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Liu YC, Xu K. Macrophage-related immune responses in inner ear: a potential therapeutic target for sensorineural hearing loss. Front Neurosci 2024; 17:1339134. [PMID: 38274500 PMCID: PMC10808290 DOI: 10.3389/fnins.2023.1339134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Hearing loss is the most common sensory disorder in human beings. Cochlear sensory cells are the basis of hearing. Cochlear sensory cells suffer from various acute or chronic injuries, such as excessive sound stimulation, ototoxic drugs, and age-related degeneration. In response to these stresses, the cochlea develops an immune response. In recent years, studies have shown that the immune response of the inner ear has been regarded as one of the important pathological mechanisms of inner ear injury. Therapeutic interventions for inflammatory responses can effectively alleviate different types of inner ear injury. As the main immune cells in the inner ear, macrophages are involved in the process of inner ear injury caused by various exogenous factors. However, its specific role in the immune response of the inner ear is still unclear. This review focuses on discusses the dynamic changes of macrophages during different types of inner ear injury, and clarifies the potential role of macrophage-related immune response in inner ear injury.
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Affiliation(s)
- Yu-Chen Liu
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Kai Xu
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, China
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Harris JP, Ciaranello AL, Tabb ES. Case 4-2022: A 55-Year-Old Man with Bilateral Hearing Loss and Eye Redness. N Engl J Med 2022; 386:583-590. [PMID: 35139277 DOI: 10.1056/nejmcpc2107349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey P Harris
- From the Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla (J.P.H.); and the Departments of Medicine (A.L.C.) and Pathology (E.S.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.C.) and Pathology (E.S.T.), Harvard Medical School - both in Boston
| | - Andrea L Ciaranello
- From the Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla (J.P.H.); and the Departments of Medicine (A.L.C.) and Pathology (E.S.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.C.) and Pathology (E.S.T.), Harvard Medical School - both in Boston
| | - Elisabeth S Tabb
- From the Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla (J.P.H.); and the Departments of Medicine (A.L.C.) and Pathology (E.S.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.C.) and Pathology (E.S.T.), Harvard Medical School - both in Boston
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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.
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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
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Brown DJ, Sokolic L, Fung A, Pastras CJ. Response of the inner ear to lipopolysaccharide introduced directly into scala media. Hear Res 2018; 370:105-112. [PMID: 30366193 DOI: 10.1016/j.heares.2018.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/03/2018] [Accepted: 10/14/2018] [Indexed: 12/18/2022]
Abstract
In an attempt to develop an animal model of immune mediated Meniere's disease, we have injected lipopolysaccharide (LPS) directly into scala media of guinea pigs and monitored functional and morphological changes over a period of 6 weeks. Depending on the concentration of LPS, changes ranged from moderate-to-severe hearing loss and endolymphatic hydrops with minimal cellular infiltrate or fibrosis, to dense cellular infiltration that filled the scalae. Interestingly, higher concentrations of LPS not only induced severe cellular infiltration, hydrops, and hearing loss, but also a substantial enlargement of the endolymphatic duct and sac. Moreover, LPS injections into perilymph failed to induce hydrops, yet still resulted in cellular infiltration and fibrosis in the cochlea. This suggests that chronic hydrops resulting from an immune challenge of the cochlea may not be due to blockage of the endolymphatic duct and sac, restricting fluid absorption. Furthermore, injecting antigen into endolymph may produce chronic immune-mediated hydrops, and provide a more promising animal model of Meniere's, although animals did not display signs of vestibular dysfunction, and the hearing loss was relatively severe.
