Sensorineural hearing loss in patients with inflammatory bowel disease

Association between gut microbiota and sensorineural hearing loss: a Mendelian randomization study

Background

Several recent studies speculated that the gut microbiota is associated with sensorineural hearing loss (SNHL) and proposed the concept of the gut-inner ear axis. However, the causal effect of gut microbiota on SNHL is still unknown. In this study, we performed a two-sample Mendelian randomization (MR) analysis to estimate the causal effect of gut microbiota on SNHL.

Methods

Gut microbiota data were obtained from the largest available genome-wide association study (n = 18,340) conducted by the MiBioGen consortium. The summary statistics of SNHL were obtained from the FinnGen consortium R8 release data (28,310 cases and 302,750 controls). The causal effects were estimated with inverse-variance weighted, MR-Egger, and weighted median. Reverse Mendelian randomization analysis was performed on the bacteria that were found to be associated with SNHL in forward Mendelian randomization analysis. We then performed sensitivity analyses, including Cochran's Q-test, MR-Egger intercept test, MR-PRESSO, cML-MA-BIC, and leave-one-out analysis, to detect heterogeneity and pleiotropy.

Results

The inverse-variance weighted results suggested that Lachnospiraceae (UCG001) had a significant protective effect against SNHL (odds ratio = 0.85, 95% confidence interval: 0.78-0.93, P = 6.99 × 10-4). In addition, Intestinimonas (odds ratio = 0.89, 95% confidence interval: 0.82-0.97, P = 8.53 × 10-3) presented a suggestively protective effect on SNHL. Rikenellaceae (RC9gutgroup) (odds ratio = 1.08, 95% confidence interval: 1.02-1.15, P = 0.01) and Eubacterium (hallii group) (odds ratio = 1.12, 95% confidence interval: 1.00-1.24, P = 0.048) suggestively increase the risk of SNHL. The results of the reverse MR analysis showed that there is no significant causal effect of SNHL on the gut microbiota. No significant heterogeneity of instrumental variables or pleiotropy was detected.

Conclusion

The evidence that the four genera mentioned above are associated with SNHL supports the hypothesis of a gut-inner ear axis. Our study provides microbial markers for the prevention and treatment of SNHL, and further studies are needed to explore the mechanisms of the gut microbiome-inner ear axis in health and diseases.

Oculomotor nerve palsy as an extraintestinal manifestation of Crohn's disease

Patients with inflammatory bowel disease (IBD) may present with extraintestinal manifestations. Neurological symptoms associated with IBD are infrequent. Thus, any unexplained neurological symptom that occurs in patients with IBD should raise the suspicion of a link between the two disorders. We report a case of a man in his 60s, who was diagnosed with Crohn's disease and developed ptosis and diplopia. Neurological examination revealed oculomotor nerve palsy, sparing the pupil. MRI and magnetic resonance angiography of the brain were insignificant and no other cause was determined. He was treated with oral corticosteroids and symptoms gradually subsided. Cranial nerve palsies associated with IBD have been rarely reported. They usually involve the optic and acoustic nerve and are attributed to a common dysimmune base. This is the first reported case of oculomotor nerve palsy (III cranial nerve) associated with IBD. Clinicians treating patients with IBD should be alert for unusual neurological complications and treat them appropriately.

Recent Advancements in Understanding the Gut Microbiome and the Inner Ear Axis

The gut microbiome and its dynamic association with organ systems beyond the gastrointestinal tract, such as the nervous and cardiovascular systems, is an emerging area of research. Although the role of the gut microbiome has been extensively characterized in the gut-brain axis, the implications of gut dysbiosis in inner ear inflammation and hearing deficits have still not been explored. With some similarities outlined between the blood-brain barrier (BBB) and the blood labyrinth barrier (BLB) of the inner ear, this review aims to explore the axis between the gut microbiome and the inner ear as it pertains to their bidirectional communication.

