1
|
V S, Sen R, B PC, G CB, M BA, M N. A Retrospective Study of Clinical Profile of Patients with Autoimmune Inner Ear Disease. Indian J Otolaryngol Head Neck Surg 2024; 76:633-638. [PMID: 38440549 PMCID: PMC10908966 DOI: 10.1007/s12070-023-04231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 03/06/2024] Open
Abstract
Bilateral sensorineural hearing loss can be a very distressing symptom and can affect the efficiency of a person and one's quality of life. Conditions causing bilateral hearing loss are very few and autoimmune aetiology is one of them. Autoimmune ear disease is characterised by bilateral, mostly fluctuating audiovestibular symptoms and symptoms which respond to steroids. Diagnosis of AIED presents a unique challenge to clinicians due to the lack of standardized diagnostic criteria or reliable pathognomonic tests. The purpose of the study is to evaluate the patients who fit into criteria of autoimmune inner ear disease and understand the clinical features and response to medications for the same. A retrospective chart review of patients presenting with rapidly progressive bilateral hearing loss was done. The clinical presentation including detailed history and examination findings along with the blood investigation reports and audiograms were recorded in a tabular form. The study included 6 patients - 3 male and 3 female patients. Age of the patients at onset of hearing loss varied between 24-35 years. 3 of 6 patients presented with primary autoimmune ear disease and other 3 had hearing loss secondary to systemic autoimmune disease. All patients were treated with systemic steroids, but however showed a varied response. Patients with primary AIED were administered inner ear steroid therapy as well. AIED is thus a diagnosis of exclusion done with high index of suspicion. Patients with bilateral progressive sensorineural hearing loss should be evaluated for autoimmune etiology. Oral steroids with intratympanic steroids are currently the mainstay of treatment for AIED. Guarded prognosis of hearing improvement is noted in these patients. Hence, emphasis should be placed on early hearing rehabilitation for better quality of life.
Collapse
Affiliation(s)
- Sreenivas V
- Department of Otorhinolaryngology, Head and Neck Surgery, St John’s Medical College Hospital, Bangalore, India
| | - Rosemary Sen
- Department of Otorhinolaryngology, Head and Neck Surgery, St John’s Medical College Hospital, Bangalore, India
| | - Pratibha C B
- Department of Otorhinolaryngology, Head and Neck Surgery, St John’s Medical College Hospital, Bangalore, India
| | - Chaithra B G
- Department of Otorhinolaryngology, Head and Neck Surgery, St John’s Medical College Hospital, Bangalore, India
| | - Balasubramanya A M
- Department of Otorhinolaryngology, Head and Neck Surgery, St John’s Medical College Hospital, Bangalore, India
| | - Nagapoornima M
- Department of Otorhinolaryngology, Head and Neck Surgery, St John’s Medical College Hospital, Bangalore, India
| |
Collapse
|
2
|
Kim KT, Park E, Lee SU, Kim B, Kim BJ, Kim JS. Clinical Features and Neurotologic Findings in Patients With Acute Unilateral Peripheral Vestibulopathy Associated With Antiganglioside Antibody. Neurology 2023; 101:e1913-e1921. [PMID: 37748887 PMCID: PMC10663017 DOI: 10.1212/wnl.0000000000207814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Anecdotal studies have reported the presence of antiganglioside antibodies in acute unilateral peripheral vestibulopathy (AUPV). This study aimed to determine the prevalence, clinical characteristics, and neurotologic findings of AUPV associated with antiganglioside antibodies. METHODS Serum antigangliosides were measured in consecutive patients with AUPV according to the Bárány Society criteria during the acute and recovery phases in a referral-based university hospital in South Korea from September 2019 to January 2023. Clinical characteristics and neurotologic findings were compared between those with and without antiganglioside antibodies. The results of video-oculography, video head impulse and bithermal caloric tests, and other neurotologic evaluations including ocular and cervical vestibular-evoked myogenic potentials and subjective visual vertical were compared between the 2. MRIs dedicated to the inner ear were also conducted when considered necessary. RESULTS One hundred five patients (mean age ± SD = 60 ± 13 years, 57 male) were included for analyses. During the acute phase, 12 patients (12/105, 11%) were tested positive for serum antiganglioside antibodies, including anti-GQ1b immunoglobulin (Ig) G (n = 5) or IgM (n = 4), anti-GM1 IgM (n = 3), and anti-GD1a IgG (n = 1, including 1 patient with a positive anti-GQ1b antibody). Patients with antiganglioside antibodies showed lesser intensity of spontaneous nystagmus (median [interquartile range] = 1.8 [1.2-2.1] vs 3.4 [1.5-9.5], p = 0.003) and a lesser degree of canal paresis (30 [17-47] vs 58 [34-79], p = 0.028) and gain asymmetry of the vestibulo-ocular reflex for the horizontal semicircular canal during head impulse tests (0.07 [-0.04 to 0.61] vs 0.36 [0.18-0.47], p = 0.032) than those without antibodies. Negative conversion of antibodies and vestibular recovery were observed in most patients (6/8, 75%). Among 30 patients with AUPV with 4-hour delayed 3D fluid-attenuated inversion recovery dedicated to the inner ear, gadolinium enhancement was observed in 18 (18/30, 60%), either in the vestibule (n = 9), semicircular canal (n = 6), or vestibular nerve (n = 5). The positivity rates based on specific antibodies could not be determined due to limited sample sizes. DISCUSSION The association between antiganglioside antibodies and AUPV suggests an immune-mediated mechanism in acute vestibular failure and extends the clinical spectrum of antiganglioside antibody syndrome.
Collapse
Affiliation(s)
- Keun-Tae Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Euyhyun Park
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Sun-Uk Lee
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea.
| | - Byungjun Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Byung-Jo Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Ji-Soo Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| |
Collapse
|
3
|
Shah S, Chidarala S, Jeong S, Zhang K, Nguyen SA, Wilkinson R, Ward C, Rizk H. Secondary autoimmune immune ear disease (AIED): a systematic review and meta-analysis on vestibular manifestations of systemic autoimmune and inflammatory disorders. Clin Rheumatol 2023; 42:2747-2759. [PMID: 37380912 DOI: 10.1007/s10067-023-06674-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
Secondary autoimmune inner ear disease (AIED) is often bilateral and asymmetric in patients presenting with audiovestibular symptoms due to a systemic autoimmune disease. This systematic review and meta-analysis are aimed at identifying and highlighting patterns in prevalence of vestibular dysfunction, symptom presentation, and diagnostic methods in extant literature by combining clinical context from case reports with quantitative analyses from cohort studies. Screening of articles by title, abstract, and full text was completed by four reviewers (K.Z., A.L., S.C., and S.J.). In this study, we grouped secondary AIED and systemic autoimmune diseases by pathophysiologic mechanism: (1) connective tissue disease (CTD), (2) vasculitides (VAS), (3) systemic inflammatory disorders (SID), and (4) other immune-mediated disorders (OIMD). The search for AIED disease identified 120 articles (cohorts and case reports) that met the final inclusion criteria. All 120 were included in the qualitative review, and 54 articles were included for meta-analysis. Of these 54 articles, 22 included a control group (CwC). Ninety individual cases or patient presentations from 66 articles were included for analysis in addition to the 54 cohort articles. Secondary AIED does not have a diagnostic algorithm for managing vestibular symptoms. The management of audiovestibular symptoms requires close collaboration between otolaryngologists and rheumatologists to preserve end-organ function of the ear. To improve our ability to understand the impact on the vestibular system, vestibular clinicians need to develop a standardized reporting method. Clinical presentation should frequently be paired with vestibular testing to contextually investigate symptom severity and provide higher quality care.
Collapse
Affiliation(s)
- Sunny Shah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shreya Chidarala
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel Wilkinson
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Celine Ward
- Department of Rheumatology, Medical University of South Carolina, Charleston, SC, USA
| | - Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
4
|
Huang KH, Lin HC, Lin CD, Wu PC. Relapsing autoimmune inner ear disease with significant response to methotrexate and azathioprine combination therapy: A case report and mini literature review. Medicine (Baltimore) 2023; 102:e33889. [PMID: 37335659 DOI: 10.1097/md.0000000000033889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
RATIONALE Autoimmune inner ear disease typically presents with bilateral hearing loss that progresses over weeks or months though its mechanisms are unknown. Corticosteroids are the first-line treatment, but their responses are variable and relapses are frequent. Thus, many experts have sought to replace corticosteroids with immunosuppressive agents. PATIENT CONCERNS A 35-year-old woman experienced a progressive hearing impairment, initially on the left side and later becoming bilateral. Her response to corticosteroid monotherapy was temporary, and there have been two relapse episodes over several months. DIAGNOSES Autoimmune inner ear disease was considered due to evidence of autoimmunity combined with a clinical course of bilateral and recurrent sensorineural hearing loss and a partial response to corticosteroid therapy. INTERVENTIONS The patient received a 3-day mini-pulse of methylprednisolone at 250 mg/d, followed by 12 mg/d maintenance, and concurrently began an azathioprine regimen gradually increasing to 100 mg/day as a corticosteroid-sparing agent. OUTCOMES Three weeks after immunosuppressive therapy, hearing and pure-tone audiometry improved, and after 7 weeks, methylprednisolone was tapered to 8 mg/d. The dosage was further reduced by adding methotrexate at 7.5 mg/week, resulting in a reduction to 4 mg/d as maintenance therapy after 4 weeks. LESSONS For patients who are unresponsive to corticosteroids or experience difficulty tolerating them, a combination therapy of methotrexate and azathioprine is recommended as a viable alternative as this regimen is well-tolerated and yields positive outcomes.
