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Paraschou V, Partalidou S, Siolos P, Papadopoulou Z, Chaitidis N. Prevalence of hearing loss in patients with Sjögren syndrome: a systematic review and meta-analysis. Rheumatol Int 2023; 43:233-244. [PMID: 36305918 DOI: 10.1007/s00296-022-05235-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/10/2022] [Indexed: 02/07/2023]
Abstract
Sjögren syndrome (SS) is a multisystem autoimmune disease, primarily targeting salivary and lacrimal glands; skin, nasal and vaginal dryness, along with musculoskeletal pain and fatigue are the most commonly reported symptoms. Hearing loss is hypothesized to be frequent as well. The purpose of this systematic review was to estimate the prevalence of Hearing loss and its different subtypes in patients with Sjögren syndrome. PRISMA guidelines were followed to ensure highest quality for our systematic review. A random effects model meta-analysis and meta-regression was conducted using I2 as heterogeneity indicator. Eleven observational studies were included in this systematic review. Ten of them were cross-sectional, while one study was case-control. Studies were assessed for risk of bias: all were rated to a moderate level, except for two rated to a low level. Pooled prevalence of any type of hearing loss was 52.2%. After excluding studies rated to moderate bias, the pooled prevalence of hearing loss was 36.7%. We also conducted a subgroup analysis depending on type of hearing loss. Pooled prevalence of sensorineural hearing loss was 42.6%., while pooled prevalence of conductive hearing loss and mixed hearing loss were 5% and 2.3%, respectively. Meta-regression was conducted in an effort to identify possible variables capable to explain high heterogeneity between studies. Sample size and year of study were separately found to account for a portion of heterogeneity between studies of sensorineural hearing loss. Year of study was also found to account for a portion of heterogeneity between studies of conductive hearing loss. In conclusion, sensorineural hearing loss, is highly prevalent in patients with Sjögren syndrome. On this basis, early screening and follow-up of patients with Sjögren syndrome by pure tone audiometry is important.
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Affiliation(s)
- Vasileios Paraschou
- Hellenic Police Medical Center, Thessaloniki, Greece.
- 2nd Pulmonary Department, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Haidari, Athens, Greece.
| | - Styliani Partalidou
- Medical Department of Educational Central of Army Aviation, Greek Military Corps, Imathia, Greece
- Internal Medicine Department, Euromedica, Thessaloniki, Greece
| | - Pavlos Siolos
- Hellenic Police Medical Center, Thessaloniki, Greece
- 1st Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi Papadopoulou
- 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Chaitidis
- 2nd Internal Medicine Department, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
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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.
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Alzokm SM, Ghanem SS. Hearing disorders in lupus patients: correlation with duration and severity of the disease. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hearing loss can greatly affect the overall quality of life. Several studies have reported that patients with SLE may suffer from audio-vestibular manifestations. The aim of this study is to evaluate the influence of systemic lupus erythematosus (SLE) on hearing and association of hearing impairment with severity and duration of SLE.
Results
Pure-tone audiometry (PTA) (air conduction and bone conduction) thresholds showed significant elevation in SLE group than controls (P ≤ 0.05). It was observed also that there is a significant association between SLE severity and duration with sensorineural hearing loss (SNHL) and its degree.
Conclusion
SLE can lead to hearing loss, and there is a positive association of SLE severity and duration with degree of hearing loss.
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Polanski JF, Tanaka EA, Barros H, Chuchene AG, Miguel PTG, Skare TL. Chloroquine, Hydroxychloroquine and Hearing Loss: A Study in Systemic Lupus Erythematosus Patients. Laryngoscope 2020; 131:E957-E960. [PMID: 32603516 PMCID: PMC7361380 DOI: 10.1002/lary.28873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
Objectives/Hypothesis Antimalarial drugs (chloroquine and hydroxychloroquine) are widely used for the treatment of systemic lupus erythematosus (SLE). However, these drugs may have side effects such as hearing loss. This study aimed to describe the hearing function in SLE patients using antimalarials. Secondarily, this study aimed to investigate whether SLE causes hearing loss and if there are any serological or clinical aspects of this diseases associated with inner ear damage. Study Design Cross‐sectional study. Methods This study included 84 individuals (43 SLE patients and 41 controls) with audiometry and tympanometry tests. Epidemiological, clinical, serological, and treatment profiles of SLE patients were extracted from the charts. Results SLE patients had more sensorineural hearing loss than controls (23.2% vs. 0; P = .001). Pure‐tone averages in SLE patients using antimalarials and not using antimalarials were similar (8.75 vs. 8.75; P = .63). At 8,000 Hz, antimalarial dug nonusers performed worse than users (10.00 vs. 22.50; P = .03). Tympanometry was normal in all participants. SLE serological and clinical profiles in patients with and without hearing loss were the same (all P = nonsignificant). Conclusions There is a high prevalence of hearing loss in SLE that is not affected by antimalarial drug use. Level of Evidence 3b Laryngoscope, 131:E957–E960, 2021