Sensorineural hearing loss and ulcerative colitis in remission

INTRODUCTION

Sensorineural hearing loss (SNHL) has been reported in association with inflammatory bowel disease (IBD). However, SNHL as an extraintestinal manifestation of IBD is frequently underreported. In the present study, we compared the prevalence and severity of SNHL among patients with IBD-ulcerative colitis (IBD-UC) in remission with controls to find out any association between SNHL and IBD-UC in remission compared to controls.

METHODS

This single-center hospital-based prospective observational study included outdoor patients with IBD-UC in remission and healthy age- and sex-matched controls. Eligible patients and healthy participants were subjected to a battery of audiological tests (otoscopy, tympanometry and pure tone audiometry [PTN]) after thorough systemic and ear, nose and throat (ENT) examination.

RESULTS

A total of 100 patients were enrolled in the study: 50 in IBD-UC in the remission group and 50 in the control group. None of the demographic variables (age, gender, residence and habits) were significantly different between the two groups. Otoscopy and tympanometry were normal in all patients and controls. The difference between the two groups in respect to frequency and severity of SNHL on PTA and in respect to unilateral and bilateral distribution of the hearing loss was not statistically significant.

CONCLUSION

There is no statistically significant difference in frequency and severity of SNHL between patients with ulcerative colitis in remission and healthy age- and sex-matched controls.

The Link between Gut Dysbiosis Caused by a High-Fat Diet and Hearing Loss

This review aims to provide a conceptual and theoretical overview of the association between gut dysbiosis and hearing loss. Hearing loss is a global health issue; the World Health Organisation (WHO) estimates that 2.5 billion people will be living with some degree of hearing loss by 2050. The aetiology of sensorineural hearing loss (SNHL) is complex and multifactorial, arising from congenital and acquired causes. Recent evidence suggests that impaired gut health may also be a risk factor for SNHL. Inflammatory bowel disease (IBD), type 2 diabetes, diet-induced obesity (DIO), and high-fat diet (HFD) all show links to hearing loss. Previous studies have shown that a HFD can result in microangiopathy, impaired insulin signalling, and oxidative stress in the inner ear. A HFD can also induce pathological shifts in gut microbiota and affect intestinal barrier (IB) integrity, leading to a leaky gut. A leaky gut can result in chronic systemic inflammation, which may affect extraintestinal organs. Here, we postulate that changes in gut microbiota resulting from a chronic HFD and DIO may cause a systemic inflammatory response that can compromise the permeability of the blood-labyrinth barrier (BLB) in the inner ear, thus inducing cochlear inflammation and hearing deficits.

Hearing evaluation with ABR in pediatric patients with celiac disease

BACKGROUND/AIMS

Celiac disease (CD) is an autoimmune and genetic disease that is triggered by gluten intolerance. We aimed to investigate whether Celiac disease have any effect on Auditory Brainstem Response (ABR) waves compare to a healthy control group, and present its association with sensorineural hearing loss (SNHL).

MATERIALS AND METHODS

Thirty-eight patients aged 2 to 16 years old were included in the study. The patients had confirmed diagnosis of Celiac disease through duodenal biopsies and transglutaminase Antibody (Ab) (+). The control group consisted of 18 children aged 3 to 17 years old who were all admitted to the pediatric gastroenterology department due to complaints of constipation and transglutaminase Ab (-).All children underwent Auditory-Brain-Stem-Evoked Responses (ABR). The data were gathered using click stimulus at 10/s frequency 90dB HL.

RESULTS

The results of ABR examination did not show any difference between the patient group and control group as regards the latency of the waves I, III, V. No difference was observed between the two groups in the interpeak latecies I-III, I-V and III-V. None of the patients was observed to have clinical hearing loss.

DISCUSSION

The exact pathogenesis of neurological damages observed in Celiac disease is still unknown. Humoral immune mechanisms are the most frequently attributed cause.

CONCLUSION

Although no significant difference was found in hearing values between the study group and healthy control group, there is a need for further research on this subject.