Collapse
Affiliation(s)
- Kuan-Hsuan Huang
- Department of Education, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Hsiao-Ching Lin
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Po-Chang Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
5
|
Foster T, Lewkowicz M, Quintas C, Ionescu CM, Jones M, Wagle SR, Kovacevic B, Wong EYM, Mooranian A, Al-Salami H. Novel Nanoencapsulation Technology and its Potential Role in Bile Acid-Based Targeted Gene Delivery to the Inner Ear. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2204986. [PMID: 36538754 DOI: 10.1002/smll.202204986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/05/2022] [Indexed: 06/17/2023]
Abstract
Hearing loss impacts a large proportion of the global population. Damage to the inner ear, in particular the sensitive hair cells, can impact individuals for the rest of their lives. There are very limited options for interventions after damage to these cells has occurred. Targeted gene delivery may provide an effective means to trigger appropriate differentiation of progenitor cells for effective replacement of these sensitive hair cells. There are several hurdles that need to be overcome to effectively deliver these genes. Nanoencapsulation technology has previously been used for the delivery of pharmaceuticals, proteins and nucleic acids, and may provide an effective means of delivering genes to trigger appropriate differentiation. This review investigates the background of hearing loss, current advancements and pitfalls of gene delivery, and how nanoencapsulation may be useful.
Collapse
Affiliation(s)
- Thomas Foster
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Michael Lewkowicz
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Christina Quintas
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
| | - Corina Mihaela Ionescu
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Melissa Jones
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Susbin Raj Wagle
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Bozica Kovacevic
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Elaine Y M Wong
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Armin Mooranian
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
- School of Pharmacy, University of Otago, Dunedin, Otago, 9016, New Zealand
| | - Hani Al-Salami
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
6
|
Sensorineural Hearing Loss in Sjögren’s Syndrome. Int J Mol Sci 2022; 23:ijms231911181. [PMID: 36232483 PMCID: PMC9569624 DOI: 10.3390/ijms231911181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Sjögren’s syndrome is a chronic autoimmune disease characterized by systemic dysfunction of exocrine glands, mainly the salivary and lachrymal glands. Sjögren’s syndrome consists of two forms: primary Sjögren’s syndrome, which is characterized by dry eyes and dry mouth without autoimmune diseases; and secondary Sjögren’s syndrome, which is characterized by symptoms associated with other autoimmune diseases, such as systemic lupus erythematosus. Disease severities vary considerably from mild glandular dryness to severe glandular involvement with numerous extraglandular and systemic features. Sensorineural hearing loss is sometimes observed in both primary and secondary Sjögren’s syndrome. This review article consists of (1) Pathology of Sjögren’s syndrome, (2) Clinical manifestation of Sjögren’s syndrome, (3) Autoimmune inner ear disease, (4) Histoanatomical features of the inner ear, (5) Immunological characteristics of the inner ear, (6) Pathophysiology of autoimmune inner ear disease, (7) Treatment for sensorineural hearing loss in Sjögren’s syndrome, and (8) Future direction. Finally, we introduce a recently developed disease model of salivary gland inflammation and discuss future expectations for the treatment of sensorineural hearing loss in Sjögren’s syndrome.
Collapse
|
7
|
Cochlear implantation in systemic autoimmune disease. Curr Opin Otolaryngol Head Neck Surg 2022; 30:291-297. [PMID: 36004773 DOI: 10.1097/moo.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Autoimmune inner ear disease (AIED) is a rare, but likely underrecognized cause of hearing loss. However, hearing loss is common in systemic autoimmune disease and it is important for the clinician to be familiar with the spectrum of disease. In this article, we will review the developments in diagnosis and management of AIED, with a focus on the outcomes and potential pitfalls of cochlear implantation. RECENT FINDINGS Hearing loss in AIED tends to be progressive and bilateral, but up to 40% can present as sudden hearing loss and one-third can present unilaterally. HSP-70 serology may help with diagnosis and may predict steroid response. Cochlear implantation provides excellent hearing and quality of life outcomes in patients deafened by AIED. Intracochlear fibrosis/ossification is found intraoperatively in the majority (54%) of patients undergoing cochlear implantation. A large percentage (32%) of patients has fluctuating impedances postimplantation, which may interfere with implant performance and mapping. SUMMARY Diagnosis of AIED is largely clinical, and a strong index of suspicion is required. Multidisciplinary care is crucial for optimal management. Cochlear implant outcomes are generally excellent, but the clinician needs to be cognizant of the pitfalls of encountering intracochlear fibrosis intraoperatively and likelihood of implant performance fluctuation related to ongoing inflammation in the cochlea.
Collapse
|
8
|
NaCl exposure results in increased expression and processing of IL-1β in Meniere's disease patients. Sci Rep 2022; 12:4957. [PMID: 35322136 PMCID: PMC8943007 DOI: 10.1038/s41598-022-08967-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/03/2022] [Indexed: 11/08/2022] Open
Abstract
Meniere's disease (MD) is a chronic disease that causes episodic vertigo, fluctuating hearing loss, and aural fullness, initially managed by dietary salt reduction, and use of diuretics. Our prior research in autoimmune inner ear disease (AIED) demonstrated that in peripheral blood mononuclear cell (PBMC) from corticosteroid-resistant AIED patients, increased production, processing and release of interleukin-1β (IL-1β) is observed and hearing could be improved with use of anakinra, an interleukin-1 receptor antagonist. We have further identified that in these AIED patients, IL-1β is uniquely processed to a 28 kDa pro-inflammatory product by caspase-7. In the present study, we characterize the production, processing and release of the pro-inflammatory cytokines IL-1β and IL-6 from PBMC of MD (n = 14) patients in response to sodium chloride (NaCl), and determined the effect of the diuretic triamterene-hydrocholothiazide (T-HCTZ), or anakinra in these patients. We observed that PBMC cultured with NaCl from MD patients show processing of IL-1β to the 28 kDa product, and that this product is abrogated with T-HCTZ. Our observations are consistent with other autoimmune diseases where high concentrations of NaCl caused release of pro-inflammatory cytokines and may provide further insight as to the mechanism of disease progression in MD patients.
Collapse
|
9
|
Combination Immunosuppressive Therapy in Primary Autoimmune Inner Ear Disease in Pregnancy. Case Rep Otolaryngol 2022; 2022:9210780. [PMID: 35340893 PMCID: PMC8956394 DOI: 10.1155/2022/9210780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. Autoimmune inner ear disease (AIED) is a rare disorder characterized by rapidly progressive, sensorineural hearing loss that demonstrates good responsiveness to corticosteroid and immunosuppressive therapy. The pathophysiology is likely driven by chronic trafficking of immune cells into the inner ear, targeting inner ear proteins to coordinate inflammation. Suppression or modulation of the immune response can minimize cochleitis allowing for potential recovery of hearing. It is an otologic emergency requiring a multidisciplinary approach to management to commence immunosuppressive therapy. This can be achieved using steroids, immunomodulators, plasmapheresis, intravenous immunoglobulin, or biologic agents. Treatment decisions are further complicated in pregnancy and require supervision by an obstetrician and maternal-fetal medicine (MFM) specialist. Concerns include safe dosing of steroids and potential for transplacental migration of immune complexes. We provide the first comprehensive literature review on AIED and its implications in pregnancy. We frame our discussion in the context of the second reported case of primary AIED in pregnancy and the first to show excellent response to immunosuppressive therapy. Methods. We reviewed the presented case and literature on AIED. Results. A 27-year-old, pregnant, HSP-70 positive woman was diagnosed with AIED and had excellent recovery of hearing and balance following a combination of steroid treatment, augmented by oral immunomodulators, plasmapheresis, and IVIG. Conclusion. AIED is a diagnostic challenge, and treatment considerations are complex when encountered in pregnancy. Management requires multidisciplinary involvement between otolaryngologists, immunologists, and obstetricians to balance maternal and fetal health outcomes.
Collapse
|
10
|
Magdy M, Elmowafy E, Elassal M, Ishak RA. Localized drug delivery to the middle ear: Recent advances and perspectives for the treatment of middle and inner ear diseases. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
11
|
Psillas G, Dimas GG, Daniilidis M, Binos P, Tegos T, Constantinidis J. Audiological Patterns in Patients with Autoimmune Hearing Loss. Audiol Neurootol 2021; 27:336-346. [PMID: 34518471 DOI: 10.1159/000518694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to illustrate clinical and audiological patterns of hearing impairment in patients with autoimmune hearing loss (AIHL). METHODS Fifty-three patients with AIHL were retrospectively recruited, and a tapering schema of steroid treatment was administered in all these patients. The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden (sensorineural hearing loss [SSHL]), fluctuating, or quickly progressing (<12 months) SSHL (uni-/bilateral), in association with the coexistence of autoimmune diseases, high antinuclear antibodies (ANA) and the presence of human leukocyte antigen (HLA) B27, B35, B51, C04, and C07. Logistic regression analysis was applied to correlate the clinical data and laboratory features of AIHL with final outcomes. RESULTS The onset of AIHL was mainly progressive (49%), followed by SSHL (39.6%) or fluctuating (11.3%). The pure-tone audiogram showed more commonly a downsloping pattern (42.6% of ears), but also an upsloping, flat, cookie-bite, or inverse cookie-bite shape. Bilateral progressive AIHL was more frequently simultaneous (23 patients) than heterochronous (4 patients). Nineteen patients (35.8%) showed a favorable response to steroid therapy. The presence of recurrent, bilateral SSHL versus recurrent, unilateral SSHL had statistically negative effect on hearing recovery (OR = 0.042, p < 0.05). The heterochronous bilateral SSHL may have better prognosis than simultaneous bilateral SSHL (OR = 10.000, p = 0.099). The gender, age, concomitant autoimmune disease, high ANA, HLA alleles, tinnitus, and vestibular symptoms had no statistical effect on a favorable outcome of AIHL. CONCLUSIONS A bilateral, simultaneous, and progressive hearing loss combined with downsloping audiogram occurred more often in patients with AIHL. Bilateral simultaneous SSHL with recurrences represents the worse prognostic form of AIHL.
