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Guo Y, Liu J. The Roles Played by Blood Inflammatory Parameters in Sudden Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2024; 103:313-318. [PMID: 34663107 DOI: 10.1177/0145561320960355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The etiology of sudden sensorineural hearing loss (SSNHL) remains unknown; inflammation may be one cause. We retrospectively studied SSHNL cases in terms of the inflammatory parameters involved. METHODS We reviewed 169 SSNHL cases. The control group contained 132 patients with vocal cord polyps. The C-reactive protein (CRP) level, CRP/serum albumin (Alb) ratio, and neutrophil/lymphocyte ratio (NLR) were compared between the 2 groups. The relationships between these parameters and the time to treatment after SSHNL onset, hearing level, and therapeutic effects were also analyzed. RESULTS The CRP level, CRP/Alb ratio, and NLR were higher in SSNHL patients than in controls, but only the NLR differed significantly between the 2 groups. We found no significant differences between patients with different hearing levels, those evaluated at various times after SSNHL onset, and those with different outcomes. CONCLUSION The NLR is a reliable SSNHL diagnostic marker. The CRP level and CRP/Alb ratio are not useful indicators.
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Affiliation(s)
- Yan Guo
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jisheng Liu
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Kim J, Lee Y, Seo E, Kim D, Lee J, Jeong Y, Kwon S, Jeong J, Lee W. Association between hearing loss and high-sensitivity C-reactive protein: the Kangbuk Samsung Cohort Study. Ann Occup Environ Med 2023; 35:e38. [PMID: 37928374 PMCID: PMC10621009 DOI: 10.35371/aoem.2023.35.e38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023] Open
Abstract
Background Hearing loss (HL) is linked to an elevated risk of cardiovascular diseases (CVDs). The pathogeneses of HL and CVD commonly involve inflammatory responses. Previous studies investigated elevated levels of inflammatory biomarkers in subjects with HL, however, their findings did not demonstrate statistical significance. In our cross-sectional and longitudinal study, we investigated the correlation between HL and increased high-sensitivity C-reactive protein (hsCRP) levels to determine how HL is associated with CVDs. Methods We conducted a cross-sectional study with workers aged over 18 years who underwent health check-ups at our institution between 2012 and 2018 (n = 566,507), followed by conducting a longitudinal study of workers aged > 18 who underwent health checkups at least twice at our institution between 2012 and 2018 (n = 173,794). The definition of HL was as an average threshold of ≥ 20 dB in pure-tone air conduction at 0.5, 1.0, and 2.0 kHz in both ears. The incidence of increased hsCRP levels throughout the follow-up period was defined as a level exceeding 3 mg/L. Logistic regression and generalized estimating equations were performed to estimate the risk of increased hsCRP levels according to the occurrence of HL in groups stratified by age. Results In the cross-sectional study, the multivariate-adjusted odds ratio (OR) was 1.17 (95% confidence interval [CI]: 1.02-1.34); the OR was 0.99 (95% CI: 0.80-1.22) in those under 40 and 1.28 (1.08-1.53) in those over 40. In the longitudinal study, the multivariable-adjusted OR was 1.05 (95% CI: 0.92-1.19); the OR was 1.10 (95% CI: 0.90-1.35) in those under 40 and 1.20 (1.01-1.43) in those over 40. Conclusions This cross-sectional and longitudinal study identified an association between HL and increased hsCRP levels in workers aged over 40 years.