Rare Causes of Unilateral Sensorineural Hearing Loss in Adults: Our Experience

Bilateral hearing loss is attributed to almost 50% of times with genetic etiology, while most unilateral sensorineural hearing loss (USNHL) are not attributable to it. Limited literature is available on epidemiology of USNHL. Etiology of USNHL is very diverse and vast, it ranges from as common as Meniere's disease to as rare as an electric shock injury. A prospective study was carried out to find rare causes of USNHL in adults. In this manuscript, we present a case series of 7 rare etiologies of USNHL in adults like auditory neuropathy, chemoradiotherapy, dialysis-induced SNHL, common cavity inner ear malformation, multiple sclerosis, acute otitis media-induced SNHL and vertebrobasilar dolichoectasia. This study discusses the rare possible etiologies of USNHL that can be easily missed if these are not ruled out properly. We present these cases to consider these heterogeneous and distinct causes of USNHL because of rarity of these etiologies. If such an etiology is diagnosed in time, they may be managed effectively.

Assessment of Hearing Function in Children with Inflammatory Bowel Disease

OBJECTIVES

Inflammatory bowel disease (IBD), a chronic pathology that affects many organ systems, appears after dysregulated immune response in genetically predisposed patients. Inner organ involvement has been shown in various autoimmune diseases because of its immunosensitivity. In this study, we aimed at showing sensorineural hearing loss (SNHL) as a result of possible subclinical inflammation in patients with IBD during the remission period.

MATERIALS AND METHODS

We included 32 children with IBD and 31 healthy volunteers with comparable sex and age. Detailed ear-nose-throat examination was conducted for all, and patients were excluded if they had a history of ear infectionor trauma. Thereafter, the results of pure tone audiometry (PTA), high-frequency audiometry, and distortion product otoacoustic emissions testing were compared between the groups.

RESULTS

There were no differences in terms of age, sex, and PTA values between controls and children with IBD. No statistical differences were found between responses at 250; 500; 2,000; 4,000; DP1000; DP1400; DP2000; DP2800;and DP4000 Hz as well as the signal-to-noise ratio (SNR) at 1,000 Hz when the controls and children with IBD (p>0.05 for all) were compared. However, the mean responses at 1,000; 8,000; 10,000; 12,500; 16,000; SNR1400; SNR2000; SNR2800; and SNR4000Hz of the children with IBD were significantly higher than those of the controls (p<0.05 for all).

CONCLUSION

Initial SNHL appears at high frequencies in pediatric patients with IBD.

Ear Involvement in Inflammatory Bowel Disease: A Review of the Literature

Inflammatory bowel disease (IBD) is a multisystemic disease. The ear is a rare but recognized site of extraintestinal manifestations of IBD. In external ear, the more common manifestations of IBD are pyoderma gangrenosum, metastatic Crohn’s disease and relapsing polychondritis and the treatment includes corticosteroids and anti-TNF agents. Sensorineural hearing loss (SNHL) is the most common ear disease in IBD and especially in patients with ulcerative colitis. In most cases of IBD patients with SNHL, the hearing loss is attributable to autoimmune inner ear disease (AIED). Diagnosis of AIED is based on clinical presentation, the demonstration of a progressive sensorineural hearing loss in periodic audiological tests, a response to immunosuppressive drugs and exclusion of other causes of SNHL. The only diagnostic test that is available for clinical use is the Otoblot test (Western blot for antibodies against 68 kD protein-inner ear antigens). Initial therapy is usually steroids, with a step up to anti-TNF-a therapy and cochlear implantations with failure of treatment. Furthermore, Cogan’s syndrome, a chronic disease characterized by deafness, vertigo keratitis and aortitis, has been associated with IBD and mainly with Crohn’s disease.