Collapse
Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios G Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Michalis Daniilidis
- 1st Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Paris Binos
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Thomas Tegos
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| |
Collapse
|
12
|
Derebery MJ, Christopher L. Allergy, Immunotherapy, and Alternative Treatments for Dizziness. Otolaryngol Clin North Am 2021; 54:1057-1068. [PMID: 34294437 DOI: 10.1016/j.otc.2021.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Allergic reactions may result in central symptoms of dizziness, including nonspecific chronic imbalance, Meniere's disease, and autoimmune inner ear disease. Excepting first-generation antihistamines, and short-term use of steroids, most pharmacotherapies used to treat allergic rhinitis have limited benefit in treating allergically induced or related dizziness. Allergy immunotherapy and/or an elimination diet for diagnosed food allergies have been found to be effective treatments. Individuals diagnosed with autoimmune inner ear disease remain challenging to treat and may require high-dose, long-term steroid treatment, biologics, or immunomodulators for symptom control.
Collapse
Affiliation(s)
- M Jennifer Derebery
- House Ear Clinic and Institute, 2100 West Third Street, Los Angeles, CA 90057, USA.
| | | |
Collapse
|
13
|
Progressive and Degenerative Peripheral Vestibular Disorders. Otolaryngol Clin North Am 2021; 54:959-971. [PMID: 34301401 DOI: 10.1016/j.otc.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Initial diagnosis of peripheral vestibulopathy requires a detailed history, physical examination, and, in some cases, audiovestibular testing, radiographic imaging, or serology. Differentiation of a peripheral vestibulopathy as progressive or degenerative is often nuanced and influenced by a characterization of a patient's symptoms or natural history over time. A diverse group of vestibular pathology may fit into this category, including Ménière's disease, autoimmune conditions, congenital pathologies, ototoxic medications, radiation therapy, and perilymphatic fistula. Differentiation among these entities may be guided by initial or subsequent symptomatology, with various combinations of audiovestibular testing, serology, and imaging. Treatment options are disparate and disease-specific, ranging from observation to medical management or surgical intervention, underscoring the need for astute investigation and diagnosis.
Collapse
|
14
|
Guo L, Wei X, Jiang P. The use of gene-modified bone marrow mesenchymal stem cells for cochlear cell therapy. Transpl Immunol 2021; 68:101433. [PMID: 34197926 DOI: 10.1016/j.trim.2021.101433] [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] [Received: 05/26/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to investigate the potential of using bone marrow mesenchymal stem cells (BMSCs) for treatment of inflammation and autoimmune sensorineural hearing loss. METHODS Fifty-five immunized guinea pigs were divided into five groups. Group A received BMSCs expressing IL-4, group B received BMSCs expressing an empty carrier vector, group C received recombinant lentivirus expressing IL-4, group D received recombinant lentivirus expressing an empty carrier vector, and group E received phosphate-buffered saline. Auditory function was monitored using brain stem responses (ABRs) to evaluate the auditory changes. The distribution of implanted BMSCs in the inner ear was estimated using fluorescence microscopy. The distribution and expression of IL-4 gene products in the inner ear were detected via immunohistochemistry. RESULTS After transplantation, the ABR III wave threshold decreased significantly in BMSCs expressing exogenous IL-4 group (group A), BMSCs expressing empty carrier vector group (group B), and recombinant lentivirus expressing IL-4 group (group C) (P < 0.001), which means the auditory functions of the experimental guinea pigs were improved. Further statistical analysis revealed that BMSCs expressing exogenous IL-4 group (group A) and BMSCs expressing empty carrier vector group (group B) were able to improve the auditory function more obviously (P < 0.05). Lentivirus-infected BMSCs were able to migrate to the inner ear. Fluorescence-positive BMSCs were scattered in the scala tympani and vestibule. CONCLUSIONS These results demonstrated that BMSCs expressing exogenous IL-4 successfully migrated into the inner ear in an in vitro study. BMSCs expressing exogenous IL-4 and BMSCs can be used to treat inflammatory injury in autoimmune inner ear diseases.
Collapse
Affiliation(s)
- Lang Guo
- Department of Otolaryngology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xu Wei
- Department of Otolaryngology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Ping Jiang
- Department of Otolaryngology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
15
|
Lee J, Biggs K, Muzaffar J, Bance M, Monksfield P. Hearing loss in inner ear and systemic autoimmune disease: A systematic review of post-cochlear implantation outcomes. Laryngoscope Investig Otolaryngol 2021; 6:469-487. [PMID: 34195369 PMCID: PMC8223457 DOI: 10.1002/lio2.563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess outcomes following cochlear implantation (CI) in patients with hearing loss secondary to primary or secondary autoimmune inner ear disease (AIED). METHODS A systematic review and narrative synthesis was completed according to PRISMA guidelines. Databases searched included MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Collection, and ClinicalTrials.gov. No limits were placed on year of publication or language. RESULTS A total of 551 studies were identified, of which 29 were included after removal of duplicates, and screening the title, abstract, and full text. All except one study were OCEBM grade IV. 114 of 115 patients displayed improvement in hearing following cochlear implantation. With implant use, roughly a third of these patients had hearing that improved over time, a third improved and plateaued, and a third remained stable. There was no additional risk of perioperative complications found in AIED patients compared what is generally accepted in general cochlear implantation, although two episodes of device failure after 6 months were noted, and four patients with secondary AIED displayed poor initial audiological outcomes. CONCLUSION CI in both primary and secondary AIED provides marked improvement in hearing. Early CI may be a valid management option, provide long-lasting hearing in patients and reduce the side effects of long-term systemic immunosuppressants. However, patients should be counseled residual hearing may be lost if there is cochlear ossification or fibrosis which may make implant insertion more traumatic. LEVEL OF EVIDENCE NA.
Collapse
Affiliation(s)
| | - Kirsty Biggs
- University Hospitals of North MidlandsStoke‐on TrentUK
| | - Jameel Muzaffar
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
- University of CambridgeCambridgeUK
| | - Manohar Bance
- University of CambridgeCambridgeUK
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Peter Monksfield
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| |
Collapse
|
16
|
Nishimura T, Okayasu T, Hosoi H, Kitahara T. Long-term (16-26 years) follow-up outcome of steroid therapy in refractory autoimmune sensorineural hearing loss. J Autoimmun 2021; 121:102664. [PMID: 34049153 DOI: 10.1016/j.jaut.2021.102664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
Autoimmune sensorineural hearing loss (ASHL) is a rare disease of uncertain etiology, with no established treatment strategy. The duration of morbidity is increased in refractory cases; and therefore, the preservation of hearing and the prevention of adverse effects with steroid therapy are serious long term issues to consider. Long-term follow up of patients treated for ASHL was performed retrospectively in order to elucidate the pathogenesis of ASHL, evaluate the consequences of steroid therapy, and determine a promising treatment course. The cohort in this study consists of four female patients with refractory ASHL that were followed for 16-26 years. Three patients already had profound deafness on one side, probably due to ASHL, before the initiation of steroid treatment. ASHL was managed with steroid administration and the hearing was evaluated through regular audiometric tests (173-212 times). The relationship between pure tone threshold average and steroid dose was reviewed over a long-term follow-up period for each patient. During follow-up, hearing deficit progressed rapidly several times in all patients, as did responsiveness to steroid therapy. Long-term high-dose steroid therapy was not required for hearing maintenance. Hearing thresholds were nearly maintained in three patients during the 16- to 21- year follow-up, and gradually declined over a 26-year follow-up period in one patient. Considering the progress due to presbycusis, the maintenance of hearing was considered sufficient in all patients. No serious adverse effects were observed in any of the patients. Management of patients affected by ASHL with regular audiometry allowed for hearing maintenance without the morbidity of prolonged steroid therapy. The current observations give insight into the pathogenesis of ASHL pathogenesis and establish an efficient course of treatment.
Collapse
Affiliation(s)
- Tadashi Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Tadao Okayasu
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroshi Hosoi
- MBT (Medicine-Based Town) Institute, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
17
|
Ishiyama G. Selected Otologic Disorders Causing Dizziness. ACTA ACUST UNITED AC 2021; 27:468-490. [PMID: 34351115 DOI: 10.1212/con.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome. RECENT FINDINGS The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered. SUMMARY This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.