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Affiliation(s)
| | - Ljiljana Sokolic
- The University of Sydney, Meniere's Research Laboratory, Australia
| | - Albert Fung
- The University of Sydney, Meniere's Research Laboratory, Australia
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Liu W, Molnar M, Garnham C, Benav H, Rask-Andersen H. Macrophages in the Human Cochlea: Saviors or Predators-A Study Using Super-Resolution Immunohistochemistry. Front Immunol 2018; 9:223. [PMID: 29487598 PMCID: PMC5816790 DOI: 10.3389/fimmu.2018.00223] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/26/2018] [Indexed: 12/20/2022] Open
Abstract
The human inner ear, which is segregated by a blood/labyrinth barrier, contains resident macrophages [CD163, ionized calcium-binding adaptor molecule 1 (IBA1)-, and CD68-positive cells] within the connective tissue, neurons, and supporting cells. In the lateral wall of the cochlea, these cells frequently lie close to blood vessels as perivascular macrophages. Macrophages are also shown to be recruited from blood-borne monocytes to damaged and dying hair cells induced by noise, ototoxic drugs, aging, and diphtheria toxin-induced hair cell degeneration. Precise monitoring may be crucial to avoid self-targeting. Macrophage biology has recently shown that populations of resident tissue macrophages may be fundamentally different from circulating macrophages. We removed uniquely preserved human cochleae during surgery for treating petroclival meningioma compressing the brain stem, after ethical consent. Molecular and cellular characterization using immunofluorescence with antibodies against IBA1, TUJ1, CX3CL1, and type IV collagen, and super-resolution structured illumination microscopy (SR-SIM) were made together with transmission electron microscopy. The super-resolution microscopy disclosed remarkable phenotypic variants of IBA1 cells closely associated with the spiral ganglion cells. Monitoring cells adhered to neurons with “synapse-like” specializations and protrusions. Active macrophages migrated occasionally nearby damaged hair cells. Results suggest that the human auditory nerve is under the surveillance and possible neurotrophic stimulation of a well-developed resident macrophage system. It may be alleviated by the non-myelinated nerve soma partly explaining why, in contrary to most mammals, the human’s auditory nerve is conserved following deafferentiation. It makes cochlear implantation possible, for the advantage of the profoundly deaf. The IBA1 cells may serve additional purposes such as immune modulation, waste disposal, and nerve regeneration. Their role in future stem cell-based therapy needs further exploration.
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Affiliation(s)
- Wei Liu
- Section of Otolaryngology, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Matyas Molnar
- Immunology, Genetics and Pathology - Biovis Platform, Uppsala University, Uppsala, Sweden
| | | | | | - Helge Rask-Andersen
- Head and Neck Surgery, Section of Otolaryngology, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Møller MN, Kirkeby S, Vikeså J, Nielsen FC, Caye-Thomasen P. Expression of histamine receptors in the human endolymphatic sac: the molecular rationale for betahistine use in Menieres disease. Eur Arch Otorhinolaryngol 2015. [DOI: 10.1007/s00405-015-3731-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Okano T. Immune system of the inner ear as a novel therapeutic target for sensorineural hearing loss. Front Pharmacol 2014; 5:205. [PMID: 25228882 PMCID: PMC4151383 DOI: 10.3389/fphar.2014.00205] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/16/2014] [Indexed: 12/20/2022] Open
Abstract
Sensorineural hearing loss (SNHL) is a common clinical condition resulting from dysfunction in one or more parts in the auditory pathway between the inner ear and auditory cortex. Despite the prevalence of SNHL, little is known about its etiopathology, although several mechanisms have been postulated including ischemia, viral infection or reactivation, and microtrauma. Immune-mediated inner ear disease has been introduced and accepted as one SNHL pathophysiology; it responds to immunosuppressive therapy and is one of the few reversible forms of bilateral SNHL. The concept of immune-mediated inner ear disease is straightforward and comprehensible, but criteria for clinical diagnosis and the precise mechanism of hearing loss have not been determined. Moreover, the therapeutic mechanisms of corticosteroids are unclear, leading to several misconceptions by both clinicians and investigators concerning corticosteroid therapy. This review addresses our current understanding of the immune system in the inner ear and its involvement in the pathophysiology in SNHL. Treatment of SNHL, including immune-mediated inner ear disorder, will be discussed with a focus on the immune mechanism and immunocompetent cells as therapeutic targets. Finally, possible interventions modulating the immune system in the inner ear to repair the tissue organization and improve hearing in patients with SNHL will be discussed. Tissue macrophages in the inner ear appear to be a potential target for modulating the immune response in the inner ear in the pathophysiology of SNHL.
