent mainly used in solid organ transplantation. After steroid withdrawal the patient remained in complete remission on MMF. This is the first report of MMF treatment in Cogan's syndrome. MMF produces a targeted inhibition of the proliferation of B and T lymphocytes, particularly interesting in Cogan's syndrome. Low long term toxicity and overall good tolerance make MMF a new treatment option in steroid dependent Cogan's syndrome.
Collapse
Affiliation(s)
- Charlotte Hautefort
- Service d'ORL, de chirurgie cervico-faciale et d'audiophonologie de l'enfant, Hôpital d'Enfants Armand Trousseau, 26 av Dr. Arnold Netter, 75012 Paris, France.
| | | | | | | | | | | |
Collapse
|
12
|
Son HJ, Ulualp SO. Course of auditory impairment in Cogan's syndrome. Am J Otolaryngol 2009; 30:65-8. [PMID: 19027517 DOI: 10.1016/j.amjoto.2008.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 01/14/2008] [Accepted: 02/01/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE Cogan's syndrome (CS), characterized by interstitial keratitis, hearing loss, and vestibular impairment, rarely occurs in children. Hearing loss is commonly bilateral and permanent in 37%-67% of patients. To date, long-term evaluation of hearing impairment in children with CS has been reported in only 3 patients. We describe the 35-month course of hearing impairment in a teenaged boy with Cogan's syndrome. MATERIALS AND METHODS The medical record of a 15-year-old boy with Cogan's syndrome was reviewed. Data included relevant history and physical examination, diagnostic workup, and management. RESULTS The patient was diagnosed with bilateral uveitis at age 12 and was placed on oral steroid and methotrexate. He developed sudden sensorineural hearing loss, intermittent tinnitus, and no vestibular dysfunction approximately 9 months after the ophthalmic disease onset. The initial audiogram revealed mild to moderate right-sided high-frequency sensorineural hearing loss and profound left-sided sensorineural hearing loss. Steroid dosage was increased, and the patient exhibited right-side hearing improvement within 2 months. Hearing thresholds reached within normal limits on the right side at 4 months and continued to improve up to 12 months on the left side. CONCLUSIONS In a teenager with Cogan's syndrome, the severity and course of hearing impairment showed interaural differences. Improvement of hearing thresholds was slower and incomplete on the left ear. Further studies examining the course of cochleovestibular impairment in a larger group of patients with Cogan's syndrome potentially improve management and counseling.
Collapse
Affiliation(s)
- Hwa J Son
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas 75390-9035, USA
| | | |
Collapse
|
13
|
Pherwani A, Bansal S, Agrawal S, Gillow T. Cystoid macular oedema in Cogans syndrome-a case report. CASES JOURNAL 2008; 1:339. [PMID: 19021901 PMCID: PMC2602997 DOI: 10.1186/1757-1626-1-339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 11/20/2008] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cogan's Syndrome is typically characterised by a non syphilitic interstitial keratitis (IK), with or without conjunctivitis, iritis or subconjunctival bleeding and progressive sensorineural hearing loss within two years of ocular signs. Atypical ocular manifestations include episcleritis, scleritis, posterior scleritis, retinal artery occlusion, choroiditis, retinal vasculitis, and optic disc oedema. We report a case of Cogan's syndrome in with recurrent cystoid macular oedema was the main feature. CASE PRESENTATION A patient was diagnosed with Cogan's syndrome nearly 2 years after first presentation. He had cystoid macular edema which failed to respond initially to steroid, methotrexate and azothiaprine however resolved after treatment with mycophenolate mofetil. CONCLUSION Cogan's syndrome is rare and presents a challenge in terms of diagnosis and treatment. Recurrent cystoid macular oedema is a unique finding in this condition and can be difficult to control. Multidisciplinary management of this multisystem disorder is vital.