Collapse
|
18
|
Corazzi V, Hatzopoulos S, Bianchini C, Skarżyńska MB, Pelucchi S, Skarżyński PH, Ciorba A. The Pathogenesis of secondary forms of Autoimmune Inner Ear Disease (AIED): advancing beyond the audiogram data. Expert Rev Clin Immunol 2021; 17:233-246. [PMID: 33476250 DOI: 10.1080/1744666x.2021.1879640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Autoimmune Inner Ear Disease (AIED) can be of a primary or secondary type. To date, a clear pathogenesis of the disease is still not available. Focusing on the secondary forms of AIED, the aim of this review is to (i) assess and describe the hearing involvement in patients affected by autoimmune diseases, (ii) describe the possible association between clinical features (among serological/laboratory data and disease activity/duration) and hearing impairment, (iii) show evidence connecting the AIED types with various etiopathogenetic mechanisms. AREAS COVERED A PRISMA-compliant systematic review was performed. Medline, Cochrane, Embase, and Cinahl were searched from 1 January 2015 through to 5 August 2020. Overall, 16 studies (involving 1043 participants) were included in the review. The data in the literature suggested that bilateral mild-to-moderate sensorineural hearing loss is a commonly reported clinical symptom of AIED. EXPERT OPINION Patients with systemic autoimmune disorders present a cochlear injury which might be associated with the humoral and/or cellular immune response against the inner ear. To date, AIED pathogenesis remains an open issue, due to the rarity of these clinical entities and due to the difficulties in investigating the inner ear immunology, considering the inner ear inaccessibility for tissue sampling.
Collapse
Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Stavros Hatzopoulos
- ENT and Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Bianchini
- ENT and Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Magdalena B Skarżyńska
- Institute of Sensory Organs, Kajetany, Poland.,Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Stefano Pelucchi
- ENT and Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Piotr Henryk Skarżyński
- Institute of Sensory Organs, Kajetany, Poland.,Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Ciorba
- ENT and Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| |
Collapse
|
19
|
Cheng H, Yang F, Zhang J, Xu L, Jia L, Zhao D, Liu W, Li H. Case Report: Anti-NMDA Receptor Encephalitis With Bilateral Hearing Loss as the Initial Symptom. Front Neurol 2021; 12:648911. [PMID: 33815260 PMCID: PMC8010237 DOI: 10.3389/fneur.2021.648911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease associated with the NMDA receptor. This paper describes a patient who presented with bilateral hearing loss as the initial symptom of anti-NMDAR encephalitis. Case Report: We describe a 31-year-old young female with anti-NMDAR encephalitis who presented with bilateral severe hearing loss after brief loss of consciousness and then accompanied by other symptoms, such as generalized tonic–clonic seizures, manic episodes, excessive salivation, severe cognitive impairment, and complex non-convulsive status epilepticus. Great improvement was achieved by a combined treatment of steroid, IVIG, and plasmapheresis, especially after surgical removal of the ovarian teratoma. When she was discharged on hospital day 43, her hearing loss obtained a significant improvement. Conclusion: This case study and literature review investigated the impairment of hearing loss and its subsequent treatment in patients with anti-NMDAR encephalitis.
Collapse
Affiliation(s)
- Hongjiang Cheng
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Fengbing Yang
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Jing Zhang
- Changzhi Medical College, Changzhi, China
| | - Lina Xu
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Longbin Jia
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Doudou Zhao
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Wei Liu
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Huimin Li
- Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| |
Collapse
|
20
|
Human Leukocyte Antigen (HLA) Influence on Prognosis of Autoimmune Hearing Loss. Audiol Res 2021; 11:31-37. [PMID: 33503870 PMCID: PMC7838950 DOI: 10.3390/audiolres11010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background: To evaluate the effect of human leukocyte antigen (HLA) on hearing outcome in patients suffering from autoimmune hearing loss (AIHL). Materials and Methods: The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden, fluctuating, or quickly progressing (<12 months) sensorineural hearing loss (uni-/bilateral). The molecular typing of HLA alleles was achieved by using polymerase chain reaction procedures. Patients underwent a tapering schema of steroid treatment and audiometric features were recorded. A logistic regression model was used to identify which HLA typing alleles were statistically significant in patients’ response to treatment. Results: Forty patients with AIHL were found to be carriers of HLA B27, B35, B51, C4, C7, and DRB1*04 alleles. No statistically significant influence of HLA B27, B35, B51, C4, C7, DRB1*04 HLA alleles typing was detected for the prognosis of AIHL. In these patients, the onset of AIHL was mainly progressive (53.8%), 29.2% of them had moderate hearing loss, and most of the cases had both bilateral hearing loss (62.5%) and downsloping audiogram (40%). Conclusion: The presence of HLA B27, B35, B51, C4, C7, and DRB1*04 alleles had no significant effect on a favorable outcome of AIHL. However, larger samples of patients are necessary in order to improve the knowledge about the HLA influence on the clinical course of AIHL.
Collapse
|
21
|
Yan F, Reddy PD, Nguyen SA, Ward C, Meyer TA. Hearing Loss in Patients With Ankylosing Spondylitis: A Systematic Review and Metaanalysis. J Rheumatol 2021; 48:40-47. [PMID: 32414955 DOI: 10.3899/jrheum.200276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence of hearing loss (HL) in patients with ankylosing spondylitis (AS) and to describe frequency-specific hearing threshold changes in this patient population compared to patients without AS. METHODS A systematic review querying 4 databases (PubMed, OVID Medline, Scopus, Cochrane) was performed to identify studies evaluating HL in patients with AS. Metaanalysis was performed to identify overall prevalence rate and OR of HL, as well as to compare mean differences in frequency-specific hearing thresholds between patients with and without AS. RESULTS Our metaanalysis included 14 studies and 1083 patients (598 with AS vs 485 without AS). The pooled prevalence of HL in patients with AS was 42.4% (95% CI 29.2-56.2). Patients with AS had a significantly higher OR of HL than patients without AS (OR 4.65, 95% CI 2.73-7.91). Mean differences in pure-tone hearing thresholds ranged from 0-5 decibels (dB) for frequencies of 0.25-4 kHz, and from 5-15 dB for frequencies of 6-16 kHz. CONCLUSION Patients with AS have higher odds of having HL than patients without AS. The AS population also presents with significantly impaired hearing thresholds across all conventional and extended pure-tone frequencies. This may manifest as slight to moderate HL. Results of this systematic review might justify increased attention to audiologic manifestations of patients with AS.
Collapse
Affiliation(s)
- Flora Yan
- F. Yan, BA, P.D. Reddy, BS, S.A. Nguyen, MD, T.A. Meyer, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina;
| | - Priyanka D Reddy
- F. Yan, BA, P.D. Reddy, BS, S.A. Nguyen, MD, T.A. Meyer, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina
| | - Shaun A Nguyen
- F. Yan, BA, P.D. Reddy, BS, S.A. Nguyen, MD, T.A. Meyer, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina
| | - Celine Ward
- C. Ward, MD, Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- F. Yan, BA, P.D. Reddy, BS, S.A. Nguyen, MD, T.A. Meyer, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina
| |
Collapse
|
22
|
Biomarkers for Inner Ear Disorders: Scoping Review on the Role of Biomarkers in Hearing and Balance Disorders. Diagnostics (Basel) 2020; 11:diagnostics11010042. [PMID: 33383894 PMCID: PMC7824431 DOI: 10.3390/diagnostics11010042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/24/2022] Open
Abstract
The diagnostics of inner ear diseases are primarily functional, but there is a growing interest in inner ear biomarkers. The present scoping review aimed to elucidate gaps in the literature regarding the definition, classification system, and an overview of the potential uses of inner ear biomarkers. Relevant biomarkers were categorized, and their possible benefits were evaluated. The databases OVID Medline, EMBASE, EBSCO COINAHL, CA PLUS, WOS BIOSIS, WOS Core Collection, Proquest Dissertations, Theses Global, PROSPERO, Cochrane Library, and BASE were searched using the keywords “biomarker” and “inner ear”. Of the initially identified 1502 studies, 34 met the inclusion criteria. The identified biomarkers were classified into diagnostic, prognostic, therapeutic, and pathognomonic; many were detected only in the inner ear or temporal bone. The inner-ear-specific biomarkers detected in peripheral blood included otolin-1, prestin, and matrilin-1. Various serum antibodies correlated with inner ear diseases (e.g., anti-type II collagen, antinuclear antibodies, antibodies against cytomegalovirus). Further studies are advised to elucidate the clinical significance and diagnostic or prognostic usage of peripheral biomarkers for inner ear disorders, filling in the literature gaps with biomarkers pertinent to the otology clinical practice and integrating functional and molecular biomarkers. These may be the building blocks toward a well-structured guideline for diagnosing and managing some audio-vestibular disorders.