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Affiliation(s)
- Takayuki Okano
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University Kyoto, Japan
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Mijovic T, Zeitouni A, Colmegna I. Autoimmune sensorineural hearing loss: the otology-rheumatology interface. Rheumatology (Oxford) 2013; 52:780-9. [DOI: 10.1093/rheumatology/ket009] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hizli S, Karabulut H, Ozdemir O, Acar B, Abaci A, Dağli M, Karaşen RM. Sensorineural hearing loss in pediatric celiac patients. Int J Pediatr Otorhinolaryngol 2011; 75:65-8. [PMID: 21067821 DOI: 10.1016/j.ijporl.2010.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/01/2010] [Accepted: 10/05/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Celiac disease (CD) is an immune-mediated chronic inflammatory gluten-dependent intestinal disease affecting 0.5-1% of the general population worldwide. CD is underdiagnosed even with sophisticated health care; approximately 10% of people affected by CD are now diagnosed. The recognition of the atypical extra-intestinal manifestations, including neurological disorders increased the diagnosis of CD. At present, no data are available on the presence of sensorineural hearing loss in pediatric CD patients. The aim of this study was to determine the incidence and severity of sensorineural hearing loss (SNHL) in different frequencies in pediatric CD patients. METHODS A sample of 32 biopsies and serologically proven newly diagnosed pediatric CD patients (CD group) (64 ears) and 32 sex and age-matched healthy subjects (64 ears) as control group (C group) were included in this study. Anthropometric measurements, physical examinations including ear nose and throat and pure-tone audiometry at frequencies 250-8000 Hz were performed in all subjects in both groups. Slight/mild SNHL was defined as a loss of detection of sound within the 16-40 dB range. The mean age of patient and control group was 11.9 and 11.3, respectively (p>0.05). RESULTS In CD group, sensorineural hearing loss was found in 13 (40.6%) patients (group A) as it was bilateral in six and unilateral in seven patients. In control group (group C), slight/mild SNHL was found in one (3.1%) subject. The frequency of hearing loss was significantly higher in CD group than in group C (p<0.001). CONCLUSION The present study showed a higher prevalence of sensory neural hearing loss in pediatric celiac patients than in healthy controls, suggesting an association between CD and SNHL. The findings of this study suggest that hearing impairment should be searched in newly diagnosed pediatric CD patients. Further longitudinal investigations on a larger sample size will be necessary to confirm the present data and to search the immunological processes which could be the basis of the association between CD and SNHL.
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Affiliation(s)
- Samil Hizli
- Gaziantep University, Faculty of Medicine, Pediatric Gastroenterology Unit, Gaziantep, Turkey.
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Okano T, Nakagawa T, Ito J. Distribution of bone marrow-derived cells in the vestibular end organs and the endolymphatic sac. Acta Otolaryngol 2010:88-94. [PMID: 20879826 DOI: 10.3109/00016489.2010.486803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONCLUSION Bone marrow-derived cells (BMDCs) are constitutively present in the vestibular end organs and in the endolymphatic sac, and may play a role in the maintenance of inner ear homeostasis. OBJECTIVES The aim was to examine the distribution and characteristics of BMDCs in the vestibular end organs and in the endolymphatic sac. METHODS Bone marrow-chimeric mice were generated by bone marrow transplantation from mice genetically labeled with enhanced green fluorescent protein to C57 Bl/6 mice to visualize BMDCs. Three months after bone marrow transplantation, inner ear specimens were processed for histochemical analyses. RESULTS BMDCs were widely distributed in the vestibular end organs and the endolymphatic sac, whereas there were differences in the phenotype and the distribution between the vestibular end organs and the endolymphatic sac. A subpopulation of BMDCs in the vestibular end organs expressed antigen-presenting protein MHC class II. Moreover, the density of BMDCs in the vestibular end organs increased in response to local mechanical stress.