Ocular, Auricular, and Oral Manifestations of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is primarily a disease of the gastrointestinal tract, though it can often affect other organ systems. These extraintestinal manifestations occur in a quarter to one-third of patients with Crohn's disease and ulcerative colitis. While musculoskeletal and dermatologic manifestations are the most common, it is also important to be cognizant of head, eye, ear, nose, and throat (HEENT) manifestations and educate IBD patients about them. Here we review the ocular manifestations in conjunction with the lesser-known but increasingly recognized ENT manifestations. Considering the lack of randomized controlled trials in treating HEENT manifestations of IBD, this review is primarily based on case reports, case series, and expert opinion with a particular focus on the newer literature supporting use of anti-TNF agents.

Neurological Complications of Gastrointestinal Disease

There is a growing interest in the extraintestinal manifestations of common pediatric gastrointestinal diseases, such as inflammatory bowel disease and celiac disease. This article specifically focuses on the neurological symptoms that manifest because of these disorders and their treatments. Many neurological symptoms have been reported in association with these diseases, including neuropathy, myopathy, ataxia, headache, and seizures, among others. It is currently believed that these neurological symptoms are largely overlooked by practitioners and could be a red flag for earlier diagnosis. However, additional research, especially in the pediatric population, is warranted to further elaborate on the causality and pathophysiology of these neurological symptoms.

Hearing Loss in Patients with Inflammatory Bowel Disease

BACKGROUND AND AIMS

Inflammatory bowel disease (IBD) has many characteristics of autoimmune diseases. Sensorineural hearing loss has been reported in many autoimmune diseases. Little is known about hearing loss in patients with IBD.

METHODS

A prospective blinded comparative study was conducted over a 3-year period. IBD patients and controls underwent a complete otorhinolaryngeal examination and eudiometry test.

RESULTS

Altogether 105 participants (76 patients and 29 controls) took part in this study. Mean age was 36, 51 % were males, and 40 % of the patients were presently hospitalized due to IBD exacerbation. Audiometric examination revealed that any hearing loss (mild to severe) was found in 29 (38 %) of the IBD population, compared to 4 (14 %) of the control group (p = 0.02). Extraintestinal manifestation (EIM) was present in 33/76 (43 %) of IBD patients. Any hearing loss and moderate to severe hearing loss were found in 17/33 (52 %) and 7/33 (21 %) in the EIM-positive group compared to 12/43 (28 %) and 4/43 (9 %) in the EIM-negative group (p = 0.036 and p = 0.14, respectively). Out of patients over the age of 40 with other EIMs, all 11/11 (100 %) of patients had any hearing loss compared to 8/12 (66 %) of patients over the age of 40 without other EIMs, p = 0.035.

CONCLUSIONS

Hearing loss may be another EIM of IBD. It is found in 38 % of IBD patients and in up to 52 % of patients with other EIMs and increases over the age of 40. Early hearing evaluation should be recommended to these high-risk IBD patients.

Cochlear involvement in patients with ulcerative colitis

Objective:

To investigate whether cochlear involvement is an extraintestinal manifestation in patients with ulcerative colitis.

Method:

Forty-four ulcerative colitis patients and 44 age-matched healthy subjects were included in the study. Pure tone and speech audiometry, and distortion product otoacoustic emission tests were performed on all participants. The audiometric test results were compared between groups and their relationship with disease activity was investigated.

Results:

Pure tone threshold averages were significantly higher in ulcerative colitis patients compared to controls (p < 0.05). Speech discrimination scores were significantly lower in ulcerative colitis patients compared to controls (p < 0.05). Distortion product otoacoustic emission amplitude values were significantly lower for all of the tested frequencies (except for 6000 Hz in the right ear) in ulcerative colitis patients compared to controls (p < 0.05). No relationship was detected between audiometric test results and disease activity (p > 0.05).

Conclusion:

Even though hearing thresholds may be within normal limits, decreased distortion product otoacoustic emission amplitude values indicate a cochlear involvement in ulcerative colitis patients.