Collapse
|
23
|
Breslin NK, Varadarajan VV, Sobel ES, Haberman RS. Autoimmune inner ear disease: A systematic review of management. Laryngoscope Investig Otolaryngol 2020; 5:1217-1226. [PMID: 33364414 PMCID: PMC7752060 DOI: 10.1002/lio2.508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The study systematically reviewed the existing literature on the management of autoimmune inner ear disease (AIED). STUDY DESIGN Systematic review. METHODS We performed a literature search of Embase, NCBI, Cochrane, and Web of Science databases from April 1990 to April 2020. Inclusion criteria included studies that were retrospective or prospective in nature evaluating the treatment of AIED with audiometric data measuring hearing outcomes during treatment. Hearing improvement was the primary study outcome and improvement in vestibular symptoms was the secondary study outcome. RESULTS Sixteen of 412 candidate articles were included in our study. Systemic steroid treatment is most commonly described. Alternative treatment modalities included intratympanic steroid treatment, methotrexate, cyclophosphamide, azathioprine, infliximab, etanercept, adalimumab, golimumab, methylprednisolone, rituximab, and anakinra. CONCLUSION Systemic corticosteroids are the first line treatment of AIED. Intratympanic steroids are a potential adjuvant or alternative treatment for patients who cannot tolerate or become refractory to steroid treatment. Steroid nonresponders may benefit from biologic therapy. Alternative treatment modalities including nonsteroidal immunosuppressants and biologics have been studied in small cohorts of patients with varying results. Prospective studies investigating the efficacy of biologic and nonsteroidal therapy are warranted. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
| | - Varun V. Varadarajan
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Eric S. Sobel
- Department of Medicine, Division of Rheumatology and Clinical ImmunologyUniversity of FloridaGainesvilleFloridaUSA
| | - Rex S. Haberman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of FloridaGainesvilleFloridaUSA
| |
Collapse
|
24
|
Antioxidant Therapy against Oxidative Damage of the Inner Ear: Protection and Preconditioning. Antioxidants (Basel) 2020; 9:antiox9111076. [PMID: 33147893 PMCID: PMC7693733 DOI: 10.3390/antiox9111076] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Oxidative stress is an important mechanism underlying cellular damage of the inner ear, resulting in hearing loss. In order to prevent hearing loss, several types of antioxidants have been investigated; several experiments have shown their ability to effectively prevent noise-induced hearing loss, age-related hearing loss, and ototoxicity in animal models. Exogenous antioxidants has been used as single therapeutic agents or in combination. Antioxidant therapy is generally administered before the production of reactive oxygen species. However, post-exposure treatment could also be effective. Preconditioning refers to the phenomenon of pre-inducing a preventative pathway by subtle stimuli that do not cause permanent damage in the inner ear. This renders the inner ear more resistant to actual stimuli that cause permanent hearing damage. The preconditioning mechanism is also related to the induction of antioxidant enzymes. In this review, we discuss the mechanisms underlying antioxidant-associated therapeutic effects and preconditioning in the inner ear.
Collapse
|
25
|
Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, Hollingsworth DB, Kelley DM, Kmucha ST, Moonis G, Poling GL, Roberts JK, Stachler RJ, Zeitler DM, Corrigan MD, Nnacheta LC, Satterfield L. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg 2020; 161:S1-S45. [PMID: 31369359 DOI: 10.1177/0194599819859885] [Citation(s) in RCA: 331] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sudden hearing loss is a frightening symptom that often prompts an urgent or emergent visit to a health care provider. It is frequently but not universally accompanied by tinnitus and/or vertigo. Sudden sensorineural hearing loss affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States. This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss. PURPOSE The purpose of this guideline update is to provide clinicians with evidence-based recommendations in evaluating patients with sudden hearing loss and sudden sensorineural hearing loss, with particular emphasis on managing idiopathic sudden sensorineural hearing loss. The guideline update group recognized that patients enter the health care system with sudden hearing loss as a nonspecific primary complaint. Therefore, the initial recommendations of this guideline update address distinguishing sensorineural hearing loss from conductive hearing loss at the time of presentation with hearing loss. They also clarify the need to identify rare, nonidiopathic sudden sensorineural hearing loss to help separate those patients from those with idiopathic sudden sensorineural hearing loss, who are the target population for the therapeutic interventions that make up the bulk of the guideline update. By focusing on opportunities for quality improvement, this guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. METHODS Consistent with the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline Development Manual, Third Edition" (Rosenfeld et al. Otolaryngol Head Neck Surg. 2013;148[1]:S1-S55), the guideline update group was convened with representation from the disciplines of otolaryngology-head and neck surgery, otology, neurotology, family medicine, audiology, emergency medicine, neurology, radiology, advanced practice nursing, and consumer advocacy. A systematic review of the literature was performed, and the prior clinical practice guideline on sudden hearing loss was reviewed in detail. Key Action Statements (KASs) were updated with new literature, and evidence profiles were brought up to the current standard. Research needs identified in the original clinical practice guideline and data addressing them were reviewed. Current research needs were identified and delineated. RESULTS The guideline update group made strong recommendations for the following: (KAS 1) Clinicians should distinguish sensorineural hearing loss from conductive hearing loss when a patient first presents with sudden hearing loss. (KAS 7) Clinicians should educate patients with sudden sensorineural hearing loss about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy. (KAS 13) Clinicians should counsel patients with sudden sensorineural hearing loss who have residual hearing loss and/or tinnitus about the possible benefits of audiologic rehabilitation and other supportive measures. These strong recommendations were modified from the initial clinical practice guideline for clarity and timing of intervention. The guideline update group made strong recommendations against the following: (KAS 3) Clinicians should not order routine computed tomography of the head in the initial evaluation of a patient with presumptive sudden sensorineural hearing loss. (KAS 5) Clinicians should not obtain routine laboratory tests in patients with sudden sensorineural hearing loss. (KAS 11) Clinicians should not routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with sudden sensorineural hearing loss. The guideline update group made recommendations for the following: (KAS 2) Clinicians should assess patients with presumptive sudden sensorineural hearing loss through history and physical examination for bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, and/or focal neurologic findings. (KAS 4) In patients with sudden hearing loss, clinicians should obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm the diagnosis of sudden sensorineural hearing loss. (KAS 6) Clinicians should evaluate patients with sudden sensorineural hearing loss for retrocochlear pathology by obtaining magnetic resonance imaging or auditory brainstem response. (KAS 10) Clinicians should offer, or refer to a clinician who can offer, intratympanic steroid therapy when patients have incomplete recovery from sudden sensorineural hearing loss 2 to 6 weeks after onset of symptoms. (KAS 12) Clinicians should obtain follow-up audiometric evaluation for patients with sudden sensorineural hearing loss at the conclusion of treatment and within 6 months of completion of treatment. These recommendations were clarified in terms of timing of intervention and audiometry and method of retrocochlear workup. The guideline update group offered the following KASs as options: (KAS 8) Clinicians may offer corticosteroids as initial therapy to patients with sudden sensorineural hearing loss within 2 weeks of symptom onset. (KAS 9a) Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy combined with steroid therapy within 2 weeks of onset of sudden sensorineural hearing loss. (KAS 9b) Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy combined with steroid therapy as salvage therapy within 1 month of onset of sudden sensorineural hearing loss. DIFFERENCES FROM PRIOR GUIDELINE Incorporation of new evidence profiles to include quality improvement opportunities, confidence in the evidence, and differences of opinion Included 10 clinical practice guidelines, 29 new systematic reviews, and 36 new randomized controlled trials Highlights the urgency of evaluation and initiation of treatment, if treatment is offered, by emphasizing the time from symptom occurrence Clarification of terminology by changing potentially unclear statements; use of the term sudden sensorineural hearing loss to mean idiopathic sudden sensorineural hearing loss to emphasize that >90% of sudden sensorineural hearing loss is idiopathic sudden sensorineural hearing loss and to avoid confusion in nomenclature for the reader Changes to the KASs from the original guideline: KAS 1-When a patient first presents with sudden hearing loss, conductive hearing loss should be distinguished from sensorineural. KAS 2-The utility of history and physical examination when assessing for modifying factors is emphasized. KAS 3-The word "routine" is added to clarify that this statement addresses nontargeted head computerized tomography scan that is often ordered in the emergency room setting for patients presenting with sudden hearing loss. It does not refer to targeted scans, such as temporal bone computerized tomography scan, to assess for temporal bone pathology. KAS 4-The importance of audiometric confirmation of hearing status as soon as possible and within 14 days of symptom onset is emphasized. KAS 5-New studies were added to confirm the lack of benefit of nontargeted laboratory testing in sudden sensorineural hearing loss. KAS 6-Audiometric follow-up is excluded as a reasonable workup for retrocochlear pathology. Magnetic resonance imaging, computerized tomography scan if magnetic resonance imaging cannot be done, and, secondarily, auditory brainstem response evaluation are the modalities recommended. A time frame for such testing is not specified, nor is it specified which clinician should be ordering this workup; however, it is implied that it would be the general or subspecialty otolaryngologist. KAS 7-The importance of shared decision making is highlighted, and salient points are emphasized. KAS 8-The option for corticosteroid intervention within 2 weeks of symptom onset is emphasized. KAS 9-Changed to KAS 9A and 9B. Hyperbaric oxygen therapy remains an option but only when combined with steroid therapy for either initial treatment (9A) or salvage therapy (9B). The timing of initial therapy is within 2 weeks of onset, and that of salvage therapy is within 1 month of onset of sudden sensorineural hearing loss. KAS 10-Intratympanic steroid therapy for salvage is recommended within 2 to 6 weeks following onset of sudden sensorineural hearing loss. The time to treatment is defined and emphasized. KAS 11-Antioxidants were removed from the list of interventions that the clinical practice guideline recommends against using. KAS 12-Follow-up audiometry at conclusion of treatment and also within 6 months posttreatment is added. KAS 13-This statement on audiologic rehabilitation includes patients who have residual hearing loss and/or tinnitus who may benefit from treatment. Addition of an algorithm outlining KASs Enhanced emphasis on patient education and shared decision making with tools provided to assist in same.