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Affiliation(s)
- Takayuki Okano
- Department of Otolaryngology, Head and Neck Surgery, Kyoto University, Kyoto, Japan
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Rawal SG, Thakkar KH, Ziai K, Santi PA, Djalilian HR. HLA-B27-Associated Bilateral Ménière Disease. EAR, NOSE & THROAT JOURNAL 2010. [DOI: 10.1177/014556131008900309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe 2 cases of bilateral Ménière disease with features resembling autoimmune inner ear disease in patients who were found to be carriers of human leukocyte antigen (HLA) B27. For immunohistochemical analysis, mouse inner ear sections were used as the tissue substrate for reaction with serum. Both patients demonstrated an increased immunofluorescence reaction compared with a normal control. We suggest that an antibody-mediated mechanism may be responsible for HLA-B27–associated Ménière disease.
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Affiliation(s)
- Shamila G. Rawal
- Department of Otolaryngology-Head and Neck Surgery,
University of Illinois at Chicago, Minneapolis
| | - Kunal H. Thakkar
- Department of Otolaryngology-Head and Neck Surgery,
University of Illinois at Chicago, Minneapolis
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery,
University of California Irvine Medical Center, Orange, Calif
| | - Peter A. Santi
- Department of Otolaryngology-Head and Neck Surgery,
University of Minnesota, Minneapolis
| | - Hamid R. Djalilian
- Department of Otolaryngology-Head and Neck Surgery,
University of California Irvine Medical Center, Orange, Calif
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Smit AL, Stokroos RJ, Litjens SGH, Kremer B, Kramer BW. Potential role for lipopolysaccharide in congenital sensorineural hearing loss. J Med Microbiol 2010; 59:377-383. [PMID: 20093374 DOI: 10.1099/jmm.0.015792-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Congenital sensorineural hearing loss (SNHL) is common. In the Western world, the incidence is 1-3 per 1000 live births. The aetiology encompasses genetic and non-genetic factors accounting for 55 % and 45 % of cases, respectively. Reports that describe the contribution of intrauterine infection to the occurrence of congenital SNHL are limited, and comparative analysis of the different pathogens is lacking. Lipopolysaccharide (LPS), a product of bacteriolysis, has been demonstrated to be associated with inner ear damage in experimental studies. To elucidate the potential role of this toxin in congenital SNHL and to identify the pathogenesis and transmission routes, we reviewed the literature. We speculate that different routes of exposure to LPS in utero may result in congenital inner ear damage.