Collapse
Affiliation(s)
| | | | | | - Timothy Gillow
- North Staffordshire University Hospital, Stoke On Trent, UK
| |
Collapse
|
14
|
Mazlumzadeh M, Matteson EL. Cogan's Syndrome: An Audiovestibular, Ocular, and Systemic Autoimmune Disease. Rheum Dis Clin North Am 2007; 33:855-74, vii-viii. [DOI: 10.1016/j.rdc.2007.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Inoue Y, Tomemori T, Suzuki S, Arima T, Tomiita M, Shimojo N, Kohno Y. Low-dose oral methotrexate for the management of childhood Cogan’s syndrome: a case report. Clin Rheumatol 2007; 26:2201-2203. [PMID: 17611707 DOI: 10.1007/s10067-007-0686-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 06/18/2007] [Accepted: 06/19/2007] [Indexed: 11/30/2022]
Abstract
Cogan's syndrome is a rare inflammatory disease characterized by nonsyphilitic ocular interstitial keratitis associated with hearing loss and vestibular impairment. Although systemic corticosteroids are usually used as the standard therapy, hearing ability in most cases gradually deteriorates. We, herein, describe a patient with childhood Cogan's syndrome who was treated with low-dose oral methotrexate, which successfully helped to taper the doses of the systemic corticosteroids. The serum levels of the complements were good markers for the disease activity in this patient.
Collapse
Affiliation(s)
- Yuzaburo Inoue
- Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba city, Chiba, Japan.
| | - Takuya Tomemori
- Department of Otorhinolaryngology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shuichi Suzuki
- Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba city, Chiba, Japan
| | - Takayasu Arima
- Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba city, Chiba, Japan
| | - Minako Tomiita
- Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba city, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba city, Chiba, Japan
| | - Yoichi Kohno
- Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba city, Chiba, Japan
| |
Collapse
|
16
|
Pasanisi E, Vincenti V, Bacciu A, Guida M, Berghenti T, Barbot A, Orsoni JG, Bacciu S. Cochlear implantation and Cogan syndrome. Otol Neurotol 2003; 24:601-4. [PMID: 12851552 DOI: 10.1097/00129492-200307000-00012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate outcomes and issues pertaining to cochlear implantation in a group of subjects affected by Cogan syndrome. STUDY DESIGN Prospective cohort. SETTING Department of Ophthalmology and Otorhinolaryngology, University of Parma. PATIENTS Five postlingually deafened adults suffering from a typical form of Cogan syndrome who underwent cochlear implantation. MAIN OUTCOME MEASURES Benefit from cochlear implantation as measured by word and everyday sentence recognition tests. Surgical issues and postoperative complications were also evaluated. RESULTS In two cases, intracochlear electrodes were inserted into the scala vestibuli because of the ossification of the scala tympani. Two patients experienced a recurrence of keratitis the day after surgery. To date, with a follow-up of 1 to 4 years, no patient has experienced flap complications or other local or systemic complications. At the 12-month postoperative evaluation, all patients had gained useful open-set speech perception, achieving a mean score of 91% and 95% on word and everyday sentence recognition tests, respectively. CONCLUSIONS Patients deafened by Cogan syndrome demonstrated high levels of speech understanding after undergoing cochlear implantation. Obliteration of the cochlea may complicate electrode implantation, requiring modifications of the surgical technique. Stress consequent to the surgical procedure may instigate an acute phase of the basic illness.
Collapse
Affiliation(s)
- Enrico Pasanisi
- Department of Ophthalmology and Otorhinolaryngology, University of Parma, Parma, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Cogan's syndrome is a rare, chronic inflammatory disorder that typically targets the eyes and vestibuloauditory apparatus, but it may also involve other organs. Three pediatric cases of Cogan's syndrome (ages 5, 13, and 18 years) are reported with long-term follow-up and complete and regular cochleovestibular functional evaluation and ophthalmologic and neurologic examinations. One case was a typical form (characterized by an interstitial keratitis and cochleovestibular impairment), whereas the other 2 cases were atypical forms with uveitis and polyarthritis. In all 3 cases, the first clinical sign was nonspecific eye redness misdiagnosed as a banal conjunctivitis, initially or secondarily associated with bilateral endocochlear sensorineural hearing loss and complete bilateral peripheral vestibular deficit. During the acute phase, early steroid treatment (prednisone, 1 mg/kg/day) was effective in treating the ocular lesions (3 of 3 cases) and improving hearing (2 of 3 cases) but less effective for the vestibular loss (2 of 3 cases). Adverse effects and dependence on the steroid occurred in 2 cases, and immunosuppressive drugs were necessary to avoid recurrences in 1 case. Over the long-term, the disease was controlled in 2 cases but continued to progress in the other. Cogan's syndrome in childhood should be suspected in cases of conjunctivitis associated with inner-ear symptoms; a prompt steroid treatment can avoid progressive impairment of multiple sensorineural functions (vision, balance, hearing). Long-term management involves limiting disease recurrences by adaptive therapies, screening for complications (aortitis in particular), and planning rehabilitation for the sensorial deficits.