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Affiliation(s)
- Jihoon Kim
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yesung Lee
- Medical Support Division, Pyeongchang County Public Health Clinic, Pyeongchang, Korea
| | - Eunhye Seo
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Daehoon Kim
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehong Lee
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youshik Jeong
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seonghyun Kwon
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsook Jeong
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woncheol Lee
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Zhou T, Chen M, Yuan Z, Xia Z, Zhang S, Zhang Z, Chen H, Lin R. Inflammatory markers and the risk of idiopathic sudden sensorineural hearing loss: A Mendelian randomization study. Front Neurol 2023; 14:1111255. [PMID: 36908593 PMCID: PMC9992207 DOI: 10.3389/fneur.2023.1111255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Background Observational studies suggest that inflammatory markers may increase the risk of idiopathic sudden sensorineural hearing loss (ISSHL). However, the causal relationship between the two has not been established. We sought to assess the possible causal effect between several genetically predicted inflammatory markers and ISSHL by Mendelian random (MR) analysis. Methods We extracted single nucleotide polymorphisms (SNPs) associated with C-reactive protein (CRP), Tumor necrosis factor-α (TNF-α), and fibrinogen from abstract data from the European Individual Large genome-wide association studies (GWAS). Genetic data for ISSHL were obtained from the FinnGen study (n = 196,592). Effect estimates were assessed using inverse variance weighting (IVW) as the primary method. Sensitivity analyses were performed using weighted median, MR-Egger, and MR-PRESSO to evaluate heterogeneity and pleiotropy. Results In the random-effects IVW approach, there was a significant causal relationship between genetic susceptibility to CRP levels and ISSHL (OR = 1.23, 95% CI = 1.02-1.49, P = 0.03). In contrast, genetic TNF-α and fibrinogen were not risked factors for ISSHL (OR = 1.14, 95% CI = 0.88-1.49, P = 0.30; OR = 0.74, 95% CI = 0.07-7.96, P = 0.30; OR = 1.05, 95% CI = 0.88-1.25, P = 0.59). All the above results were consistent after validation by different Mendelian randomization methods and sensitivity analyses. Conclusion This Mendelian randomization study provides causal evidence that CRP is a risk factor for ISSHL, while TNF-α and fibrinogen do not increase the risk for ISSHL Introduction.
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Affiliation(s)
- Tingfeng Zhou
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mengjiao Chen
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ziyi Yuan
- Wenzhou Medical University, Wenzhou, China
| | - Zhigang Xia
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shurou Zhang
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ziheng Zhang
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huanqi Chen
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Renyu Lin
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Frosolini A, Franz L, Daloiso A, Lovato A, de Filippis C, Marioni G. Digging into the Role of Inflammatory Biomarkers in Sudden Sensorineural Hearing Loss Diagnosis and Prognosis: A Systematic Review and Meta-Analysis. Medicina (B Aires) 2022; 58:medicina58070963. [PMID: 35888682 PMCID: PMC9324865 DOI: 10.3390/medicina58070963] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Sudden Sensorineural Hearing Loss (SSNHL) is a quite common clinical finding in otolaryngology. Most cases are classified as idiopathic and there is a dearth of information on factors able to predict the response to treatment and hearing recovery. The main aim of this systematic review and meta-analysis was to assess and critically discuss the role of circulating inflammatory biomarkers in SSNHL. Materials and Methods: A search was conducted of the English literature published between 1 January 2009 and 7 July 2022 on Pubmed, Scopus, Web of Science, ScienceDirect, and Cochrane following PRISMA guidelines. Results: A total of 256 titles were retrieved from the search. After full-text screening and application of inclusion/exclusion criteria, 13 articles were included. Twelve out of thirteen studies reported significant differences in biomarkers values in SSNHL patients, of which Tumor Necrosis Factor alpha (TNF-α) and C-reactive Protein (CRP) were the most analyzed. Our meta-analysis for CRP’s mean values in SSNHL groups vs. controls showed significantly higher CRP levels with a pooled overall difference of 1.07; confidence interval (CI) at 95%: 0.03; 2.11. For TNF-α, discordant results were found: three studies showed significantly higher levels in SSNHL patients vs. controls, whereas other three investigations showed lower levels in the SSNHL groups (overall pooled difference 1.97; 95% CI: −0.90; 4.84). A high between-study heterogeneity was found. Conclusions: This systematic review pointed out that, although there exists a growing literature in the field of circulatory biomarkers identification in SSNHL, there is a high heterogeneity of results and low quality of evidence. CRP resulted to be higher in SSNHL patients than in controls, while TNF-α showed more heterogeneous behavior. The data reported herein needs to be confirmed in well-designed prospective multicenter randomized studies, with the objective of improving SSNHL treatment and outcome and thereby reducing the social burden of hearing loss.
