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Papadopoulou M, Tzortsou S, Chatzi I, Baltogiannis C. Oculomotor nerve palsy as an extraintestinal manifestation of Crohn's disease. BMJ Case Rep 2023; 16:e254456. [PMID: 37202111 PMCID: PMC10201219 DOI: 10.1136/bcr-2022-254456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
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.
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Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, University of West Attica, Egaleo, Greece
- Department of Neurology, Hygeias Melathron, Athens, Greece
| | - Sofia Tzortsou
- Department of Neurology, Hygeias Melathron, Athens, Greece
| | - Ioanna Chatzi
- Department of Neurology, Hygeias Melathron, Athens, Greece
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Bodh V, Kumar R, Sharma R, Sharma B, Sachdeva A, Azad R. Sensorineural hearing loss and ulcerative colitis in remission. Indian J Gastroenterol 2022; 41:143-148. [PMID: 35247189 DOI: 10.1007/s12664-021-01216-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/19/2021] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Vishal Bodh
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, 171 001, India
| | - Rajesh Kumar
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, 171 001, India
| | - Rajesh Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, 171 001, India
| | - Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, 171 001, India.
| | - Amit Sachdeva
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, 171 001, India
| | - Ramesh Azad
- Department of Otolaryngorhinology, Indira Gandhi Medical College, Shimla, 171 001, India
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Polat E, Çınar Z, Keskindemirci G, Yiğit Ö, Kutluk G, Türe M, Akça T, Alkaya E. Assessment of Hearing Function in Children with Inflammatory Bowel Disease. J Int Adv Otol 2020; 16:362-366. [PMID: 33136017 DOI: 10.5152/iao.2020.6035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Esra Polat
- Department of Pediatric Gastroenterology, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul , Turkey
| | - Zehra Çınar
- Department of Otolaryngology, University of Health Sciences İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Gonca Keskindemirci
- Department of Social Pediatrics, Istanbul University Institute of Health Sciences, Institute of Child Health, Istanbul, Turkey
| | - Özgür Yiğit
- Department of Otolaryngology, University of Health Sciences İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Günsel Kutluk
- Department of Pediatric Gastroenterology, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul , Turkey
| | - Muhammet Türe
- Department of Otolaryngology, University of Health Sciences İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Tuğberk Akça
- Department of Pediatric Clinics, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Esat Alkaya
- Department of Otolaryngology, University of Health Sciences İstanbul Training and Research Hospital, Istanbul, Turkey
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Fousekis FS, Saridi M, Albani E, Daniel F, Katsanos KH, Kastanioudakis IG, Christodoulou DK. Ear Involvement in Inflammatory Bowel Disease: A Review of the Literature. J Clin Med Res 2018; 10:609-614. [PMID: 29977417 PMCID: PMC6031254 DOI: 10.14740/jocmr3465w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/15/2018] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology, Medical School of Ioannina, Ioannina, Greece
| | - Maria Saridi
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece.,Hellenic Open University, Patras, Greece
| | - Eleni Albani
- Nursing Department, Technological University of Patras, Patra, Greece
| | - Fady Daniel
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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Gunes A, Karakus MF, Telli TA, Gunes NA, Mutlu M. The effect of thyroid autoantibody positivity on the functions of internal ear. Eur Arch Otorhinolaryngol 2017; 274:3853-3858. [PMID: 28821945 DOI: 10.1007/s00405-017-4723-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
The objective of the study is to investigate if any significant difference exists in hearing thresholds and tympanometric examination results among patients whose thyroid antibody positivity was detected approximately 1 year or at least 5 years ago. Study population aged less than 40 years consisted of 17 patients who had thyroid antibody positivities for an average of 1 year (first group), 15 patients who were followed up for at least 5 years for thyroid antibody positivity (second group), and 18 volunteers (third group). Tympanometric examination results, stapes reflex, SRT, SD, and pure tone values were examined. When the second group and the third group were compared, significant results were obtained at hearing frequencies between 500 and 4000 Hz. When the first group and the third group were compared, only at 1000 Hz threshold significant results were obtained. During evaluation of hearing frequencies between 250 and 8000 Hz, significant results were not observed between the second group and the first group. When the first and the second groups were compared with the control group, significant results were obtained as for tympanometric examination findings and significant results were not observed between the second group and the first group. A significant difference was not detected as for the results of stapes reflex. Since thyroid antibody positivity affects the functions of internal ear, these patients should be more closely monitored. Since these effects become deeper in line with increased exposure to autoantibody positivity, variations in auditory responses should be more attentively monitored.