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Affiliation(s)
- Jose F Polanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Federal University of Parana, and Mackenzie Evangelical School of Medicine-Parana, Curitiba, Brazil
| | - Eloise A Tanaka
- Rheumatology Clinic, Mackenzie Evangelical University Hospital, Mackenzie Evangelical School of Medicine -Parana, Curitiba, Brazil
| | - Harymy Barros
- Rheumatology Clinic, Mackenzie Evangelical University Hospital, Mackenzie Evangelical School of Medicine -Parana, Curitiba, Brazil
| | - Adriana G Chuchene
- Audiology Clinic, Mackenzie Evangelical University Hospital, Mackenzie Evangelical School of Medicine-Parana, Curitiba, Brazil
| | - Patricia T G Miguel
- Audiology Clinic, Mackenzie Evangelical University Hospital, Mackenzie Evangelical School of Medicine-Parana, Curitiba, Brazil
| | - Thelma L Skare
- Rheumatology Clinic, Mackenzie Evangelical University Hospital, Mackenzie Evangelical School of Medicine -Parana, Curitiba, Brazil
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Erez D, Abarbuch E, Natour A, Meyer A, Natour A, Dovrish Z, Levy Y. Audiological disturbances in patients with primary antiphospholipid syndrome. Lupus 2020; 29:533-538. [DOI: 10.1177/0961203320904780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Antiphospholipid syndrome (APS) is an autoimmune disease of hypercoagulability state in the presence of antibodies against phospholipids. Many neurological deficits related to APS have been described. Sensory neural hearing loss has been described only anecdotally, mostly in case reports. This study investigated a possible association between hearing disorders and APS. Methods Seventeen patients (aged 20–80 years) diagnosed with primary APS were evaluated for evidence of hearing disorders. All had otoscopy, full audiometry test, brainstem evoked response audiometry and otoacoustic emissions testing, and completed a questionnaire. Hearing levels were compared to the standard hearing levels of the general population by age group. Results Of the 17 APS patients, 10 (age groups 20–29 and 50–59) had significantly reduced hearing levels in all or part of the tested frequencies compared to standard levels. Three patients (age group 60–69) had better hearing levels at low frequencies compared to standard hearing levels. Conclusion These findings support the existence of hearing disorders in primary APS.
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Affiliation(s)
- Daniel Erez
- Department of Medicine D, Meir Medical Centre, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Abarbuch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology Head and Neck Surgery, Meir Medical Centre, Kfar Saba, Israel
| | - Amed Natour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology Head and Neck Surgery, Meir Medical Centre, Kfar Saba, Israel
| | - Avraham Meyer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Centre, Kfar Saba, Israel
| | - Aiman Natour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Centre, Kfar Saba, Israel
| | - Zamir Dovrish
- Department of Medicine D, Meir Medical Centre, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Centre, Kfar Saba, Israel
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Riera JL, Del R Maliandi M, Musuruana JL, Cavallasca JA. Sudden Sensorineural Hearing Loss in Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A Clinical Review. Curr Rheumatol Rev 2019; 16:84-91. [PMID: 31804161 DOI: 10.2174/1573397115666191016101741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL) is defined as a sudden loss of hearing, usually unilateral, of more than 30 dB in 3 contiguous frequencies of the tonal audiometry. SSNHL estimates an incidence ranging from 5 to 20 per 100.000 people per year. In approximately 75% of cases, a cause cannot be identified. However, it could be a clinical manifestation of Systemic lupus erythematosus (SLE) and Antiphospholipid Syndrome (APS). OBJECTIVE This review will focus on the clinical presentation, diagnosis, and management of the SLE and APS associated SSNHL. METHODS We searched in PubMed, Scopus, Lilacs, and Cochrane reviewing reports of Sudden sensorineural hearing loss in SLE and/or APS. Articles written in English and Spanish, and were available in full text, were included. RESULTS In patients with SLE, bilateral involvement was frequent. Antiphospholipid antibodies were positive in the majority of the patients. Corticosteroids were the mainstay of the treatment. The auditory prognosis was poor with total hearing loss recovery reached in only 22% of patients. On the other hand, most of the patients with SSNHL and APS were males and presented associated symptoms such as vertigo, tinnitus and/or headache, 75% had bilateral disease. Lupus anticoagulant and aCL were found in equal proportions, all patients were anticoagulated, and aspirin was associated in 25% of the cases. Complete resolution or improvement of symptoms was observed in 25% of the patients. CONCLUSION Sudden sensorineural hearing loss, can be a clinical feature of SLE and APS. Treating physicians should be aware of this devastating complication, especially when bilateral involvement occurs.