Symptom management in inflammatory bowel disease

Patients with inflammatory bowel disease can present with a wide variety of symptoms. Most are related to disease activity and should be managed with appropriate medical therapy for inflammatory bowel disease. However, some patients may develop symptoms due to the side effects of the medications, or due to immunosuppression. In these cases, the offending medications should be discontinued until resolution of the symptoms and a few may be able to restart therapy. Symptoms can also occur as an extraintestinal manifestation of the disease or due to concomitant autoimmune-mediated disorders. Regardless of the etiology, symptoms should be addressed promptly with immediate evaluation and appropriate therapy, as a delay may lead to permanent sequela.

Chronic diseases and life events accounted for 2-18 % population attributable risks for adult hearing loss: UK Adult Psychiatric Morbidity Survey, 2007

Links between chronic diseases and hearing loss in adults have emerged. However, previous investigations were not complete, and the role of life events was unclear. Therefore, it was aimed to examine the relationships of common chronic diseases and life events and adult hearing loss in a country-wide and population-based study. Data were retrieved from UK Adult Psychiatric Morbidity Survey, 2007, being cross-sectional, including demographics, self-reported prior health conditions and hearing loss (ever and in the last 12 months), and several major life events. Analyses included Chi square test, t test, logistic regression model, and population attributable risk estimation. People who had prior health conditions including cancer, migraine, dementia, depression, cataracts, chronic bronchitis, allergy, bowel problem, bladder problem, arthritis, muscle problem or skin problem tended to report hearing loss than their counterparts. People who have experienced major life events including post-traumatic stress disorder, serious illness of close relatives, death of family, serious problems with friends, major financial crisis, valuables stolen, being bullied, violence at home, sexual abuse or running away from home were also more likely to experience ever hearing loss problem or that in the last 12 months. 2.0-13.1 % adult hearing loss could be delayed or prevented by managing chronic diseases while 4.1-18.1 % might be delayed or prevented by minimizing the negative effects of life events. Chronic diseases and life events were associated with hearing loss in adults. Better managing lifestyle to minimize detrimental impacts in future health and nursing programs would be suggested.

Neurological disorders and inflammatory bowel diseases

Extraintestinal manifestations occur in about one-third of patients living with inflammatory bowel disease (IBD) and may precede the onset of gastrointestinal symptoms by many years. Neurologic disorders associated with IBD are not frequent, being reported in 3% of patients, but they often represent an important cause of morbidity and a relevant diagnostic issue. In addition, the increasing use of immunosuppressant and biological therapies for IBD may also play a pivotal role in the development of neurological disorders of different type and pathogenesis. Hence, we provide a complete and profound review of the main features of neurological complications associated with IBD, with particular reference to those related to drugs and with a specific focus on their clinical presentation and possible pathophysiological mechanisms.

Inflammatory bowel disease: An increased risk factor for neurologic complications

Only a very few systematic studies have investigated the frequency of neurologic disorders in patients with Crohn’s disease (CD) and ulcerative colitis (UC), which are the two main types of inflammatory bowel disease (IBD). Results have been inconsistent and variable, owing to differences in case-finding methods and evaluated outcomes in different studies. The most frequent neurologic manifestations reported in CD and UC populations are cerebrovascular disease (with either arterial or venous events), demyelinating central nervous system disease, and peripheral neuropathy (whether axonal or demyelinating); however, the literature describes numerous nervous system disorders as being associated with IBD. The pathogenesis of nervous system tissue involvement in IBD has yet to be elucidated, although it seems to be related to immune mechanisms or prothrombotic states. The recently-introduced tumor necrosis factor (TNF) inhibitors have proven successful in controlling moderate to severe IBD activity. However, severe neurologic disorders associated with TNF inhibitors have been reported, which therefore raises concerns regarding the effect of anti-TNF-α antibodies on the nervous system. Although neurological involvement associated with IBD is rarely reported, gastroenterologists should be aware of the neurologic manifestations of IBD in order to provide early treatment, which is crucial for preventing major neurologic morbidity.