Collapse
Affiliation(s)
- Issa C Ndiaye
- Otorhinolaryngology Department, Robert Debré Pediatric Hospital, Paris, France
| | | | | |
Collapse
|
18
|
Matteson EL, Fabry DA, Facer GW, Beatty CW, Driscoll CL, Strome SE, McDonald TJ. Open trial of methotrexate as treatment for autoimmune hearing loss. ARTHRITIS AND RHEUMATISM 2001; 45:146-150. [PMID: 11324778 DOI: 10.1002/1529-0131(200104)45:2%3c146::aid-anr167%3e3.0.co;2-i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To assess the efficacy of low-dose methotrexate (MTX) administered for the treatment of autoimmune hearing loss. METHODS This was a prospective, 12-month, open-label study of 17 patients with refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in one or both ears prior to enrollment despite traditional medical therapy. The MTX dose was 7.5-25 mg/week. Hearing loss and vertigo were evaluated at baseline and at completion of the study. Hearing improvement was defined as an improvement in pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%; worsening was defined as a decrease of >10 dB in PT or a decrease of >15% in SD in at least one ear. RESULTS MTX was well tolerated. Among patients with Meniere's disease, 5 of 9 had improvement or resolution of vertigo. Equilibrium improved in all 3 patients with Cogan's syndrome and improved in 2 out of 3 patients with idiopathic hearing loss and this symptom. According to the parameters defined above, hearing improved in 11 patients (65%), was unchanged in 4 patients (23%), and worsened in 2 patients (12%). CONCLUSION Long-term low-dose MTX therapy may be a useful therapy for at least some patients who have hearing loss with a presumptively autoimmune-mediated component that is refractory to traditional therapies.
Collapse
Affiliation(s)
- E L Matteson
- Division of Rheumatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Matteson EL, Fabry DA, Facer GW, Beatty CW, Driscoll CL, Strome SE, McDonald TJ. Open trial of methotrexate as treatment for autoimmune hearing loss. ARTHRITIS AND RHEUMATISM 2001; 45:146-50. [PMID: 11324778 DOI: 10.1002/1529-0131(200104)45:2<146::aid-anr167>3.0.co;2-i] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the efficacy of low-dose methotrexate (MTX) administered for the treatment of autoimmune hearing loss. METHODS This was a prospective, 12-month, open-label study of 17 patients with refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in one or both ears prior to enrollment despite traditional medical therapy. The MTX dose was 7.5-25 mg/week. Hearing loss and vertigo were evaluated at baseline and at completion of the study. Hearing improvement was defined as an improvement in pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%; worsening was defined as a decrease of >10 dB in PT or a decrease of >15% in SD in at least one ear. RESULTS MTX was well tolerated. Among patients with Meniere's disease, 5 of 9 had improvement or resolution of vertigo. Equilibrium improved in all 3 patients with Cogan's syndrome and improved in 2 out of 3 patients with idiopathic hearing loss and this symptom. According to the parameters defined above, hearing improved in 11 patients (65%), was unchanged in 4 patients (23%), and worsened in 2 patients (12%). CONCLUSION Long-term low-dose MTX therapy may be a useful therapy for at least some patients who have hearing loss with a presumptively autoimmune-mediated component that is refractory to traditional therapies.