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Affiliation(s)
- Julia L Riera
- Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, Santa Fe, Argentina
| | - María Del R Maliandi
- Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, Santa Fe, Argentina
| | - Jorge L Musuruana
- Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, Santa Fe, Argentina
| | - Javier A Cavallasca
- Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, Santa Fe, Argentina
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Xie S, Ning H, She Y, Jing Q, Jiang Q, Zhang Y, Mei L, Feng Y, Wu X. Effect of systemic lupus erythematosus and rheumatoid arthritis on sudden sensorineural hearing loss. Laryngoscope 2019; 130:2475-2480. [PMID: 31800112 DOI: 10.1002/lary.28455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Recent reports have identified autoimmune systemic diseases as a significant risk factor for sudden sensorineural hearing loss (SSNHL). We investigated whether systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) were correlated with the hearing recovery of SSNHL. STUDY DESIGN A retrospective study. METHODS Records of 663 SSNHL patients between January 2008 and January 2019 were retrospectively reviewed, including demographic, comorbid diseases, and hearing recovery. Patients were divided into four groups (complete, partial, slight, and no recovery) according to Siegel's criteria and Chinese Medical Association of Otolaryngology (CMAO) criteria. Multinomial logistic regression was performed to evaluate the effects of onset of treatment, initial hearing threshold, audiogram pattern, diabetes mellitus, SLE, and RA on the prognosis of SSNHL according to both criteria. RESULTS Patients in complete recovery, partial recovery, slight recovery, and no improvement were 95 (14.3%), 183 (27.6%), 170 (25.6%), and 215 (32.4%) by Siegel's criteria, and 90 (13.6%), 152 (22.9%), 188 (28.4%), and 233 (35.1%) by CMAO criteria, respectively. Among the four groups, onset of treatment, initial hearing threshold, diabetes mellitus, SLE, RA, and profound audiogram pattern were found to be associated with recovery outcome by both Siegel's criteria and CMAO criteria (P < .05). According to analysis results, presence of SLE, RA, diabetes mellitus and higher initial hearing threshold were significantly correlated with a poor prognosis by both Siegel's criteria and CMAO criteria (P < .05). CONCLUSION Comorbid SLE or RA may negatively affect the prognosis of SSNHL. Lower initial hearing threshold and absence of diabetes mellitus are associated with favorable hearing recovery. LEVEL OF EVIDENCE 4. Laryngoscope, 130:2475-2480, 2020.
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Affiliation(s)
- Shaobing Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yongchuan She
- Department of Otolaryngology Head and Neck Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Qiancheng Jing
- Department of Otolaryngology Head and Neck Surgery, Changsha Central Hospital, University of South China, Changsha, Hunan, China
| | - Qian Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, China
| | - Yanni Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, China
| | - Lingyun Mei
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, China
| | - Yong Feng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, China
| | - Xuewen Wu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, China
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Jeong J, Lim H, Lee K, Hong CE, Choi HS. High Risk of Sudden Sensorineural Hearing Loss in Several Autoimmune Diseases according to a Population-Based National Sample Cohort Study. Audiol Neurootol 2019; 24:224-230. [PMID: 31550708 DOI: 10.1159/000502677] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We investigated the risk of sudden sensorineural hearing loss (SSNHL) in patients with autoimmune diseases compared with a control group in a population-based study using a National Health Insurance Service National Sample Cohort data from Korea. METHODS We enrolled autoimmune-disease patients who were ≥20 years of age in 2006 into the autoimmune-disease group, and selected a control group with similar demographic characteristics. We tracked the 2 groups from 2006 to 2015 and compared the proportions of patients who developed SSNHL. RESULTS Of 13,250 patients in the autoimmune-disease group, 145 experienced an SSNHL event (1.09%). Of the 66,250 in the control group, 484 experienced an SSNHL event (0.73%). The SSNHL risk was significantly higher in the autoimmune-disease group than in the control group. SSNHL incidence was significantly higher among patients with antiphospholipid syndrome (APS), multiple sclerosis (MS), rheumatoid arthritis (RA), and connective-tissue diseases including Sjögren syndrome and Behçet disease. In detailed stratified analyses using reinforced additional diagnostic codes, only RA patients had a significantly higher SSNHL incidence than the control group. CONCLUSION The association of several autoimmune diseases with SSNHL was evaluated in this large-scale, population-based, big-data study. The risk of SSNHL was significantly higher in patients with APS, MS, RA, and connective-tissue diseases including Sjögren syndrome and Behçet disease than in patients without autoimmune diseases. SSNHL, in particular, was significantly associated with RA according to detailed analyses using reinforced additional diagnostic codes.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hyunsun Lim
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kyuin Lee
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Chang Eui Hong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hyun Seung Choi
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea,
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Lasso de la Vega M, Villarreal IM, López Moya J, García-Berrocal JR. Extended high frequency audiometry can diagnose sub-clinic involvement in a seemingly normal hearing systemic lupus erythematosus population. Acta Otolaryngol 2017; 137:161-166. [PMID: 27608500 DOI: 10.1080/00016489.2016.1219049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSIONS Sensorineural hearing loss must be considered within the clinical picture of systemic lupus erythematosus. The results confirm the usefulness of extended high-frequency audiometry in the audiologic testing of these patients, enabling the possibility of modifying or applying a preventive treatment for a possible hearing loss. OBJECTIVES Hearing involvement is usually under-diagnosed with routine auditory examination. This study proposes the use of extended high-frequency audiometry to achieve a correct detection of a possible asymptomatic hypoacusis in early stages of the disease. The aim of this study is to analyze the hearing levels in extended high-frequencies in these patients and to correlate the hearing loss with the severity of the disease and the immunological parameters. METHODS A descriptive cross-sectional study was performed. Fifty-five patients with systemic lupus erythematosus were included in the study. The control group consisted of 71 patients paired by age and sex with the study population. Both a pure tone audiometry and an extended high-frequency audiometry (8-18 KHz) were performed. RESULTS In total, 70% were diagnosed with sensorineural hearing loss with extended high-frequency audiometry, overcoming the results obtained with pure tone audiometry (30.9%). Statistically significant correlations were found within the patients regarding sensorineural hearing loss related with age, disease activity and cryoglobulinemia.