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Affiliation(s)
- Akif Gunes
- Department of Otorhinolaryngology, Eskisehir State Hospital, Eskisehir, Turkey.
| | - Mehmet Fatih Karakus
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Tugba Akin Telli
- Department of Medical Oncology, Medical School, Marmara University, Istanbul, Turkey
| | | | - Murad Mutlu
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Abstract
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.
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Affiliation(s)
- Melissa Shapiro
- From the Section of Gastroenterology, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA
| | - David A Blanco
- From the Section of Gastroenterology, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
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Abstract
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.
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Gunes A, Gundogdu I, Mutlu M, Ozturk EA, Cakci A, Akin I. Functions of the inner ear in psoriatic arthritis. Auris Nasus Larynx 2016; 43:626-31. [PMID: 26915283 DOI: 10.1016/j.anl.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to investigate whether there is a negative impact as a result of psoriatic arthritis disease of the inner ear function. METHODS Twenty-four successive patients and 38 healthy volunteers, younger than 60 years of age, who were followed up for at least for one year in the outpatient clinics of physical therapy and rehabilitation with the diagnosis of PsA according to CASPAR criteria (17) and who did not complain of any hearing impairment were included in the study. Distortion-product otoacoustic emission (DPOAE) values between 1kHz and 4kHz, tympanometric examination results, stapes reflex values, speech reception threshold (SRT) and speech discrimination (SD) values, pure-tone values between 250 and 8000Hz and high-frequency values between 10,000, 12,500 and 16,000Hz were analyzed. Statistical comparisons between both groups were performed using chi-square test and Mann-Whitney U test. p<0.05 was accepted as the level of statistical significance. RESULTS Our study population consisted of 24 [9 male (37.5%) and 15 female (62.5%)] patients with a mean age of 47.21±11.28 (range, 28-59) years and 38 [16 male (42.1%) and 22 female (57.9%)] healthy volunteers with a mean age of 44.39±8.12 (range, 29-59) years as the control group. Mean duration of arthritis was 7.62±4.88 years. In the evaluation of hearing frequencies of the patients between 4000 and 6000Hz, a statistically significant difference was found relative to the control group (p<005). DPOAE values of the patients were analyzed within the 1000-4000Hz interval. When compared with the control group, a statistically significant difference was found at 3000 and 4000Hz (p<005). CONCLUSION Our study provides strong evidence suggesting the necessity of monitorization of these patients regarding sensorineural hearing loss so as to take measures against the development of hearing loss during early stage, which may be another disability in patients with PsA, which is itself a potential cause of severe disability.
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Affiliation(s)
- Akif Gunes
- Department of Otorhinolaryngology, Golbasi Hasvak State Hospital, Ankara, Turkey.
| | - Ibrahim Gundogdu
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Murad Mutlu
- Department of Otorhinolaryngology, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Erhan Arif Ozturk
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Aytul Cakci
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Istemihan Akin
- Department of Otorhinolaryngology, Kafkas University Medical School, Kars, Turkey
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Cochlear involvement in patients with ulcerative colitis. The Journal of Laryngology & Otology 2015; 130:128-33. [DOI: 10.1017/s0022215115002583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective: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.