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Affiliation(s)
- Andrea Frosolini
- Department of Neuroscience DNS, Audiology Unit, University of Padova, 31100 Treviso, Italy; (A.F.); (C.d.F.)
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy; (L.F.); (A.D.)
- Guided Therapeutics (GTx) International Scholarship Program, Techna Institute, University Health Network (UHN), Toronto, ON M5G2C4, Canada
| | - Antonio Daloiso
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy; (L.F.); (A.D.)
| | - Andrea Lovato
- Otolaryngology Unit, Vicenza Hospital, 36100 Vicenza, Italy;
| | - Cosimo de Filippis
- Department of Neuroscience DNS, Audiology Unit, University of Padova, 31100 Treviso, Italy; (A.F.); (C.d.F.)
| | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy; (L.F.); (A.D.)
- Correspondence: ; Tel.: +39-049-8212-029
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Doo JG, Kim D, Kim Y, Yoo MC, Kim SS, Ryu J, Yeo SG. Biomarkers Suggesting Favorable Prognostic Outcomes in Sudden Sensorineural Hearing Loss. Int J Mol Sci 2020; 21:ijms21197248. [PMID: 33008090 PMCID: PMC7583026 DOI: 10.3390/ijms21197248] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a medical emergency, making detailed examination to determine possible causes and early treatment important. However, etiological examinations in SSNHL do not always reveal a cause, and several factors have been found to affect treatment outcomes. Various studies are being performed to determine the prognosis and effects of treatment in patients who experience sudden hearing loss, and to identify biomarkers associated with this condition. Embase, PubMed, and the Cochrane database were searched using the key words SSNHL, prognostic, and biomarker. This search identified 4 articles in Embase, 28 articles in PubMed, and 36 in the Cochrane database. Of these 68 articles, 3 were duplicates and 37 were unrelated to the research topic. After excluding these articles, the remaining 28 articles were reviewed. Factors associated with SSNHL were divided into six categories: metabolic, hemostatic, inflammatory, immunologic, oxidative, and other factors. The associations between these factors with the occurrence of SSNHL and with patient prognosis were analyzed. Low monocyte counts, low neutrophil/lymphocyte ratio (NLR) and monocyte/high-density lipoproteins (HDL) cholesterol ratio (MHR), and low concentrations of fibrinogen, platelet glycoprotein (GP) IIIa, and TNF-α were found to be associated with good prognosis. However, these factors alone could not completely determine the onset of and recovery from SSNHL, suggesting the need for future basic and clinical studies.
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Affiliation(s)
- Jeon Gang Doo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea; (J.G.D.); (J.R.)
| | - Dokyoung Kim
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Yong Kim
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul 02447, Korea; (Y.K.); (M.C.Y.)
| | - Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul 02447, Korea; (Y.K.); (M.C.Y.)
| | - Sung Su Kim
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, School of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Jeewon Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea; (J.G.D.); (J.R.)
| | - Seung Geun Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea; (J.G.D.); (J.R.)