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Affiliation(s)
| | - Ithzel María Villarreal
- ENT Department, ‘Puerta de Hierro-Majadahonda’ University Hospital, Majadahonda, Madrid, Spain
| | - Julio López Moya
- ENT Department, ‘Severo Ochoa’ University Hospital, Leganes, Madrid, Spain
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Chawki S, Aouizerate J, Trad S, Prinseau J, Hanslik T. Bilateral sudden sensorineural hearing loss as a presenting feature of systemic lupus erythematosus: Case report and brief review of other published cases. Medicine (Baltimore) 2016; 95:e4345. [PMID: 27603334 PMCID: PMC5023856 DOI: 10.1097/md.0000000000004345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sudden sensorineural hearing loss is an unusual presenting clinical feature of systemic lupus erythematosus. CASE REPORT We report the case of a young woman who was admitted to hospital for sudden sensorineural hearing loss and hemophagocytic syndrome which was attributed to systemic lupus erythematosus on the basis of specific renal involvement, thrombocytopenia, and consistent autoantibodies. Favorable outcome was obtained on high-dose corticosteroids, and the hearing fully recovered. DISCUSSION Sudden sensorineural hearing loss in systemic lupus erythematosus is seemingly more frequently associated with severe systemic involvement and antiphospholipid antibodies may be present. Although management remains empirical, the high risk of permanent hearing impairment seems to justify emergency treatment with high-dose corticosteroids. When the clinical and laboratory criteria of antiphospholipid syndrome are met, antiplatelets agents or anticoagulation therapy shall be considered.
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Affiliation(s)
- Sylvain Chawki
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, APHP, Boulogne Billancourt
- Université de Versailles Saint Quentin en Yvelines, UVSQ, Versailles
- Correspondence: Sylvain Chawki, 20 avenue Corot, Le Vesinet 78110, France (e-mail: )
| | - Jessie Aouizerate
- Service de Néphrologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, APHP, Créteil
| | - Selim Trad
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, APHP, Boulogne Billancourt
- Université de Versailles Saint Quentin en Yvelines, UVSQ, Versailles
| | - Jacques Prinseau
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, APHP, Boulogne Billancourt
- Université de Versailles Saint Quentin en Yvelines, UVSQ, Versailles
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, APHP, Boulogne Billancourt
- Université de Versailles Saint Quentin en Yvelines, UVSQ, Versailles
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136
- INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
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Low-Density Lipoprotein Cholesterol Is Associated With Asymptomatic Sensorineural Hearing Loss in Patients With Systemic Lupus Erythematosus. J Clin Rheumatol 2016; 22:312-5. [DOI: 10.1097/rhu.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Rossini BAA, Penido NDO, Munhoz MSL, Bogaz EA, Curi RS. Sudden Sensorioneural Hearing Loss and Autoimmune Systemic Diseases. Int Arch Otorhinolaryngol 2016; 21:213-223. [PMID: 28680488 PMCID: PMC5495599 DOI: 10.1055/s-0036-1586162] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/03/2016] [Indexed: 10/25/2022] Open
Abstract
Introduction Several authors have demonstrated the relationship between sudden sensorineural hearing loss (SNHL) and systemic autoimmune diseases (SAD). Immune-mediated SNHL can rarely present as unilateral sudden SNHL and manifests itself in the contralateral ear only after years. It presents clinical relevance for being one of the few SNHL that may be reversible given that early and appropriate treatment is applied. Objective The objective of this study is to describe the clinical presentations and audiological findings from patients with idiopathic sudden SNHL and SAD associated with a probable diagnosis of immune-mediated SNHL. Furthermore, we strive to estimate the prevalence of SAD in patients with sudden SNHL. Methods This is an observational retrospective cohort. We have selected and studied patients with SAD. Revision of available literature on scientific repositories. Results We evaluated 339 patients with sudden SNHL. Among them, 13 (3.83%) patients suffered from SAD. Three patients had bilateral involvement, a total of 16 ears. We evaluate and describe various clinical, epidemiological, and audiological aspects of this sample. Conclusion In our sample of patients with sudden SNHL, the prevalence of SAD was found relevant. The majority had tinnitus and dizziness concomitant hearing loss, unilateral involvement and had experienced profound hearing loss at the time of the installation. In spite of instituted treatment, most cases showed no improvement in audiometric thresholds. Apparently, patients with sudden SNHL and SAD have a more severe initial impairment, higher percentage of bilateral, lower response to treatment, and worse prognosis than patients with sudden SNHL of unknown etiology.