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Evaluation of Hearing and Outer Hair Cell Function of Cochlea in Patients With Psoriatic Arthritis. Clin Exp Otorhinolaryngol 2015; 8:183-8. [PMID: 26330908 PMCID: PMC4553344 DOI: 10.3342/ceo.2015.8.3.183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 04/11/2014] [Accepted: 04/21/2014] [Indexed: 01/21/2023] Open
Abstract
Objectives The aim of this study was to investigate hearing and outer cells function in patients with psoriatic arthritis. Our investigation was a prospective case control study. Methods A total of 31 psoriatic arthritis patients (62 ears) and 31 healthy control subjects (62 ears) were enrolled in the study. We investigated hearing changes of patients and controls via pure tone audiometry, speech discrimination scores, tympanometry, acoustic reflex, and transient product otoacoustic emission. Results The mean age of psoriatic arthritis patients was 36.1±8.5 years (range, 14 to 62 years). The average age of the control group was 37.9±8.1 years (range, 16 to 62 years). There were statistically significant differences between pure tone audiometry in all frequencies and right and left emission at the 4.0 and 1.0 in psoriatic arthritis patients versus controls (P<0.05). This difference was evident, especially at high frequencies. There was no statistically significant difference between the ages and genders of the patient and control groups (P>0.05). Both audiological and otoacoustic emissions were not significantly different between right and left ear (P>0.05). Conclusion Based on the audiological and otoacoustic findings; it is likely that the cochlear outer hair cells become subtly damaged in psoriatic arthritis patients, consequently leading to changes in hearing thresholds. These data suggest that it is important to screen psoriatic arthritis patients for hearing changes with otoacoustic emissions and audiologic tests regularly.
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Gad GI, Abdelateef H. Function of the audiovestibular system in children with systemic lupus erythematosus. Curr Allergy Asthma Rep 2014; 14:446. [PMID: 24803303 DOI: 10.1007/s11882-014-0446-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus can affect inner ear by disrupting either the hearing or balance system. Affection of hearing can be anatomically categorized into conductive and sensorineural hearing loss, while affection of the equilibrium system manifests either as an isolated manifestation like vertigo or as a part of a spectrum like Meniere's disease. Most cases show asymptomatic affection requiring an objective audiovestibular assessment. More focus should be given to routine evaluation especially with disease flares and for proper treatment. In pediatric patients, more concern should be given owing to the added effect of ototoxicity with several drugs and the educational impact of such comorbidity.
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Abstract
Labyrinthitis with vestibulocochlear dysfunction in chronic inflammatory bowl disease is a rare but well described manifestation or complication. The diagnostic and therapeutic possibilities and limitations of this inflammatory otopathy are presented and discussed in the context of a case report. A bilateral loss of vestibular function and sensorineural hearing loss occurred in a 26-year-old male patient with previously diagnosed Crohn's disease. He was treated with immune suppressive therapy during the onset and development of cochleovestibular symptoms. Diagnostic tests included pure tone audiograms, speech audiometry, caloric tests, VEMPs, and MRI. Therapy included azathioprine, corticosteroids (systemic and intratympanic), monoclonal antibodies, and cochlear implants. Despite immunosuppressive therapy including monoclonal antibodies, the patient progressively lost his hearing. Finally, bilateral cochlear implantation was carried out with good results. The treatment of patients with systemic inflammatory or autoimmune disease affecting the cochlear-vestibular organ is challenging. An interdisciplinary approach is needed. In cases of bilateral deafness, cochlear implantation is a satisfactory treatment and should not be delayed unnecessarily.
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Zois CD, Katsanos KH, Kosmidou M, Tsianos EV. Neurologic manifestations in inflammatory bowel diseases: current knowledge and novel insights. J Crohns Colitis 2010; 4:115-24. [PMID: 21122494 DOI: 10.1016/j.crohns.2009.10.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 10/26/2009] [Accepted: 10/27/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC), widely known as inflammatory bowel diseases (IBD), are thought to result from an inappropriate activation of the mucosal immune system driven by intestinal bacterial flora. METHODS Although the extraintestinal manifestations of IBD are well documented, the association of IBD with neurologic and neuromuscular involvement is rare and often controversial, with sporadic and conflicting data on its prevalence and spectrum. In addition, a serious number of the latter manifestations may become life-threatening, playing a very important role in disease morbidity. To define the pattern of neurologic involvement in IBD, the most important manifestations in these patients have been reviewed, exploring also their clinical significance. RESULTS There is evidence that UC and CD can manifest both in the PNS and CNS. Thrombotic complications are common in IBD patients, but cerebral vascular involvement is rare. CONCLUSIONS Neurologic manifestations in IBD patients are more common than previously estimated and may follow a different pattern of involvement in CD and UC. Small numbers of patients currently preclude a better characterization of the clinical spectrum and a better understanding of pathogenesis.