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Affiliation(s)
- A L Smit
- Department of Otorhinolaryngology/Head and NeckSurgery, Maastricht University Medical Centre, PO Box 5800, Maastricht, TheNetherlands
| | - R J Stokroos
- Department of Otorhinolaryngology/Head and NeckSurgery, Maastricht University Medical Centre, PO Box 5800, Maastricht, TheNetherlands
| | - S G H Litjens
- Faculty of Health, Medicine and Life Sciences, Universityof Maastricht, PO Box 616, Maastricht, The Netherlands
| | - B Kremer
- School of Oncology and Developmental Biology, Universityof Maastricht, PO Box 5800, Maastricht, The Netherlands.,Department of Otorhinolaryngology/Head and NeckSurgery, Maastricht University Medical Centre, PO Box 5800, Maastricht, TheNetherlands
| | - B W Kramer
- Department of Pediatrics, Maastricht University MedicalCentre, PO Box 5800, Maastricht, The Netherlands.,School of Oncology and Developmental Biology, Universityof Maastricht, PO Box 5800, Maastricht, The Netherlands
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Cochlin isoforms and their interaction with CTL2 (SLC44A2) in the inner ear. J Assoc Res Otolaryngol 2007; 8:435-46. [PMID: 17926100 DOI: 10.1007/s10162-007-0099-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 08/30/2007] [Indexed: 10/22/2022] Open
Abstract
Choline transporter-like protein 2 (CTL2) is a multi-transmembrane protein expressed on inner ear supporting cells that was discovered as a target of antibody-induced hearing loss. Its function is unknown. A 64 kDa band that consistently co-precipitates with CTL2 from inner ear extracts was identified by mass spectroscopy as cochlin. Cochlin is an abundant inner ear protein expressed as multiple isoforms. Its function is also unknown, but it is suspected to be an extracellular matrix component. Cochlin is mutated in individuals with DFNA9 hearing loss. To investigate the CTL2-cochlin interaction, antibodies were raised to a cochlin-specific peptide. The antibodies identify several cochlin polypeptides on western blots and are specific for cochlin. We show that the heterogeneity of the cochlin isoforms is caused, in part, by in vivo post-translational modification by N-glycosylation and, in part, caused by alternative splicing. We verified that antibody to CTL2 co-immunoprecipitates cochlin from the inner ear and antibody to cochlin co-immunoprecipitates CTL2. Using cochlear cross-sections, we show that CTL2 is more widely distributed than previously described, and its prominent expression on cells facing the scala media suggests a possible role in homeostasis. A prominent but previously unreported ribbon-like pattern of cochlin in the basilar membrane was demonstrated, suggesting an important role for cochlin in the structure of the basilar membrane. CTL2 and cochlin are expressed in close proximity in the inner sulcus, the spiral prominence, vessels, limbus, and spiral ligament. The possible functional significance of CTL2-cochlin interactions remains unknown.
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Lobo D, López FG, García-Berrocal JR, Ramírez-Camacho R. Diagnostic tests for immunomediated hearing loss: a systematic review. The Journal of Laryngology & Otology 2007; 122:564-73. [PMID: 17908357 DOI: 10.1017/s002221510700059x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To quantitatively evaluate the diagnostic accuracy of diagnostic tests for immunomediated hearing loss. DATA SOURCES We searched Medline and the Cochrane Database of Systematic Reviews for potentially relevant studies. STUDY SELECTION Twenty-five studies met the inclusion criteria of this systematic review. The diagnosis of immunomediated hearing loss was based on the clinical presentation and the response to corticosteroid administration. DATA EXTRACTION The following data were extracted from the selected studies and entered into a standardised database: population demographics; exclusion and inclusion criteria; diagnostic tests; sensitivity; specificity; the number of true positive, true negative, false positive and false negative values; therapy used, including dose and duration; and delay between symptom onset and therapy commencement. DATA SYNTHESIS This systematic review combined data from 679 patients with immunomediated hearing loss, reported by 22 research teams. Substantial heterogeneity was found among the included studies; for this reason, summary sensitivity and specificity values were not computed. CONCLUSIONS The results of diagnostic tests for immunomediated hearing loss depend on many factors, and there is a risk of potential bias. This is the first time that such a systematic review has been presented; such a review is a more rigorous method of demonstrating the utility of the available diagnostic tests.
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Affiliation(s)
- D Lobo
- Ear Research Group, Department of Otorhinolaryngology, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Spain.