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Affiliation(s)
| | | | | | | | - Renata Souza Curi
- Department of ENT, Universidade Federal de São Paulo, São Paulo, Brazil
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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.
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Gad GI, Abdelateef H. Function of the audiovestibular system in children with systemic lupus erythematosus. Curr Allergy Asthma Rep 2014; 14:446. [PMID: 24803303 DOI: 10.1007/s11882-014-0446-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus can affect inner ear by disrupting either the hearing or balance system. Affection of hearing can be anatomically categorized into conductive and sensorineural hearing loss, while affection of the equilibrium system manifests either as an isolated manifestation like vertigo or as a part of a spectrum like Meniere's disease. Most cases show asymptomatic affection requiring an objective audiovestibular assessment. More focus should be given to routine evaluation especially with disease flares and for proper treatment. In pediatric patients, more concern should be given owing to the added effect of ototoxicity with several drugs and the educational impact of such comorbidity.
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Gad GI, Mohamed ST, Awwad KS, Mohamed RF. Study of audiovestibular dysfunction in children with systemic lupus erythematosus. Int J Pediatr Otorhinolaryngol 2013; 77:1561-6. [PMID: 23916731 DOI: 10.1016/j.ijporl.2013.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Inner ear dysfunction in systemic lupus erythematosis patients has been reported but audiovestibular involvement is not well documented especially in pediatrics. This study was designed to evaluate silent audiovestibular dysfunction among SLE children. METHODS Case control study examined in allergy and immunology clinic; pediatrics hospital and audiovestibular clinic; Ain Shams University from January 2009 to December 2010. Thirty-five systemic lupus erythematosus children (diagnosed according to American College of Rheumatology); age group 8-16 years, were randomly selected. Five of them were excluded due to one or more exclusion criteria (previous otitis media, stroke, lupus cerebritis, meningitis or encephalitis, audiovestibular symptom). Ten of them refused enrollment or could not complete full battery. Seventeen females and three males, mean age 12.9 ± 2.6 years, completed the study. Control group included 20 normal subjects, age and sex matched. Full clinical assessment, basic audiological evaluation and vestibular testing (videonystagmography VNG and computerized dynamic posturography CDP) were conducted for children included in the study. RESULTS Five systemic lupus erythematosus patients had sensorineural hearing loss strongly associated with +ve antiphospholipid antibody and two had conductive hearing loss. Two children in control group had conductive hearing loss (p=0.05). Abnormal VNG findings was significantly higher among systemic lupus erythematosus children (40%) compared to controls (0%) and associated with +ve antiphospholipid antibodies (χ(2)=10, p=0.002, Fisher exact test=0.003). Twenty-five percentage of systemic lupus erythematosus children had abnormal CDP findings reflecting impaired balance function associated with positive antiphospholipid antibodies showing significant statistical difference compared to controls (0% affection) (χ(2)=5.7, p=0.017, Fisher exact test=0.047). CONCLUSION Silent audiovestibular dysfunction is prevalent among systemic lupus erythematosus children especially those positive for antiphospholipid antibodies necessitating routine regular evaluation.
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Affiliation(s)
- Ghada Ibrahim Gad
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Cho CH, Jung BS, Jung JH, Lee JH, Lee JH. Expression of Autoantibodies in Patients with Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2013; 122:131-4. [DOI: 10.1177/000348941312200209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to establish the expression rate of autoimmunity in patients with sudden sensorineural hearing loss and to determine whether a positive marker is associated with a higher rate of hearing recovery after steroid treatment. Methods: A prospective study was performed on 137 patients who experienced sudden sensorineural hearing loss and underwent immunoserologic investigations. Autoantibodies evaluated on the day of admission included anti-double-stranded DNA, rheumatoid factor, antiphospholipid immunoglobulins G and M, antinuclear antibody, and complements C3 and C4. Results: Of 137 patients, 75 were male and 62 were female (mean age, 45.1 years). Hearing loss was found on the left side in 61 patients and on the right side in 76 patients. Elevation of at least 1 autoantibody or abnormal complement levels were found in 80 patients (58%), and abnormalities of 2 or more antibodies were found in 28 (20%). There were no statistically significant correlations between autoantibody abnormalities and age, initial hearing level, or positive treatment response. Conclusions: There is no clear evidence of a correlation between autoimmunity and hearing improvement in patients with autoantibody abnormalities. A high (but not significant) expression rate of autoantibody abnormality and complement level was seen in patients with sudden sensorineural hearing loss.