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Affiliation(s)
- Christos D Zois
- 1st Department of Internal Medicine, Hepato-Gastroenterology Unit, Medical School, University of Ioannina, 451 10 Ioannina, Greece
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Abstract
In recent years, there has been increasing recognition of the presence of gastrointestinal (GI) dysfunction in the setting of neurologic diseases. Parkinson's disease is a particularly well-known example, but GI dysfunction also may occur in multiple sclerosis, stroke, and in various myopathic and peripheral neuropathic processes. There is much less awareness, however, that primary GI diseases may also display neurologic dysfunction as part of their clinical picture. This article focuses on some of those disease processes. Illnesses primarily targeting the GI tract are addressed and examples of primary esophageal, gastric, and intestinal disease processes are described.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, University of Tennessee Health Science Center, 855 Monroe Avenue, Memphis, TN 38163, USA.
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Kalyoncu D, Urganci N, Calis AB, Ozbal A. Sensorineural hearing loss in pediatric patients with inflammatory bowel disease. Dig Dis Sci 2010; 55:150-2. [PMID: 19255853 DOI: 10.1007/s10620-009-0714-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 01/12/2009] [Indexed: 12/09/2022]
Abstract
OBJECTIVES Sensorineural hearing loss as an extraintestinal manifestation of inflammatory bowel disease has been reported in several studies, including adult patients. The aim of this study is to determine the presence of subclinical sensorineural hearing loss associated with inflammatory bowel disease in pediatric patients. METHODS Otoscopy, tympanometry, and pure tone audiometry were performed in 24 patients with disease and 20 healthy age- and sex-matched controls. RESULTS Pure tone audiometry did not show significant sensorineural hearing loss over all frequencies in patients with inflammatory bowel disease compared with controls (P > 0.05). CONCLUSIONS Subclinical sensorineural hearing loss was demonstrated in adult patients with inflammatory bowel disease; therefore we recommend performing audiometric examinations in pediatric patients to recognize hearing loss early during the course of the disease.
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Affiliation(s)
- Derya Kalyoncu
- Department of Pediatrics, Sisli Etfal Training and Research Hospital, 34270 Istanbul, Turkey.
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Karmody CS, Valdez TA, Desai U, Blevins NH. Sensorineural hearing loss in patients with inflammatory bowel disease. Am J Otolaryngol 2009; 30:166-70. [PMID: 19410121 DOI: 10.1016/j.amjoto.2008.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 04/11/2008] [Accepted: 04/17/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The study aimed to discuss the association between sensorineural hearing loss (SNHL) and inflammatory bowel disease (IBD). METHODS We reviewed cases of patients with known IBD seen in an otolaryngology practice with documentation of all otologic data including age of onset, family history of otologic problems, exposure to noise, audiometric findings, and so on. RESULTS Of 38 patients with a history of IBD, 22 had documented SNHL. Nineteen of these had no other identifiable etiology for their inner ear dysfunction. Fourteen of these patients had a diagnosis of ulcerative colitis and 5 had Crohn disease. Sixteen patients had bilateral SNHL, and 3 patients had unilateral SNHL. Only one patient had a lasting response of SNHL to medical treatment. CONCLUSION This review suggests that SNHL is an extraintestinal association of IBD. As IBD is considered to be a local or systemic immunopathy, the associated SNHL might also be an expression of systemic immune dysfunction.
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Affiliation(s)
- Collin S Karmody
- Department of Otolaryngology, Head and Neck Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
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Inner-ear obliteration in ulcerative colitis patients with sensorineural hearing loss. The Journal of Laryngology & Otology 2007; 122:871-4. [DOI: 10.1017/s0022215107001351] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:Systemic autoimmune diseases, including ulcerative colitis, may involve the inner ear. Several ulcerative colitis cases presenting with sensorineural hearing loss have been reported. We report the T2-weighted, three-dimensional, inner-ear magnetic resonance imaging findings in the inner ears of two such patients.Methods:Case reports and a review of the literature concerning autoimmune disease and sensorineural hearing loss are presented.Results:We describe two cases of ulcerative colitis with sensorineural hearing loss in which three-dimensional magnetic resonance imaging revealed obliteration of the inner ear. Those inner ears with obliteration had severe hearing loss, and responded poorly to steroid therapy.Conclusion:To our knowledge, there has been no previous published report of the T2-weighted, inner-ear magnetic resonance imaging findings of cases of ulcerative colitis with sensorineural hearing loss. This paper represents the first published report in the world literature of inner-ear obliteration in such patients. Three-dimensional magnetic resonance imaging is beneficial in elucidating the pathophysiology of the inner-ear involvement seen in ulcerative colitis.