Collapse
Affiliation(s)
- Sujana S Chandrasekhar
- 1 ENT & Allergy Associates, LLP, New York, New York, USA.,2 Zucker School of Medicine at Hofstra-Northwell, Hempstead, New York, USA.,3 Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Laura J Bontempo
- 6 University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Sandra A Finestone
- 8 Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | | | - David M Kelley
- 10 University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Steven T Kmucha
- 11 Gould Medical Group-Otolaryngology, Stockton, California, USA
| | - Gul Moonis
- 12 Columbia University Medical Center, New York, New York, USA
| | | | - J Kirk Roberts
- 12 Columbia University Medical Center, New York, New York, USA
| | | | | | - Maureen D Corrigan
- 15 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lorraine C Nnacheta
- 15 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa Satterfield
- 15 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
26
|
Sohal K, Moshy J, Owibingire S, Shuaibu I. Hearing loss in children: A review of literature. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmedsci.jmedsci_166_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
27
|
Strum D, Kim S, Shim T, Monfared A. An update on autoimmune inner ear disease: A systematic review of pharmacotherapy. Am J Otolaryngol 2020; 41:102310. [PMID: 31733712 DOI: 10.1016/j.amjoto.2019.102310] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David Strum
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States
| | - Sunny Kim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States
| | - Timothy Shim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States
| | - Ashkan Monfared
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States.
| |
Collapse
|
28
|
Das S, Bakshi SS, Seepana R. Demystifying autoimmune inner ear disease. Eur Arch Otorhinolaryngol 2019; 276:3267-3274. [DOI: 10.1007/s00405-019-05681-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
|
29
|
[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society]. HNO 2019; 65:887-893. [PMID: 28770282 DOI: 10.1007/s00106-017-0387-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes two categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 min and 12 h. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 min to 24 h.
Collapse
|
30
|
Hofauer B, Chaker A, Thürmel K, Knopf A. [Manifestations of autoimmune disorders in otorhinolaryngology : Classical symptoms and diagnostic approach]. HNO 2019; 65:695-708. [PMID: 28710538 DOI: 10.1007/s00106-017-0380-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Manifestations of autoimmune disorders represent a diagnostic challenge. Many autoimmune disorders show typical manifestations in the ear, nose and throat and should be taken into account in the differential diagnosis. Sjogren's syndrome, various vasculitides and sarcoidosis represent the most common autoimmune disorders in otorhinolaryngology, but IgG4-related diseases, relapsing polychondritis and autoimmune disorders of the mucosa are also observed. Autoimmune diseases can lead to sensorineural deficits. Both hypo- and hyperthyroidism can be caused by autoimmune disorders. The diagnosis is usually based on the corresponding classification criteria, whose correct application can facilitate the clarification of these diseases.
Collapse
Affiliation(s)
- B Hofauer
- Hals-Nasen-Ohren-Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - A Chaker
- Hals-Nasen-Ohren-Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - K Thürmel
- Rheumatologie, II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - A Knopf
- Hals-Nasen-Ohren-Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| |
Collapse
|
31
|
Ciorba A, Corazzi V, Bianchini C, Aimoni C, Pelucchi S, Skarżyński PH, Hatzopoulos S. Autoimmune inner ear disease (AIED): A diagnostic challenge. Int J Immunopathol Pharmacol 2019; 32:2058738418808680. [PMID: 30376736 PMCID: PMC6213300 DOI: 10.1177/2058738418808680] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autoimmune inner ear disease (AIED) has been defined as a condition of bilateral
sensorineural hearing loss (SNHL), caused by an ‘uncontrolled’ immune system
response. The inner ear can be the direct target of the immune response, but it
can be additionally damaged by a deposition of circulating immune complexes or
by systemic immune-mediated diseases. The clinical expression of immune-mediated
inner ear disease shows a progressive bilateral and asymmetric SNHL profile,
which typically benefits from a steroid and immunosuppressive therapy. The onset
of AIED is between 3 and 90 days. Cochlear symptoms can be associated with
vestibular disorders and in 15%–30% of cases, AIED occurs in the contest of a
systemic autoimmune disease. Currently, the onset of immune-mediated SNHL is not
a well-understood process and the pathogenetic mechanisms of AIED remain
unclear. Furthermore, there are no standardized diagnostic criteria or reliable
diagnostic tests for the diagnosis of AIED. Hence, the definition of
immune-mediated cochleovestibular disorders is a challenging diagnosis based on
exclusion. A close collaboration between otolaryngologists, audiologists and
rheumatologists is recommended, in order to achieve the multidisciplinary
management of this rare entity, since an early AIED identification and a prompt
medical treatment might result in acceptable hearing outcomes. The paper
describes the clinical features of AIED and offers a diagnostic flow-chart to
use in the clinical assessment of this condition.
Collapse
Affiliation(s)
- Andrea Ciorba
- 1 Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | - Virginia Corazzi
- 1 Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | - Chiara Bianchini
- 1 Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | - Claudia Aimoni
- 1 Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | - Stefano Pelucchi
- 1 Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | - Piotr Henryk Skarżyński
- 2 Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,3 Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland.,4 Institute of Sensory Organs, Kajetany, Poland
| | | |
Collapse
|
32
|
Suh MJ, Jeong J, Kim HJ, Jung J, Kim SH. Clinical Characteristics of Bilateral Meniere's Disease in a Single Asian Ethnic Group. Laryngoscope 2018; 129:1191-1196. [PMID: 30284277 DOI: 10.1002/lary.27423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS To identify the clinical characteristics of patients with bilateral Meniere's disease (MD) in an Asian population. STUDY DESIGN Cross-sectional retrospective study. METHODS We compared the clinical features of bilateral MD (BMD) and unilateral MD (UMD) in 320 Asian patients with single ethnicity. Demographic variables; age of onset; inner ear function; the coexistence of related disorders such as vestibular migraine, delayed MD, systemic autoimmune diseases, and familial MD; and prognoses were analyzed and compared. RESULTS The overall prevalence of BMD was 5.6%. The mean age of disease onset was 40.3 ± 14.8 and 47.0 ± 14.1 years for patients with BMD and UMD, respectively (P = .07). Demographic variables were not significantly different between patients with BMD and UMD (P > .05). Inner ear function, evaluated by hearing thresholds, caloric tests, and cervical vestibular evoked myogenic potentials, was significantly more deteriorated in the first involved ear of patients with BMD than in the second involved ear or the affected side of patients with UMD (P < .05). Among the comorbid conditions, only the prevalence of delayed MD was significantly higher in patients with BMD than in patients with UMD. Systemic autoimmune disease was found in only three patients with UMD. There was no significant prognostic difference between patients with UMD and BMD (P > .05). CONCLUSIONS A low prevalence of BMD, a higher frequency of delayed MD in BMD patients, and a low frequency of systemic autoimmune diseases in both UMD and BMD patients are significant findings in an Asian population. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1191-1196, 2019.
Collapse
Affiliation(s)
- Michelle J Suh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hyun Ji Kim
- Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, South Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.,Airway Mucus Institute, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
33
|
Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
Collapse
Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| |
Collapse
|
34
|
Azathioprine Reduces the Risk of Audiometric Relapse in Immune-mediated Hearing Loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
35
|
Betancur JF, Londoño A, Estrada VE, Puerta SL, Osorno SM, Loaiza A, Carmona JA, Gómez-Puerta JA. Uncommon patterns of antinuclear antibodies recognizing mitotic spindle apparatus antigens and clinical associations. Medicine (Baltimore) 2018; 97:e11727. [PMID: 30142759 PMCID: PMC6112870 DOI: 10.1097/md.0000000000011727] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Antinuclear antibodies (ANA) are key biomarkers in the evaluation of rheumatic diseases. The prevalence and clinical significance of uncommon or rare patterns, particularly those directed at the mitotic spindle apparatus (MSA), are not well understood. We aimed to investigate the prevalence and clinical significance of anti-MSA patterns in a Colombian population.During 2013 and 2014, 113,491 consecutive determinations of ANA were studied for the presence of uncommon patterns. Clinical and laboratory data of anti-MSA positive patients were retrospectively collected and analyzed.Of the 113,491 patients tested, 60,501 (53%) were positive for ANA, of which 834 (1.3%) were positive for uncommon/rare patterns of ANA (anti-MSA in 592 cases). Of these 592 cases, complete data were available in 329 patients, of whom 116 had an established diagnosis. Anti-MSA antibodies were the only ANA positive test in 81% patients. At least one fine reactivity was identified in 19/116 (16.3%) of ANA-positive patients, of which anti-Ro was the most prevalent (18/116, 15.5%).The most frequent patterns were nuclear mitotic apparatus (NuMA) (56%) and MSA-2 (25%). The NuMA pattern had the highest ANA titers: mean 320 (range 80-2560) and behaved as monospecific antibodies. The most frequent systemic autoimmune diseases were Sjögren syndrome (SS) (18.1%), rheumatoid arthritis (RA) (13.8%), and systemic lupus erythematosus (SLE) (11%). Undifferentiated connective tissue disease (UCTD) was associated with the centrosome (P < .001), NuMA (P < .02) and MSA-2 (P < .45) patterns. Chronic idiopathic urticaria (CIU) was associated with the NuMA pattern (P < .02) and sensorineural hearing loss (SNHL) was associated with the MSA-2 (P < .001), centrosome (P < .68) and CENP-F (P < .38) patterns, previously unreported findings. Malignancies were found in 8 patients (50% were papillary thyroid cancer).In a large cohort of ANA determinations, uncommon patterns were found in around 1% of cases. The most frequent anti-MSA patterns found were NuMA and MSA-2. More than 50% of patients with anti-MSA had an associated CTD, mainly SS, RA and SLE, and anti-MSA behaved as monospecific antibodies. Other entities of presumed autoimmune origin, like CIU and SNHL, might be associated with these patterns.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - José Alfredo Gómez-Puerta
- Dinámica IPS, Medellín, Colombia
- Rheumatology Department, Hospital Clinic, Barcelona, Catalonia, Spain
| |
Collapse
|
36
|
Mancini P, Atturo F, Di Mario A, Portanova G, Ralli M, De Virgilio A, de Vincentiis M, Greco A. Hearing loss in autoimmune disorders: Prevalence and therapeutic options. Autoimmun Rev 2018; 17:644-652. [PMID: 29729446 DOI: 10.1016/j.autrev.2018.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/20/2022]
Abstract
The objective of this study was to review our current knowledge relative to the correlation between sensorineural hearing loss (SNHL) and autoimmune diseases, focusing on the prevalence of hearing loss in different pathologies and possible therapeutic approaches. A review of the literature on hearing loss in different forms of autoimmune disease has been carried out, with emphasis on incidence and prevalence of SNHL. Therapeutic protocols have been assessed including both conservative medical and rehabilitative methods. Cochlear implant outcomes have been investigated. The prevalence of hearing loss in autoimmune and immune-mediated inner ear diseases, as referred by case reports or single-center statistics, is widely variable. More difficult is the evaluation of severe/profound SNHL, usually reported in relation to cochlear implantation. Though these patients represent ideal candidates for cochlear implantation, as they become deaf after years of hearing; the associated systemic disease, the specific damage on inner ear structures and the medication taken may influence the result of cochlear implantation. The main problem is the cochlear fibrosis or ossification that has been found to affect 50% of implanted ears in patients suffering from autoimmune and immune-mediated SNHL. Hence, in the presence of severe/profound SNHL earlier implantation may be indicated before post-inflammatory obliterative changes to the cochlea.