Hearing loss in Muckle-Wells syndrome

OBJECTIVE

Muckle-Wells syndrome (MWS) is an inherited autoinflammatory disease characterized by fevers, rashes, arthralgia, conjunctivitis, and sensorineural hearing loss. In MWS, NLRP3 gene mutations are associated with excessive interleukin-1 release. The aims of this study were to determine the otologic characteristics of MWS, define trajectories of hearing loss, and explore the association with distinct NLRP3 genotypes.

METHODS

A prospective observational cohort study of children and adults diagnosed as having MWS was conducted at a single center. NLRP3 gene mutations were determined. Patients underwent standardized clinical, laboratory, and otologic assessments, including pure tone audiometry, vestibular organ testing, and tinnitus evaluation. Trajectories of hearing loss were defined for each genotype. The genotype-specific risk of progression of hearing loss was determined.

RESULTS

A total of 33 patients ages 3-75 years who were members of 5 families with 4 different NLRP3 gene mutations were included. The majority of patients (67%) experienced bilateral sensorineural hearing loss. Even in cases of profound hearing loss vestibular reactivity remained normal. Fourteen adult patients reported nondebilitating tinnitus. Overall, hearing impairment progressed with age. Patients with the T348M mutation were at highest risk of rapid progression of sensorineural hearing loss.

CONCLUSION

Patients with MWS are at risk of developing progressive sensorineural hearing loss without vestibular involvement. Hearing impairment starts at high frequencies and can subsequently progress to profound hearing loss. Progression is age dependent. Patients with different NLRP3 mutations had distinctly different trajectories of hearing loss, suggesting a mutation-specific risk that should be considered when making treatment decisions.

Neurologic complications in patients with inflammatory bowel disease: increasing relevance in the era of biologics

Extraintestinal manifestations of inflammatory bowel disease (IBD) can involve almost every organ system. Neurologic complications are not infrequent in patients with IBD, but are poorly recognized and underreported. Pathophysiologically, these may represent immune-mediated phenomenon, nonimmunologic complications due to micronutrient deficiencies, thromboembolism, or be medication-induced. Peripheral neuropathy is the most common neurologic complication of IBD and may be immune-mediated, or caused by therapy with anti-tumor necrosis factor-alpha (TNF-α) therapy or metronidazole. Multiple sclerosis occurs with a greater frequency in patients with IBD. Anti-TNF-α therapy can cause neurologic disease characterized by central demyelination that mimics multiple sclerosis. Hence, patients with a history of demyelinating diseases or with symptoms of polyneuropathy should be carefully evaluated before initiation of anti-TNF-α therapy. Natalizumab has been associated with fatal progressive multifocal leukoencephalopathy due to reactivation of JC virus, and occurs with greater frequency in patients with previous JC virus infection. Stroke secondary to venous or arterial thromboembolism can be seen in patients with active Crohn's disease. It is important for gastroenterologists to be aware of the neurologic complications in patients with IBD. Neurologic symptoms in these patients should be promptly evaluated.

The evaluation of hearing loss in children with celiac disease

BACKGROUND AND AIMS

Celiac disease (CD) is an autoimmune enteropathy. The disease may be presented with extraintestinal manifestations including neurological findings. Epilepsy and ataxia are well known neurological disorders in CD. But there are very limited numbers of reports on sensory-neural hearing loss in CD in the literature. The aim of this study was to investigate the hearing functions in children with newly diagnosed CD.

MATERIALS AND METHODS

Ninety-seven (194 ears) [56 girls, 41 boys (age range: 1.5-17 years)] newly diagnosed celiac disease patients and 85 sex and age-matched controls (170 ears) were included in this study. Hearing function was assessed by pure-tone audiometry, speech audiometry, tympanometry and otoacoustic emissions measurements.

RESULTS

No significant difference were found between the patients and control groups measurements including the pure-tone audiometry, speech audiometry, tympanometry and otoacoustic emissions No significant difference was found for pure-tone audiometry, speech audiometry, tympanometry and otoacoustic emissions measurements in celiac patients according to the Marsh-Oberhuber classification (P>0.05).

CONCLUSIONS

Our results showed that hearing functions of children with newly diagnosed CD were similar to healthy controls.