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Prescinotto R, Zanini RVR, Rapoport PB, Anadão CA, de Mendonça RR, Petrilli RBN. Autoimmune hearing loss and ulcerative colitis. Braz J Otorhinolaryngol 2007; 72:572. [PMID: 17143440 PMCID: PMC9445685 DOI: 10.1016/s1808-8694(15)31007-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Roverano S, Cassano G, Paira S, Chiavarini J, Graf C, Rico L, Heredia C. Asymptomatic Sensorineural Hearing Loss in Patients With Systemic Lupus Erythematosus. J Clin Rheumatol 2006; 12:217-20. [PMID: 17023806 DOI: 10.1097/01.rhu.0000242777.71604.69] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hearing loss can accompany systemic lupus erythematosus (SLE). The purpose of this study was to evaluate the prevalence of asymptomatic sensorineural hearing loss (ASNHL) in patients with SLE. METHODS Thirty-one unselected consecutive female patients with SLE (American College of Rheumatology criteria, 1982) were evaluated (in a prospective and descriptive study) for evidence of hearing abnormalities. Twenty-five healthy age-matched women served as controls. All patients and control groups underwent both a normal tympanoscopy and an audiometric testing as a prerequisite to be included in the study. RESULTS Patients with SLE had a mean age of 35 years (range, 19-64 years) and the follow-up time (median) was 48 months (range, 4-180 months). One of 31 patients was excluded because of middle ear infectious disease. Of the remaining 30 patients, 21 (70%) had impaired hearing; 20 (66%) had sensorineural loss at high frequencies in a bilateral and symmetric way, and one had conductive alteration. Ten patients had normal audiometric studies. Four women in the control group had alterations of the audiometric tests: 3 patients had conductive alteration and the other one had bilateral ASNHL. No statistically significant correlation was found among the presence of ASNHL, the detection of antiphospholipid antibodies, and the treatment with hydroxychloroquine. Also, no correlation was observed between impaired hearing and SLE activity. CONCLUSION If it can be established how often this ASNHL progresses to a clinical problem, it can be important that, as part of initial studies, patients with SLE undergo audiometric tests.
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MESH Headings
- Adult
- Antibodies, Anticardiolipin/blood
- Antibodies, Antiphospholipid/blood
- Antirheumatic Agents/therapeutic use
- Audiometry, Pure-Tone
- Case-Control Studies
- Female
- Hearing Loss, Bilateral/etiology
- Hearing Loss, Bilateral/physiopathology
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Humans
- Hydroxychloroquine/therapeutic use
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/physiopathology
- Middle Aged
- Prevalence
- Prospective Studies
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Affiliation(s)
- Susana Roverano
- Department of Rheumatology, Hospital José María Cullen, Santa Fe, Argentina
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Iwai H, Lee S, Inaba M, Baba S, Yamashita T, Ikehara S. Bone marrow transplantation as a strategy for the treatment of autoimmune hearing loss in MRL/Mp-lpr/lpr mice. J Neuroimmunol 2005; 168:76-82. [PMID: 16146652 DOI: 10.1016/j.jneuroim.2005.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 07/07/2005] [Accepted: 07/08/2005] [Indexed: 10/25/2022]
Abstract
Sensorineural hearing loss (SNHL) has been reported to develop as a main part of or in combination with systemic and organ-specific autoimmune diseases. The aim of the current study is to treat autoimmune SNHL in MRL/Mp-lpr/lpr (MRL/lpr) mice, a murine model of systemic autoimmune disease, using allogeneic bone marrow transplantation (BMT), which replaces recipient bone marrow cells with bone marrow cells from a non-autoimmune-prone donor. The results indicate that BMT can be used to treat SNHL; cochlear pathology, serum autoantibodies and lupus nephritis are ameliorated. Therefore, it is conceivable that the autoimmune SNHL in the MRL/lpr mice results not from defects in the cochlea, including the stria vascularis, but from defects in the bone marrow, and BMT would therefore provide a curative effect on inner ear autoimmune dysfunction associated with systemic autoimmune diseases.