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García Berrocal JR, Lobo D, García López F, Ramírez-Camacho R. Enfermedad inmunomediada del oído interno: validación diagnóstica mediante un análisis sistemático de la literatura científica. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74914-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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García Berrocal JR, Lobo D, García López F, Ramírez-Camacho R. Immunomediated Inner Ear Disease: Diagnostic Validation by Means of a Systematic Analysis of the Scientific Literature. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Niparko JK, Wang NY, Rauch SD, Russell GB, Espeland MA, Pierce JJ, Bowditch S, Masuda A, Gulya AJ, Gantz BJ, Hughes GB, Brookhouser PE, Hannley MT, Telian SA, Harris JP. Serial Audiometry in a Clinical Trial of AIED Treatment. Otol Neurotol 2005; 26:908-17. [PMID: 16151337 DOI: 10.1097/01.mao.0000185081.28598.5c] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We analyzed pure-tone and speech audiometric results from a prospective trial of anti-inflammatory treatment of subjects with active autoimmune inner ear disease (AIED). We sought to characterize the pattern and size of the treatment effect as reflected in clinical audiometry and to identify audiometric predictors of response to steroid treatment of AIED. SUBJECTS Adult participants demonstrated clinically established criteria for AIED (n = 116). Eligibility required audiometric evidence of active AIED as indicated by idiopathic sensorineural hearing loss with threshold elevations within 3 months of enrollment. METHODS We evaluated audiometric changes after 4 weeks of treatment with pharmacologic doses (60 mg/day) of prednisone. We examined the relationship between audiometric pure-tone thresholds at baseline and changes in word intelligibility score (WIS) using parametric and nonparametric analyses. Magnitudes of change were assessed using independent or paired t-tests. Separate analyses were performed on subgroups that did or did not show improved WIS score with steroid treatment. RESULTS Overall mean pure-tone averages improved from baseline to closeout of prednisone treatment in better hearing ears from 52.4 to 48.3 dB (p < .0001). Mean WIS improved in the better ear from 71.4% to 78.1% (p < .0001). Of pure-tone measures, only the six-tone average showed significant correlation with both the absolute improvements in WIS and with the percentage change in WIS after treatment. Individual frequencies at baseline showed no significant relationship with changes in WIS score after treatment. In 69 (59.5%) of 116 subjects, WIS improved (range, 2-80%) in the better ear. In these subjects, the baseline pure-tone thresholds and pure-tone averages correlated significantly and positively with improvement in WIS. CONCLUSIONS Steroid treatment in AIED-mediated hearing loss produce variable but significant hearing gains. Neither a focal, cochleotopic region of greatest vulnerability to AIED nor frequency-specific amenability to treatment were evident. We did observe that analysis of predictors and the degree of treatment effect vary with different approaches to measuring change in the WIS. Depending on the approach adopted, the size of the treatment effect may be greatest across intermediate hearing levels at baseline. These observations offer an audiometric database that may enable greater precision in judging clinically meaningful parameters for future studies of AIED treatment and other interventions for sensorineural hearing loss.
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Affiliation(s)
- John K Niparko
- Department of Otolaryngology, Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Kakigi A, Okada T, Takeda T, Takeuchi S, Sawada S, Higashiyama K, Azuma H, Yamakawa K, Seguchi H. Endocytosis in the Epithelial Cells of the Endolymphatic Sac. Acta Histochem Cytochem 2004. [DOI: 10.1267/ahc.37.241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Taizo Takeda
- Department of Otolaryngology, Kochi Medical School
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Fuse T, Hayashi T, Oota N, Fukase S, Asano S, Kato T, Aoyagi M. Immunological responses in acute low-tone sensorineural hearing loss and Ménière's disease. Acta Otolaryngol 2003; 123:26-31. [PMID: 12625569 DOI: 10.1080/0036554021000028074] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The autoimmune response appears to play an important role in some types of acute sensorineural hearing loss. Endolymphatic hydrops associated with fluctuating hearing loss has also been suggested to be caused by an immunological mechanism. Acute low-tone hearing loss (ALHL) associated with Ménière's disease (MD) is characterized by fluctuating hearing loss, and its etiology is thought to involve endolymphatic hydrops. The aim of this study was to attempt to determine the etiology of ALHL in MD. MATERIAL AND METHODS A flow cytometer was used to analyze intracellular cytokine levels in peripheral blood from 19 patients with ALHL and 26 patients with MD and the data compared to those obtained from age- and gender-matched healthy volunteers. RESULTS The patients with ALHL showed significantly increased levels of Th1 subsets (interferon-gamma-producing helper T cells) as compared to those in normal controls. The levels of Th2 (IL-4-producing helper T cells) subsets did not differ from those in the control group and thus Th1 predominated in ALHL patients. The patients with MD showed significantly increased natural killer cell activity but no Th1 dominance. These patients had no obvious systemic or local disease except in the inner ear. CONCLUSION An abnormality of the Th1/Th2 balance in ALHL and increased natural killer cell activity in MD are thought to relate to inner ear disorder. These results are consistent with the possibility that the etiology of ALHL and MD involves an immune response.