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Young systemic lupus erythematosus patients with no hearing involvement: 10-year follow up. The Journal of Laryngology & Otology 2012; 127:38-42. [DOI: 10.1017/s0022215112002769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To evaluate patients with systemic lupus erythematosus and normal hearing over 10 years, compared with healthy controls.Methods:Thirty patients diagnosed with systemic lupus erythematosus were evaluated in a prospective, descriptive study. Eight patients fulfilled the inclusion criteria, i.e. normal otoscopy, normal hearing, normal imaging and disease duration of less than one year. Eleven healthy companions of ENT patients were recruited as controls.Results:At study commencement, the mean patient age was 32.75 years (range, 15–49 years) and there were no statistically significant audiometric differences between patients and controls. No statistically significant audiometric changes were found either within or between the patient and control groups at 10-year follow up.Conclusion:These results supply no evidence for progressive hearing loss in systemic lupus erythematosus patients with no hearing involvement at study commencement. Therefore, we recommend audiometric tests only for systemic lupus erythematosus patients complaining of hearing loss, or for other clinical purposes. It is conceivable that asymptomatic hearing loss could be observed over a more extended follow-up period (i.e. more than 10 years).
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19
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Auditory function in patients with systemic lupus erythematosus. Auris Nasus Larynx 2010; 38:26-32. [PMID: 20576373 DOI: 10.1016/j.anl.2010.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/26/2010] [Accepted: 04/27/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) may develop hearing and balance disorders as a result of the immune-mediated inner ear damage due to vasculitis or ototoxicity of drugs used in SLE treatment. The aim of the study was evaluation of the hearing organ disorders in patients with SLE with particular regard to their prevalence and relationship to duration and severity of disease. The severity was assessed from involvement of organs that resulted in poorer SLE outcome, i.e. kidneys and central nervous system (CNS), and from the presence of antibodies associated with unfavourable SLE prognosis. METHODS Thirty-five unselected, consecutive patients (33 women, two men, mean age 47.8 years) with SLE diagnosed in compliance to the international diagnostic criteria of the American Rheumatism Association (1982) were enrolled into the study. The control group consisted of 30 otologically healthy persons matched to the SLE group for age and sex. Case history was recorded for all patients from questionnaire data and laryngological examinations were performed, followed by pure-tone, speech and impedance audiometry and auditory brainstem response audiometry (ABR). RESULTS In the anamnesis 71.4% of patients reported vertigo, 62.9% headaches, 40% tinnitus, 25.7% hyperacusis, 17.1% hearing loss and 2.9% ear fullness. It was found that SLE patients had a significantly poorer mean hearing thresholds than the control group for all frequencies, except for 500; 2000 and 4000 Hz. Longer ABR latency averages were observed in the group of SLE patients compared to control. Ten patients (28.6%) developed high-frequency and symmetric sensorineural hearing loss (SNHL). Significant positive correlation between mean air-conduction hearing thresholds and SLE duration (r = 0.46, p < 0.001) was found. After taking age into consideration, hearing acuity in SLE was related to duration of disease in younger patients. Furthermore, no relation was seen between hearing level and severity of disease. CONCLUSIONS Auditory system involvement ought to be considered as one of elements of the clinical picture of systemic lupus erythematosus while determination of its character, original or secondary, requires further research.
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Saleh Z, Menassa J, Abbas O, Atweh S, Arayssi T. Cranial nerve VI palsy as a rare initial presentation of systemic lupus erythematosus: case report and review of the literature. Lupus 2009; 19:201-5. [DOI: 10.1177/0961203309345722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 48-year-old woman presented with isolated sixth cranial nerve palsy. She subsequently developed systemic lupus erythematosus (SLE) based on clinical and laboratory parameters. Three years later, she presented again with sixth cranial nerve palsy affecting the contralateral eye. Within 2 weeks of steroid initiation, complete recovery occurred. The unusual rare presentation of SLE in the current patient, as well as the pathogenesis and treatment of cranial neuropathy in SLE are discussed. Lupus (2010) 19, 201—205.
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Affiliation(s)
- Z. Saleh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - J. Menassa
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - O. Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - S. Atweh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - T. Arayssi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
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Yehudai D, Shoenfeld Y, Toubi E. The autoimmune characteristics of progressive or sudden sensorineural hearing loss. Autoimmunity 2009; 39:153-8. [PMID: 16698672 DOI: 10.1080/08916930500499599] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Autoimmune sensorineural hearing loss (ASNHL) is a clinical syndrome that typically produces a bilateral rapidly progressive hearing loss. Autoantibodies and autoreactive T cells have been implicated in the etiopathogenesis of ASNHL. However, the identity of a specific or highly relevant inner-ear self-antigen is still required. In recent years, a role for antiphospholipid antibodies has been also suggested, assuming sudden/progressive hearing loss to be part of the primary antiphospholipid syndrome (APS). In this review, we address the need for specific diagnostic tools in order to establish an autoimmune origin for hearing loss. Moreover, the decision of whether anti-inflammatory drugs or anti-coagulation should be given is also discussed.