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Affiliation(s)
- Hiroshi Iwai
- Department of Otolaryngology, Rakusai New Town Hospital, Kansai Medical University, Kyoto, Japan
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22
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Akbayir N, Caliş AB, Alkim C, Sökmen HMM, Erdem L, Ozbal A, Bölükbaş F, Akbayir N. Sensorineural hearing loss in patients with inflammatory bowel disease: a subclinical extraintestinal manifestation. Dig Dis Sci 2005; 50:1938-45. [PMID: 16187200 DOI: 10.1007/s10620-005-2964-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Accepted: 02/17/2005] [Indexed: 12/09/2022]
Abstract
Isolated case reports in which symptomatic hearing loss develops suddenly during the course of inflammatory bowel disease (IBD) have been reported, but the presence of subclinical sensorineural hearing loss (SNHL) associated with IBD has been investigated in only two preliminary studies. In order to research this further, we aimed to investigate the presence of subclinical SNHL in IBD by comparison with a control group and to examine possible relations between the bowel disease parameters and hearing loss.Otoscopy, tympanometry, and pure tone audiometry were carried out in 39 patients with IBD (21 Crohn's disease [CD], 18 ulcerative colitis [UC]) and 25 healthy age- and sex-matched controls. All patients and control subjects had normal otoscopy findings and tympanometry was unremarkable, excluding middle ear disease and conductive hearing loss. Analysis of each frequency examined showed that the average hearing thresholds were increased significantly in the study group compared to those of the control group at higher frequencies (2, 4, and 8 kHz). When these parameters were compared with the control group according to subgroups of IBD, a significant difference was determined for the UC group at frequencies of 2, 4, and 8 kHz and for the CD group only at the frequency of 4 kHz. Although there was a trend of increment in SNHL as the age of the patient and duration and extent of UC increased, no significant correlation was observed between SNHL and these parameters or sex, activity, involvement site, medication history of IBD, and coexistence of other extraintestinal manifestations. In conclusion, it was demonstrated that a subclinical SNHL may be associated with UC and somewhat with CD, affecting mainly the high frequencies. In light of this finding, it may be advisable to investigate labyrinth functions as well as other extraintestinal manifestations in patients with IBD.
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Affiliation(s)
- Nihat Akbayir
- Department of Gastroenterology, Sişli Etfal Training and Research Hospital, Istanbul.
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Pfeiffer RF. NEUROLOGICAL DYSFUNCTION IN GASTROINTESTINAL DISEASES. Continuum (Minneap Minn) 2005. [DOI: 10.1212/01.con.0000293720.86238.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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García Callejo FJ, Laporta Marín P, Velert Vila MM, Orts Alborch MH, de Paula Vernetta C, Marco Algarra J. Hipoacusia asociada a colitis ulcerosa. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:68-73. [PMID: 15782645 DOI: 10.1016/s0001-6519(05)78574-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To value the eventual immunomediation in sensorineural hearing loss (SHL) on patients bearing of ulcerative colitis (UC). MATERIAL AND METHODS In a group of forty-nine cases with a mean age of 41.6+/-9.3 years old we studied the hearing loss level, the disease activity index, the peripheral blood inflammation markers and the anticochlear antibodies by mean of Western-blot technique (WB). RESULTS The 26.5% knew about their deafness, although SHL was detected in 59.1% of cases. The mean age of onset was 40.3+/-9.8 years. 48.9% showed a positive WB, always in 68-70 kDa molecular weight blots. Moreover, patients with positive WB showed more severe deafness, higher disease activity and more altered parameters, especially erythrosedimentation rate. CONCLUSIONS Audiologic and peripheral blood findings observed allow us to establish a reasonable suspicion of an autoimmune or immunomediated pathway of hearing loss on UC.
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Affiliation(s)
- F J García Callejo
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia.