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Affiliation(s)
- Takeo Fuse
- Department of Otolaryngology, Yamagata University School of Medicine, Yamagata, Japan.
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Spencer RF, Sismanis A, Kilpatrick JK, Shaia WT. Demyelination of Vestibular Nerve Axons in Unilateral Ménière's Disease. EAR, NOSE & THROAT JOURNAL 2002. [DOI: 10.1177/014556130208101113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a study to determine whether vestibular nerves inpatients with unilateral Ménière's disease whose symptoms are refractory to medical management exhibit neuropathologic changes. We also endeavored to determine whether retrocochlear abnormalities are primary or secondary factors in the disease process. To these ends, we obtained vestibular nerve segments from five patients during retrosigmoid (posteriorfossa) neurectomy, immediately fixed them, and processed them for light and electron microscopy. We found that all five segments exhibited moderate to severe demyelination with axonal sparing. Moreover, we noted that reactive astrocytes produced an extensive proliferation of fibrous processes and that the microglia assumed a phagocytic role. We conclude that the possible etiologies of demyelination include viral and/or immune-mediated factors similar to those seen in other demyelinating diseases, such as multiple sclerosis and Guillain-Barré syndrome. Our findings suggest that some forms of Ménière's disease that are refractory to traditional medical management might be the result of retrocochlear pathology that affects the neuroglial portion of the vestibular nerve.
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Affiliation(s)
- Robert F. Spencer
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
- Department of Anatomy, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
| | - Aristides Sismanis
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
| | - Jefferson K. Kilpatrick
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
| | - Wayne T. Shaia
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
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Boulassel MR, Tomasi JP, Deggouj N, Gersdorff M. COCH5B2 is a target antigen of anti-inner ear antibodies in autoimmune inner ear diseases. Otol Neurotol 2001; 22:614-8. [PMID: 11568667 DOI: 10.1097/00129492-200109000-00009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was designed to identify the 58-kDa inner ear protein against which the sera of some patients with idiopathic, progressive sensorineural hearing loss or Ménière's disease strongly react. BACKGROUND We and other groups have previously demonstrated that a 58-kDa protein extracted from guinea pig or bovine inner ear tissue is a target of antibodies in serum samples from some patients with autoimmune inner ear diseases. METHODS After separation of inner ear proteins by 10% sodium dodecyl sulfate polyacrylamide gel electrophoresis, the bands corresponding to 58 kDa were localized and excised from the gel. The concentrated protein was then digested with trypsin, and the peptide fragments were separated by high-pressure liquid chromatography. Three fractions were subjected to amino acid sequencing by the classic Edman degradation. RESULTS The sequence of a stretch of 14 amino acids of the first fragment was identical to that of amino acids 526 to 539 of the COCH5B2 protein. The sequences of 11 and 10 amino acids of the second and third fragments, respectively, also were identical to residues 417 to 427 and 396 to 405 of the COCH5B2 protein. These data, together with two-dimensional gel electrophoresis followed by Western blot experiments, confirmed that the 58-kDa inner ear protein is the COCH5B2 protein. DISCUSSION These findings indicate that the 58-kDa target protein of antibodies in serum samples of patients with autoimmune inner ear diseases is the COCH5B2 protein, a molecule that is highly and specifically expressed in the cochlea and vestibule.