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Affiliation(s)
- D Yehudai
- Bnai-Zion Medical Center Affiliated with the Technion Faculty of Medicine, Division of Clinical Immunology and Allergy, Haifa, Israel
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Gomides APM, do Rosário EJ, Borges HM, Gomides HHM, de Pádua PM, Sampaio-Barros PD. Sensorineural dysacusis in patients with systemic lupus erythematosus. Lupus 2008; 16:987-90. [PMID: 18042593 DOI: 10.1177/0961203307084160] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to establish the frequency of involvement of the auditory apparatus in 45 female patients with systemic lupus erythematosus (SLE) submitted to general clinical and laboratory assessments, and tone and vocal audiometry accompanied by a questionnaire evaluating auditory symptoms. The control group consisted of 45 healthy women, matched by age. Auditory symptoms were present in 25 (55.5%) patients, with a diagnosis of sensorineural hearing loss in seven (15.6%) patients. A significant correlation with hypoacusis (P < 0.001), ear fullness (P = 0.012) and tinnitus (P = 0.017) was observed in patients with hearing loss. None of the clinical or laboratory parameters showed an association with sensorineural hearing loss. In the control group, three women (6.7%) presented audiometric alterations, including two with altered tympanometry results and one with mild sensorineural hearing loss. In conclusion, an adequate investigation of auditory symptoms is important during the follow-up of patients with SLE, since manifestations of the auditory apparatus and sensorineural hearing loss can affect a significant proportion of patients.
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Affiliation(s)
- A P M Gomides
- Rheumatology Unit; Audiology Section, Santa Casa de Belo Horizonte, MG, Brazil.
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Sensorineural hearing loss in systemic lupus erythematosus: case report and literature review. The Journal of Laryngology & Otology 2008; 122:1371-6. [PMID: 18282337 DOI: 10.1017/s0022215108001783] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We present a case of systemic lupus erythematosus with symptomatic sensorineural hearing loss which was successfully treated with azathioprine, as assessed both clinically and radiologically. We also present a review of the relevant literature. CASE REPORT A woman with systemic lupus erythematosus presented with sensorineural hearing loss, initially on the right and subsequently developing on the left over several months. An audiogram revealed profound neurosensory hearing loss bilaterally. The patient was treated with prednisone 60 mg daily and azathioprine 200 mg daily. An improvement on the left was noted on follow-up audiography as well as on magnetic resonance imaging of the internal auditory canals and surrounding structures. CONCLUSION Sensorineural hearing loss has been described in autoimmune disorders but is rare. Aural symptoms have been described, with varying incidences (0-57.5 per cent), in systemic lupus erythematosus. However, symptomatic sensorineural hearing loss is rare in systemic lupus erythematosus. Prednisone appears essential when an immunological or vasculitic cause is found. The use of azathioprine should be considered, as well as follow-up with magnetic resonance imaging to detect improvement.
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Banerjee SS, Lammin K, Carpentier JD. Nasal septal perforation and antiphospholipid syndrome (Hughes syndrome). The Journal of Laryngology & Otology 2007; 121:1197-200. [PMID: 17553182 DOI: 10.1017/s0022215107008754] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case of a 19-year-old woman who developed a nasal septal perforation and atrophic rhinitis following septal surgery. During the subsequent five years, she also experienced intermittent episodes of swelling and ischaemia of the left foot, as well as livedo reticularis. Ultimately, haematological investigations revealed the presence of lupus anticoagulant and elevated antiphospholipid immunoglobulin M levels. A diagnosis of antiphospholipid syndrome (Hughes syndrome) was made.A search of the literature revealed that nasal septal perforation has been described in up to 0.8 per cent of patients with antiphospholipid syndrome. However, it is undescribed in the otorhinolaryngological literature. The impact of this syndrome on otorhinolaryngology practice is examined.
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Affiliation(s)
- S S Banerjee
- Department of Otorhinolaryngology, Royal Preston Hospital, Preston, UK.
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Kang KT, Young YH. Sudden sensorineural hearing loss in a patient with primary antiphospholipid syndrome. The Journal of Laryngology & Otology 2007; 122:204-6. [PMID: 17419896 DOI: 10.1017/s0022215107007736] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Despite multiple systemic manifestations, sudden sensorineural hearing loss in a patient with antiphospholipid syndrome is rarely reported.Patient:A 46-year-old man with primary antiphospholipid syndrome had a sudden onset of hearing loss and tinnitus in the right ear in December 2005, because he discontinued use of warfarin and acetylsalicylic acid for a few days.Results:Audiometry revealed saucer-type sensorineural hearing loss with a pure tone average of 73 dB in the right ear, and flat-type hearing loss with a pure tone average of 25 dB in the left ear. Electronystagmography displayed multiple central signs and bilateral canal paresis, while a vestibular evoked myogenic potential test revealed bilateral delayed responses. After admission, the patient was re-treated with warfarin and acetylsalicylic acid. Follow-up audiometry showed recovery of right-sided hearing, with a pure tone average of 12 dB, three days after presentation.Conclusion:Consensus exists on the effectiveness of anticoagulant agents in aiding a favourable outcome of sudden sensorineural hearing loss in patients with antiphospholipid syndrome.