Collapse
Affiliation(s)
- Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Francesca Atturo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Alessia Di Mario
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy
| | - Ginevra Portanova
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy
| | - Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, Viale Manzoni 56, 20089, Rozzano (MI)
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| |
Collapse
|
37
|
Liu X, Li M, Smyth H, Zhang F. Otic drug delivery systems: formulation principles and recent developments. Drug Dev Ind Pharm 2018; 44:1395-1408. [PMID: 29659300 DOI: 10.1080/03639045.2018.1464022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Disorders of the ear severely impact the quality of life of millions of people, but the treatment of these disorders is an ongoing, but often overlooked challenge particularly in terms of formulation design and product development. The prevalence of ear disorders has spurred significant efforts to develop new therapeutic agents, but perhaps less innovation has been applied to new drug delivery systems to improve the efficacy of ear disease treatments. This review provides a brief overview of physiology, major diseases, and current therapies used via the otic route of administration. The primary focuses are on the various administration routes and their formulation principles. The article also presents recent advances in otic drug deliveries as well as potential limitations. Otic drug delivery technology will likely evolve in the next decade and more efficient or specific treatments for ear disease will arise from the development of less invasive drug delivery methods, safe and highly controlled drug delivery systems, and biotechnology targeting therapies.
Collapse
Affiliation(s)
- Xu Liu
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| | - Mingshuang Li
- b Department of Communication Sciences and Disorders , The University of Texas at Austin , Austin , TX , USA
| | - Hugh Smyth
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| | - Feng Zhang
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| |
Collapse
|
38
|
Mata-Castro N, Gavilanes-Plasencia J, Ramírez-Camacho R, García-Fernández A, García-Berrocal JR. Azathioprine reduces the risk of audiometric relapse in immune-mediated hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:260-267. [PMID: 29502794 DOI: 10.1016/j.otorri.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/12/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Current schemes for treatment of immune-mediated hearing loss with sporadic short-course, low-dose corticosteroids, are insufficient. METHODS To determine the role of azathioprine in the control of auditory impairment, a longitudinal, observational, descriptive study was performed with 20 patients treated with azathioprine (1.5-2.5mg/kg/day into two doses) for 1year. The loss of 10dB on two consecutive frequencies or 15dB on an isolated frequency was considered as relapse. RESULTS The mean age of the patients was 52.50years (95%CI: 46.91-58.17), half were women. Bilateral affectation was 65%. 75% had organ specific disease and 25% had systemic autoimmune disease. The difference between baseline PTA (46.49dB; DS18.90) and PTA at 12months (45.47dB; DS18.88) did not reach statistical significance (P=.799). There was a moderate positive correlation between female sex and the presence of systemic disease (R=.577). By applying Student's t for paired data, a significant difference (P=.042) was obtained between the PTA in frequencies up to 1000 Hz (PTA125-1000Hz). The relative incidence rate of relapse per year was .52 relapses/year (95%CI: .19-1.14]). The median time to audiometric relapse-free was 9.70months (DS1.03). CONCLUSIONS Azathioprine maintains the hearing threshold, decreases the risk of relapse, and slows down the rate at which patients relapse, altering the course of immune-mediated inner ear disease.
Collapse
Affiliation(s)
- Nieves Mata-Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
| | | | - Rafael Ramírez-Camacho
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | | | - José Ramón García-Berrocal
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| |
Collapse
|
39
|
Almeida RS, Oliveira AA, Pego PM, Abuowda Y, Gaspar I, Costa JM. Sensorineural hearing loss as the first manifestation of Sjögren's syndrome. Rev Assoc Med Bras (1992) 2017; 63:7-9. [PMID: 28225872 DOI: 10.1590/1806-9282.63.01.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Raquel Sousa Almeida
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Ana Alves Oliveira
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Petra M Pego
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Yahia Abuowda
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Iuri Gaspar
- Otorhinolaryngology Department, Hospital Distrital de Santarém, Portugal
| | - João Matos Costa
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| |
Collapse
|
40
|
Bakhos D, Aussedat C, Legris E, Aoustin JM, Nevoux J. [Adult deafness: Towards new paradigm]. Presse Med 2017; 46:1033-1042. [PMID: 29107467 DOI: 10.1016/j.lpm.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/24/2022] Open
Abstract
Screening and early treatment of deafness regardless of age is essential. Deafness leads to social isolation, depression, and decreased cognitive function. The diagnosis requires an otoscopy and a confirmation of the type and degree of deafness by audiometry. Sudden deafness and meningitis are neuro-sensorial emergencies. Deafness may be the mode of disclosure of an autoimmune disease or part of the evolutionary profile. Hearing complaints with a normal classical audiogram may be the manifestation of a so-called "hidden" hearing loss and must be explored more carefully.
Collapse
Affiliation(s)
- David Bakhos
- CHU de Tours, service ORL et chirurgie cervicofaciale, 37000 Tours, France; Université François-Rabelais de Tours, faculté de médecine, Inserm UMR-S930, 37000 Tours, France.
| | - Charles Aussedat
- CHU de Tours, service ORL et chirurgie cervicofaciale, 37000 Tours, France
| | - Elsa Legris
- CHU de Tours, service ORL et chirurgie cervicofaciale, 37000 Tours, France
| | - Jean-Marie Aoustin
- CHU de Tours, service ORL et chirurgie cervicofaciale, 37000 Tours, France
| | - Jérôme Nevoux
- AP-HP, hôpital Bicêtre, service d'ORL et de chirurgie cervicofaciale, 94270 Le Kremlin-Bicêtre, France; Université Paris-Saclay, faculté de médecine, 94275 Le Kremlin-Bicêtre, France; Inserm U1185, 94275 Le Kremlin-Bicêtre, France
| |
Collapse
|
41
|
Kohlert S, Bromwich M. Mobile tablet audiometry in fluctuating autoimmune ear disease. J Otolaryngol Head Neck Surg 2017; 46:18. [PMID: 28270231 PMCID: PMC5341391 DOI: 10.1186/s40463-017-0195-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autoimmune inner ear disease (AIED) is a rare condition characterized by bilateral fluctuating sensorineural hearing loss (SNHL). The labile nature of this hearing loss makes it difficult to accurately quantify with conventional methods, and therefore it is challenging to rehabilitate. METHODS Over a 9-month period one pediatric patient with severe AIED was monitored and conducted home audiograms using a previously validated testing system (Shoebox Audiometry). During this period he also underwent several clinical audiograms. The correlation between clinical and home audiograms was analyzed with a Pearson coefficient, and the range and frequency of fluctuations was recorded. RESULTS Sixty-four automated home audiograms and nine clinical audiograms were conducted. When tested at home using a calibrated system the pure tone average (PTA) fluctuated between 12 dB and 72 dB indicating large variability in hearing. Fluctuations were frequent: on 28 occasions the PTA varied by at least 5 dB when retested within 4 days. The mean PTA was 50 dB and 95% of the thresholds were within 36 dB of the mean. Clinical audiograms obtained on the same day or within 1 day of home testing were highly concordant (with a Pearson coefficient of 0.93). CONCLUSION AIED can result in significant fluctuations in hearing over short periods of time. Home testing enables a more granular look at variations over time and correlates well with clinical testing, and thus facilitates rapid action and informed rehabilitation.