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Affiliation(s)
- M R Boulassel
- Laboratory of Autoimmunity, University of Louvain Medical School, Brussels, Belgium
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Boulassel MR, Tomasi JP, Deggouj N, Gersdorff M. Identification of beta-actin as a candidate autoantigen in autoimmune inner ear disease. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2000; 25:535-41. [PMID: 11122295 DOI: 10.1046/j.1365-2273.2000.00416.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It has been shown that sera from patients with autoimmune inner ear disease contain antibodies to several inner ear antigens. We report here the characterization of the 42-43 kDa protein against which a significant number of patients' sera react strongly. After separation of inner ear proteins from guinea-pig cochleas by SDS-PAGE, the band corresponding to the 42-43 kDa protein was digested with trypsin and the peptide fragments were separated by high-performance liquid chromatography. Two fractions were then subjected to amino acid sequencing by the classical automated Edman degradation. The sequence of a stretch of 15 amino acids of the first fragment was identical to that of amino acids 148-162 of beta-actin. The sequence of the 10 amino acids of the second fragment was also identical to beta-actin. On Western blots, monoclonal antibody directed against beta-actin reacted with the inner ear 42-43 kDa proteins. The serum samples from the patients and the monoclonal antibody reacted with the non-muscle actin used as antigen in Western blotting. Immunoblot analysis of inner ear proteins after two-dimensional gel electrophoresis showed a spot, corresponding to the region of the 43 kDa as compared to the protein standards. On the basis of these data it is concluded that the target 42-43 kDa protein for antibodies in sera of patients with autoimmune inner ear disease is beta-actin, a molecule, which has important and numerous functions inside cells. This is the first report to identify the cytoskeletal protein beta-actin as a candidate autoantigen in autoimmune inner ear disease.
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Affiliation(s)
- M R Boulassel
- Laboratory of Autoimmunity and Department of Otorhinolaryngology, University of Louvain Medical School, 1200 Brussels, Belgium.
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Abstract
There are numerous disorders that can present with hearing loss and vertigo or dysequilibrium. The combination of vertigo and imbalance associated with hearing loss are symptoms suggestive of a peripheral vestibular disorder. This article summarizes presentation, diagnosis, and treatment of the various common and rare peripheral vestibular disorders that can present with these symptoms.
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Affiliation(s)
- M J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Abstract
Work originating in the 1940s led to the characterization of a rare, chronic inflammatory disorder with a unique predilection for the cornea and vestibuloauditory apparatus, now called Cogan's syndrome (CS) after the ophthalmologist who first described it. CS occurs primarily in young adults and typically presents with interstitial keratitis (IK) and Ménière's-like episodes developing within several months of each other. The inflammatory process may target other ocular sites, and the disease itself may be accompanied by aortitis or a Takayasu's-like or medium-sized vessel vasculitis. Morbidity in CS results from deafness and complications from cardiovascular disease. Most evidence suggests that the ocular and vestibuloauditory manifestations are not a consequence of vasculitis but rather mediated by other immunologic mechanisms, possibly organ-specific autoimmunity. The cornerstone of treatment in CS is corticosteroids, topically for IK and systemically for inner ear dysfunction. Early corticosteroid therapy appears to be critical for reversing hearing loss. Cochlear implants can partially restore auditory function and have been a salvation for patients who suffer from deafness as a result of permanent cochlear damage.
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Affiliation(s)
- E W St Clair
- Division of Rheumatology, Allergy and Clinical Immunology, Duke University Medical Center, Durham, NC 27710, USA
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Affiliation(s)
- A F Ryan
- Department of Surgery, UCSD Medical School, La Jolla, California 92093, USA.
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