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Affiliation(s)
- K-T Kang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Karatas E, Onat AM, Durucu C, Baglam T, Kanlikama M, Altunoren O, Buyukhatipoglu H. Audiovestibular disturbance in patients with systemic lupus erythematosus. Otolaryngol Head Neck Surg 2007; 136:82-6. [PMID: 17210339 DOI: 10.1016/j.otohns.2006.06.1255] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 06/22/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the audiovestibular disturbance in patients with systemic lupus erythematosus (SLE). STUDY DESIGN AND SETTING Twenty-eight patients with SLE and 28 healthy control subjects were included. Pure-tone audiometry, impedance audiometry, and electronystagmography (ENG) were used for baseline evaluation. Laboratory tests were carried out. Cranial and brain stem magnetic resonance imagings (MRI) were undertaken. RESULTS Nineteen (67%) patients reported audiovestibular symptoms. Sensorineural hearing loss was found in 6 (21%) patients. Abnormal results on ENG were significantly higher (50%) (P < 0.01). Abnormal laboratory data were available from 26 patients (P < 0.05). MRI did not show any pathosis. CONCLUSION The audiovestibular disturbances in SLE are more prevalent than previously recognized. Although no cause and effect relationship can be established by this type of study, it appears that a relationship exists. SIGNIFICANCE Audiologic research should be directed toward routine, pure tone audiometry, and ENG assessment for patients with SLE to enable crucial treatment.
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Affiliation(s)
- Erkan Karatas
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
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Roverano S, Cassano G, Paira S, Chiavarini J, Graf C, Rico L, Heredia C. Asymptomatic Sensorineural Hearing Loss in Patients With Systemic Lupus Erythematosus. J Clin Rheumatol 2006; 12:217-20. [PMID: 17023806 DOI: 10.1097/01.rhu.0000242777.71604.69] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hearing loss can accompany systemic lupus erythematosus (SLE). The purpose of this study was to evaluate the prevalence of asymptomatic sensorineural hearing loss (ASNHL) in patients with SLE. METHODS Thirty-one unselected consecutive female patients with SLE (American College of Rheumatology criteria, 1982) were evaluated (in a prospective and descriptive study) for evidence of hearing abnormalities. Twenty-five healthy age-matched women served as controls. All patients and control groups underwent both a normal tympanoscopy and an audiometric testing as a prerequisite to be included in the study. RESULTS Patients with SLE had a mean age of 35 years (range, 19-64 years) and the follow-up time (median) was 48 months (range, 4-180 months). One of 31 patients was excluded because of middle ear infectious disease. Of the remaining 30 patients, 21 (70%) had impaired hearing; 20 (66%) had sensorineural loss at high frequencies in a bilateral and symmetric way, and one had conductive alteration. Ten patients had normal audiometric studies. Four women in the control group had alterations of the audiometric tests: 3 patients had conductive alteration and the other one had bilateral ASNHL. No statistically significant correlation was found among the presence of ASNHL, the detection of antiphospholipid antibodies, and the treatment with hydroxychloroquine. Also, no correlation was observed between impaired hearing and SLE activity. CONCLUSION If it can be established how often this ASNHL progresses to a clinical problem, it can be important that, as part of initial studies, patients with SLE undergo audiometric tests.
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MESH Headings
- Adult
- Antibodies, Anticardiolipin/blood
- Antibodies, Antiphospholipid/blood
- Antirheumatic Agents/therapeutic use
- Audiometry, Pure-Tone
- Case-Control Studies
- Female
- Hearing Loss, Bilateral/etiology
- Hearing Loss, Bilateral/physiopathology
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Humans
- Hydroxychloroquine/therapeutic use
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/physiopathology
- Middle Aged
- Prevalence
- Prospective Studies
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Affiliation(s)
- Susana Roverano
- Department of Rheumatology, Hospital José María Cullen, Santa Fe, Argentina
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Sugiura M, Naganawa S, Teranishi M, Sato E, Kojima S, Nakashima T. Inner ear hemorrhage in systemic lupus erythematosus. Laryngoscope 2006; 116:826-8. [PMID: 16652096 DOI: 10.1097/01.mlg.0000215206.75542.bf] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 33-year-old man had systemic lupus erythematosus (SLE) with anticardiolipin antibody. At the age of 40 years, he experienced bilateral hearing deterioration. The three-dimensional fluid-attenuated inversion recovery of magnetic resonance imaging showed high signals bilaterally in the cochlea and vestibule. He was diagnosed with bilateral inner ear hemorrhage on the basis of the presence of anticardiolipin antibody. This is the first published case of inner ear hemorrhage in a patient with SLE. Our findings suggest that inner ear hemorrhage is associated with hearing deterioration in some patients with SLE.
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Affiliation(s)
- Makoto Sugiura
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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