Collapse
Affiliation(s)
- E L Matteson
- Division of Rheumatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Watanabe K, Nishimaki T, Yoshida M, Shinzawa J, Yoshioka R, Suzuki S, Kasukawa R. Atypical Cogan's syndrome successfully treated with corticosteroids and pulse cyclophosphamide therapy. Fukushima J Med Sci 2000; 46:49-54. [PMID: 11446378 DOI: 10.5387/fms.46.49] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An 18-year-old woman was admitted to the medical center near her home with complaints of high fever and severe headache in June 1995. A diagnosis of adult-onset Still's disease was suspected and 50 mg/day of prednisolone was orally administered. In early April 1997, the patient suffered from sudden bilateral hearing loss and high fever. Pure tone audiogram taken at the same time showed an asymmetric bilateral neurosensorial hearing loss. A diagnosis of Cogan's syndrome was made. Administration of 60 mg prednisolone daily improved fever. Audiogram taken one month after administration of prednisolone showed improvement in the right ear. Monthly cyclophosphamide pulse therapy 700 mg combined with oral prednisolone was instituted. This combination therapy enabled the successful tapering of prednisolone without recurrence of hearing loss. Combined corticosteroid and pulse cyclophosphamide therapy would appear to be one effective regimen for Cogan's syndrome.
Collapse
Affiliation(s)
- K Watanabe
- Department of Internal Medicine II, Fukushima Medical University School of Medicine, Fukushima City, Japan
| | | | | | | | | | | | | |
Collapse
|
21
|
Matteson EL, Tirzaman O, Facer GW, Fabry DA, Kasperbauer J, Beatty CW, McDonald TJ. Use of methotrexate for autoimmune hearing loss. Ann Otol Rhinol Laryngol 2000; 109:710-4. [PMID: 10961801 DOI: 10.1177/000348940010900802] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the efficacy of low-dose methotrexate (MTX) given long-term for the treatment of autoimmune hearing loss, we performed a prospective open-label study of 11 patients with treatment-refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in 1 or both ears before enrollment despite traditional medical therapy. The MTX dose was 7.5 to 17.5 mg/wk. Hearing loss and vertigo were evaluated at baseline and at completion of the study. Hearing improvement was defined as an improvement in the pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%, whereas worsening was defined as a worsening of >10 dB in PT or a decrease of >15% in SD in at least 1 ear. The MTX was well tolerated. Among the 6 patients with Meniere's disease. 4 had improvement or resolution of vertigo, while 2 had no improvement. Disequilibrium improved in all 3 patients with Cogan's syndrome. According to the parameters defined above, hearing improved in 9 patients (82%), was unchanged in 1 patient (9%), and worsened in 1 patient (9%). Long-term low-dose MTX therapy may be a useful therapy for some patients who have hearing loss with a presumptively autoimmune-mediated component that is refractory to traditional therapies.
Collapse
Affiliation(s)
- E L Matteson
- Division of Rheumatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Methotrexate has proven to be a safe, effective, long-term therapy for rheumatoid arthritis. Its property as a corticosteroid-sparing drug in rheumatoid arthritis has been recognized and its potential has been explored in other inflammatory and autoimmune diseases. This article describes and analyzes the use of methotrexate for a wide variety of diseases, some of which are not the usual province of rheumatologists, to provide some guidance concerning its role for treatment. Methotrexate therapy seems promising for systemic lupus erythematosus, inflammatory myopathy, inflammatory eye disease, inflammatory bowel disease, and some manifestations of sarcoidosis. Its role in other diseases is not as well defined.
Collapse
Affiliation(s)
- W S Wilke
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Ohio, USA
| |
Collapse
|
23
|
Dekker JJ, Dinant HJ, Van Soesbergen RM. Cogan's syndrome as an extra-articular manifestation of rheumatoid arthritis. Clin Rheumatol 1996; 15:374-7. [PMID: 8853171 DOI: 10.1007/bf02230360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J J Dekker
- Department of Rheumatology, Slotervaartziekenhuis, Amsterdam, The Netherlands
| | | | | |
Collapse
|
24
|
Pouchot J, Vinceneux P, Bouccara D, Sterkers O, Bodelet B. Methotrexate as a steroid-sparing agent in Cogan's syndrome: comment on the concise communication by Richardson. ARTHRITIS AND RHEUMATISM 1995; 38:1348-9. [PMID: 7575739 DOI: 10.1002/art.1780380936] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|