Collapse
Affiliation(s)
- Scott Kohlert
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Canada.,Department of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8 L1, Canada
| | - Matthew Bromwich
- Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Canada. .,Department of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8 L1, Canada.
| |
Collapse
|
42
|
Fioretti A, Di Rubbo V, Peri G, Vitti E, Cisternino S, Varakliotis T, Eibenstein A. Cochlear Impairment and Autoimmune Ear Disorder in a Patient with Breast Cancer. Audiol Res 2017; 7:165. [PMID: 28458811 PMCID: PMC5391518 DOI: 10.4081/audiores.2017.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to consider the possible role of autoimmune diseases and paraneoplastic syndrome in the genesis of tinnitus. The incidence of autoimmune inner ear disease (AIED) is rare, accounting for <1% of all cases of hearing impairment and dizziness. In presence of auditory and vestibular deficit in oncological patients, a paraneoplastic syndrome with cochleovestibulopathy should be considered. We described a 50-year-old Caucasian woman came to our attention with complaints of severe disabling bilateral tinnitus (Tinnitus Handicap Inventory, THI: 96), ear fullness and headache. The onset of tinnitus was associated to the last breast implant and prolonged antibiotic therapy. Serological autoimmunity tests were positive and a diagnosis of mixed connective tissue disease with notes of fibromyalgia was made. Pure tone audiometry testing revealed bilateral fluctuating mild hearing loss on high frequencies. The tinnitus was successfully treated with bilateral wideband sound generators (listening 8-9 h for day) regulated at the mixing point. At 12 months follow up THI has shrunk considerably (THI: 4) and the patient has continued treatment only with the sound pillow. In conclusion significant progress is needed to better understand the role of autoantibodies in the pathogenesis and diagnosis of paraneoplastic cochleovestibulopathy. To our knowledge, our study is the first in which hearing loss and tinnitus is considered as a manifestation of a paraneoplastic syndrome.
Collapse
Affiliation(s)
| | - Vittoria Di Rubbo
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | | | - Elisa Vitti
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | - Sara Cisternino
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | - Theodoros Varakliotis
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | - Alberto Eibenstein
- Tinnitus Center, European Hospital, Rome.,Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| |
Collapse
|
43
|
Davies R, Luxon LM, Bamiou DE, Bronstein A. Neuro-Otology. Neurology 2016. [DOI: 10.1002/9781118486160.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
44
|
Kao S, Soares VY, Kristiansen AG, Stankovic KM. Activation of TRAIL-DR5 pathway promotes sensorineural degeneration in the inner ear. Aging Cell 2016; 15:301-8. [PMID: 26791792 PMCID: PMC4783338 DOI: 10.1111/acel.12437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 01/23/2023] Open
Abstract
Tumor necrosis factor (TNF) family cytokines are important mediators of inflammation. Elevated levels of serum TNF‐α are associated with human sensorineural hearing loss via poorly understood mechanisms. We demonstrate, for the first time, expression of TNF‐related apoptosis‐inducing ligand (TRAIL) and its signaling death receptor 5 (DR5) in the murine inner ear and show that exogenous TRAIL can trigger hair cell and neuronal degeneration, which can be partly prevented with DR5‐blocking antibodies.
Collapse
Affiliation(s)
- Shyan‐Yuan Kao
- Eaton Peabody Laboratories and Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston MA USA
| | - Vitor Y.R. Soares
- Eaton Peabody Laboratories and Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston MA USA
- Department of Otology and Laryngology Harvard Medical School Boston MA USA
| | - Arthur G. Kristiansen
- Eaton Peabody Laboratories and Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston MA USA
| | - Konstantina M. Stankovic
- Eaton Peabody Laboratories and Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston MA USA
- Department of Otology and Laryngology Harvard Medical School Boston MA USA
- Program in Speech and Hearing Bioscience and Technology Harvard Medical School Boston MA USA
| |
Collapse
|
45
|
Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A. Criterios diagnósticos de enfermedad de Menière. Documento de consenso de la Bárány Society, la Japan Society for Equilibrium Research, la European Academy of Otology and Neurotology (EAONO), la American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) y la Korean Balance Society. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:1-7. [DOI: 10.1016/j.otorri.2015.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/24/2015] [Indexed: 11/25/2022]
|
46
|
An open label study to evaluate the safety and efficacy of intratympanic golimumab therapy in patients with autoimmune inner ear disease. Otol Neurotol 2015; 35:1515-21. [PMID: 25203561 DOI: 10.1097/mao.0000000000000566] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of intratympanically injected golimumab (GLM), a TNF-α inhibitor, as a steroid-sparing agent for patients with steroid-dependent autoimmune inner ear disease (AIED). STUDY DESIGN Open label. SETTING Tertiary referral center. PATIENTS Ten patients with steroid-dependent AIED were enrolled in Stage 2. The average patient age at enrollment was 59, with an average of 12.5 years from the start of bilateral hearing loss symptoms. The average dose of daily prednisone at the start of injections was 18 mg. INTERVENTION Intratympanic injection of GLM. MAIN OUTCOME MEASURE Hearing loss progression (treatment failure) was defined as either an increase in pure-tone thresholds by frequency or a decrease in word recognition score. RESULTS There were no serious adverse events. Five of seven per-protocol subjects experienced stable pure-tone thresholds in the injected ear, whereas 4 had stable word recognition scores. Two subjects experienced an improvement in word recognition scores. The results support the hypothesis that GLM may be a promising treatment. CONCLUSIONS The TNF-α inhibitor GLM stabilized hearing in 3 of 7 per-protocol subjects with AIED and allowed a complete tapering off of prednisone in those 7 subjects. Studies with larger samples sizes are warranted.
Collapse
|
47
|
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.
Collapse
|
48
|
Kuo M. How might contact with nature promote human health? Promising mechanisms and a possible central pathway. Front Psychol 2015; 6:1093. [PMID: 26379564 PMCID: PMC4548093 DOI: 10.3389/fpsyg.2015.01093] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/16/2015] [Indexed: 01/09/2023] Open
Abstract
How might contact with nature promote human health? Myriad studies have linked the two; at this time the task of identifying the mechanisms underlying this link is paramount. This article offers: (1) a compilation of plausible pathways between nature and health; (2) criteria for identifying a possible central pathway; and (3) one promising candidate for a central pathway. The 21 pathways identified here include environmental factors, physiological and psychological states, and behaviors or conditions, each of which has been empirically tied to nature and has implications for specific physical and mental health outcomes. While each is likely to contribute to nature’s impacts on health to some degree and under some circumstances, this paper explores the possibility of a central pathway by proposing criteria for identifying such a pathway and illustrating their use. A particular pathway is more likely to be central if it can account for the size of nature’s impacts on health, account for nature’s specific health outcomes, and subsume other pathways. By these criteria, enhanced immune functioning emerges as one promising candidate for a central pathway between nature and health. There may be others.
Collapse
Affiliation(s)
- Ming Kuo
- Landscape and Human Health Laboratory, Department of Natural Resources and Environmental Sciences, University of Illinois at Urbana-Champaign Urbana, IL, USA
| |
Collapse
|
49
|
Şahin Y, Durucu C, Şahin DA. Evaluation of hearing loss in pediatric celiac patients. Int J Pediatr Otorhinolaryngol 2015; 79:378-81. [PMID: 25596648 DOI: 10.1016/j.ijporl.2014.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Celiac disease (CD) is a chronic immune-mediated enteropathy caused by the ingestion of gluten in genetically predisposed individuals. In some reports, sensorineural hearing loss (SNHL) has been identified as an extraintestinal symptom of CD. We aimed to further investigate the possible association between CD and SNHL by examining a greater number of pediatric CD patients. METHODS The study was carried out from March to September 2014 and included 110 pediatric patients with biopsy-confirmed CD (220 ears) and 41 age- and sex-matched controls (82 ears); participants were evaluated by tympanometry and pure tone audiometry (frequency, 250-8000Hz frequency). RESULTS Audiometric bone conduction thresholds were significantly different between the CD patients and the controls (p<0.05), but there were no significant differences in pure tone averages for air conduction (p>0.05). When the results for CD patients were analyzed according to duration of disease (≤36 months and >36 months), a significant difference in bone conduction thresholds (p<0.05) was noted, with significant increments at the later stages of disease. However, this difference was not sufficient to define clinical hearing loss, as the pure tone average thresholds remained below 20dB. CONCLUSION These results indicate that subclinical hearing loss may be present in children with CD, which could presage more serious hearing impairments at older ages and later stages of the disease. Hearing screenings should be recommended for children with CD in order to prevent the potentially unfavorable effects of hearing loss on the emotional, behavioral, cognitive, and sensorimotor development of these patients.
Collapse
Affiliation(s)
- Yasin Şahin
- Gaziantep University, Faculty of Medicine, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Gaziantep, Turkey.
| | - Cengiz Durucu
- Gaziantep University, Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Gaziantep, Turkey.
| | - Derya Aydın Şahin
- Gaziantep University, Faculty of Medicine, Department of Pediatric Cardiology, Gaziantep, Turkey.
| |
Collapse
|
50
|
Al-Shagahin H, Al-Hamaidah AM. Cogan’s Syndrome in a Jordanian patient: A case report. ALEXANDRIA JOURNAL OF MEDICINE 2014. [DOI: 10.1016/j.ajme.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Hani Al-Shagahin
- Department of Otolaryngology, Faculty of Medicine , Mutah University , Karak, Jordan
| | - Ali M. Al-Hamaidah
- Department of Internal Medicine, Al-Karak Governmental Teaching Hospital , Karak, Jordan
| |
Collapse
|