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Loveman DM, de Comarmond C, Cepero R, Baldwin DM. Autoimmune sensorineural hearing loss: Clinical course and treatment outcome. Semin Arthritis Rheum 2004; 34:538-43. [PMID: 15505769 DOI: 10.1016/j.semarthrit.2003.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Autoimmune sensorineural hearing loss (ASHL) originally was defined both by the presence of progressive hearing loss (with or without vertigo) and a positive response to glucocorticoid therapy. Subsequently, antibodies to a 68-kd inner-ear antigen were identified in a high percentage of patients with ASHL. OBJECTIVE To analyze the disease progression and treatment outcome of ASHL. METHODS Retrospective chart review of 30 patients with a diagnosis of ASHL referred to Texas Tech Rheumatology Clinic. All subjects were tested for anti-68-kd antibody, had audiometric evidence of hearing loss, and were treated with glucocorticoids. RESULTS The median duration from onset of symptoms to audiometric testing was 25.5 weeks (mean, 144 weeks; range, 3-1,040 weeks), and to testing for anti-68-kd antibody was 40 weeks (mean, 157.3; range, 4-1,092 weeks). Ninety percent of subjects tested positive for anti-68-kd antibodies. By audiometric testing, 50% of subjects were steroid-responsive; minimal improvement or no change was recorded in 12%, and worsening occurred in 39% after steroid therapy. The 3 subjects who were anti-68-kd antibody-negative were steroid-unresponsive, and 1 progressed to complete deafness. CONCLUSIONS AND RELEVANCE This series of patients with ASHL suggests a more variable and benign course with a better prognosis than previously reported. Immunosuppressive therapy other than steroids rarely was required, and rapid progression to complete hearing loss was very uncommon in this cohort.
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Affiliation(s)
- Donald M Loveman
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Odessa, TX, USA.
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Nemoto H, Iguchi H, Ichikawa Y, Wakata N, Kurihara T. Ulcerative colitis presenting as sensorineural deafness, brainstem encephalopathy, and white matter lesions. Neurologist 2004; 10:165-8. [PMID: 15140276 DOI: 10.1097/01.nrl.0000126590.16002.39] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several rare neurologic complications of ulcerative colitis have been reported. REVIEW SUMMARY We report a 69-year-old Japanese woman who developed bilateral sensorineural deafness, 2 attacks of bilateral ophthalmoplegia, and bilateral facial nerve palsy in association with ulcerative colitis. Laboratory data showed elevated cerebrospinal fluid (CSF) protein without pleocytosis, abnormal auditory brainstem evoked potentials, and multiple high signal lesions on magnetic resonance imaging of the brainstem and cerebral deep white matter. Her symptoms improved with corticosteroid therapy except for sensorineural deafness and an exacerbation of cerebral deep white matter lesions without any new clinical signs. CONCLUSION Immunologic mechanisms may have led to her central and peripheral nervous system findings in addition to her colon disorder.
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Affiliation(s)
- Hiroshi Nemoto
- Fourth Department of Internal Medicine, Toho University School of Medicine, Ohashi, Meguro-ku, Tokyo.
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Kakigi A, Sawada S, Takeda T, Takeuchi S, Higashiyama K, Azuma H, Yamakawa K. Electrocochleographic findings in cases of autoimmune disease with sensorineural deafness. Auris Nasus Larynx 2004; 30:349-54. [PMID: 14656559 DOI: 10.1016/j.anl.2003.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To present electrocochleographic findings in patients with autoimmune disease (AD) with sensorineural deafness (ADSD), and to discuss the etiologies of sensorineural hearing loss (SNHL) in cases of ADSD. METHODS Study design is a retrospective review of electrocochleographic results of 26 patients with ADSD. To evaluate the electrocochleographic results, average SP/AP ratios were compared between ADSD and normal subjects. In the ADSD group, audiologic pattern, fluctuations in hearing and results of the glycerol test were also reviewed. Electrocochleography (ECoG) was recorded using the extratympanic method, and the SP to AP ratio (SP/AP ratio) was analyzed. RESULTS The mean of average SP/AP ratios in the ADSD groups (0.46) was significantly higher than that in normal subjects (0.27). Further, 17 of 29 affected ears in patients with ADSD showed fluctuating hearing loss. Eighteen ears showed low tone loss (rising and peak audiologic patterns). Only 5 of 26 ears (19.2%) showed positive results on glycerol test. There was no correlation between glycerol test results and hearing fluctuation or between glycerol test results and the SP/AP ratio on chi(2)-test. There was no tendency between audiologic pattern and glycerol test results or between audiologic pattern and the SP/AP ratio. CONCLUSION These results suggest the etiologies of SNHL in cases of ADSD remain unclear. However, some cases showed clinical findings similar to endolymphatic hydrops. We should bear in mind that clinical Meniere's syndrome involves ADSD. Further investigation is needed to resolve the etiology of SNHL of ADSD.
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Affiliation(s)
- Akinobu Kakigi
- Department of Otolaryngology, Kochi Medical School, Nankoku, 783-8505, Kochi, Japan.
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Lee S, Iwai H, Sugiura K, Takeuchi K, Kushida T, Tomoda K, Inaba M, Yamashita T, Ikehara S. Prevention of autoimmune hearing loss in MRL/lpr mice by bone marrow transplantation. Bone Marrow Transplant 2000; 26:887-92. [PMID: 11081390 DOI: 10.1038/sj.bmt.1702636] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined the effects of bone marrow transplantation (BMT) on immune-mediated inner ear diseases in MRL/Mp-lpr/lpr (MRL/lpr) mice, which manifest not only lupus nephritis but also sensorineural hearing loss (SNHL) at the age of 20 weeks. These mice were treated with cyclophosphamide (CY) and irradiation (5 Gy x 2), followed by the transplantation of bones plus bone marrow cells from allogeneic normal C57BL/6 mice at the age of 12 weeks. Hematolymphoid cells were reconstituted with donor-derived cells 3 months after BMT. Thus-treated MRL/lpr mice showed neither lupus nephritis nor SNHL even 24 weeks after BMT. No pathological findings were observed in either glomeruli or cochleae. These findings suggest that BMT can be used to prevent the development of autoimmune SNHL in MRL/lpr mice.
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Affiliation(s)
- S Lee
- First Department of Pathology, Kansai Medical University, Osaka, Japan
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Kumar BN, Smith MS, Walsh RM, Green JR. Sensorineural hearing loss in ulcerative colitis. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2000; 25:143-5. [PMID: 10816220 DOI: 10.1046/j.1365-2273.2000.00342.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sensorineural hearing loss has been described in a small number of patients with ulcerative colitis. At present, it is not known whether this is a rare and sporadic association, or whether these reports represent an under recognised extra-intestinal manifestation of ulcerative colitis. The aim of this study was to determine the prevalence of hearing loss in patients with ulcerative colitis. Twenty patients with active ulcerative colitis (mean age 45 years) were recruited prospectively along with 20 healthy age- and sex-matched controls. Otoscopy, tympanometry and pure tone audiometry were performed. The activity of the disease was scored according to a 12-month cumulative disease activity index. No patients complained of auditory symptoms. Otoscopy and tympanometry were normal in all patients and controls. Pure tone audiometry showed significant sensorineural hearing loss over all frequencies in patients with ulcerative colitis compared with controls. This preliminary study indicates that subclinical sensorineural hearing loss is associated with ulcerative colitis. Further study is warranted to determine the nature of the relationship and its pathological basis.
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Affiliation(s)
- B N Kumar
- Department of Otolaryngology-Head and Neck Surgery, North Staffordshire Royal Infirmary, Stoke on Trent, UK
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Abstract
The known etiologies of acquired sensorineural hearing loss include acoustic trauma, physical trauma, ototoxicity, genetic predisposition, infections, Meniere's disease, aging, and autoimmune disease. Treatments are directed at eliminating or managing the underlying disease process and aiding hearing with amplification. Rarely is it possible to improve unaided hearing after sensorineural loss except when the severe to profound level of loss is reached and cochlear implantation becomes an option. Autoimmune inner ear disease, however, is a treatable cause of sensorineural hearing loss and it is important for physicians and hearing health professionals to recognize that proper early diagnosis and management strategies may result in stabilization and possibly improvement in hearing.
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Affiliation(s)
- J T Roland
- Director Otology/Neurotology, New York University Medical Center, 530 First Avenue, Suite 3C, New York, NY 10016, USA.
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