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, School of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
- Correspondence: ; Tel.: +82-2-958-8980; Fax: +82-2-958-8470
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Turhal G, Eraslan S, Kaya İ, Midilli R, Karcı B, Göde S. Procalcitonin Levels in Chronic Rhinosinusitis. Turk Arch Otorhinolaryngol 2019; 57:113-116. [PMID: 31620691 PMCID: PMC6779101 DOI: 10.5152/tao.2019.4343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/02/2019] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVE The aim of this study was to evaluate and compare procalcitonin levels of patients diagnosed with chronic rhinosinusitis (CRS) with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP) along with healthy controls. METHODS A total of 67 subjects were included. Twenty-two CRSwNP patients were included in group A, 25 CRSsNP patients in group B, and the control group (group C) consisted of 20 healthy subjects. Procalcitonin level was assessed after CRSwNP or CRSsNP diagnosis. Healthy individuals scheduled for septorhinoplasty constituted the control group. Nasal polyposis was graded according to the Meltzer Clinical Scoring System. RESULTS The mean procalcitonin levels of patients of groups A, B and C were 0.042±0.020 μg/L, 0.031±0.016 μg/L and 0.031±0.010 μg/L, respectively. Mean procalcitonin levels were significantly higher in group A compared to groups B and C (p=0.05 and p=0.032). However, mean procalcitonin levels were not significantly different between group B and group C (p=0.962). Four patients (18%) had grade 1, three had (13.6%) grade 2, eight had (36.4%) grade 3, and seven had (31.8%) grade 4 polyposis. Mean procalcitonin levels for grades 1, 2, 3 and 4 polyposis were 0.045±0.030 μg/L, 0.037±0.006 μg/L, 0.041±0.021 μg/L and 0.043±0.019 μg/L, respectively. No statistical significance was present regarding the mean procalcitonin levels of polyposis grades (p>0.05). CONCLUSION Procalcitonin, which is an important inflammatory marker especially in sepsis and systemic inflammation, was significantly elevated in CRSwNP patients compared to CRSsNP patients and healthy controls. This may support the presence of chronic mucosal inflammation in CRSwNP patients. However, procalcitonin is an indirect marker of inflammation and further studies with larger patient groups are warranted.
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Affiliation(s)
- Göksel Turhal
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Sevinç Eraslan
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - İsa Kaya
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Raşit Midilli
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Karcı
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
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Risk of sudden sensorineural hearing loss in patients with dysrhythmia: A nationwide population-based cohort study. PLoS One 2019; 14:e0218964. [PMID: 31242251 PMCID: PMC6594636 DOI: 10.1371/journal.pone.0218964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/12/2019] [Indexed: 01/08/2023] Open
Abstract
Objective Whether dysrhythmia is a risk factor of sudden sensorineural hearing loss (SSNHL) remains unclear. In this study, we aimed to investigate the risk of developing SSNHL among patients with dysrhythmia in different age and gender groups by using population-based data in Taiwan. Methods We conducted a matched cohort study by analyzing data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. 41,842 newly diagnosed dysrhythmia patients and 83,684 comparison subjects without dysrhythmia were selected from claims. The incidence of sudden sensorineural hearing loss at the end of 2013 was determined in both groups. Univariate and multivariate logistic regression analyses were used to investigate the risk of SSNHL among patients with dysrhythmia. Results The incidence of SSNHL was 1.30-fold higher in the dysrhythmia group compared with the control group (53.2 versus 40.9 per 100,000 person-years), and using Cox proportional hazard regressions, the adjusted hazard ratio (HR) was 1.40 (95% confidence interval [CI], 1.15–1.70). Gender-stratified analysis revealed a significantly higher risk of SSNHL in patients with dysrhythmia than in those without dysrhythmia for both men and women (HR = 1.34, 95% CI = 1.02–1.76, P = 0.039, HR = 1.35, 95% CI = 1.02–1.78, P = 0.035, respectively). Age-stratified analysis revealed remarkable associations between dysrhythmia and SSNHL among those aged less than 40 years and more than 65 years (HR = 2.18, 95% CI = 1.03–4.64, P = 0.043 and HR = 1.54, 95% CI = 1.14–2.09, P = 0.006, respectively). Conclusions Our findings support dysrhythmia as an independent risk factor for SSNHL. Based on the study results, clinicians managing patients with dysrhythmia should be aware of the increased risk of developing SSNHL, especially among patients aged <40 and >65 years, and counsel patients to seek medical advice immediately if they experience any acute change in their hearing ability.
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Baradaranfar M, Dadgarnia M, Zand V, Vaziribozorg S, Mirzade FS, Mirzade M. The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2018; 30:219-223. [PMID: 30083528 PMCID: PMC6064766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL). MATERIALS AND METHODS This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group. RESULTS There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P<0.05). However, differences in mean CRP, anti-Ds DNA, Hb, anti-CCP, white blood cells (WBC), neutrophils, lymphocytes, eosinophils, and platelets were not statistically significant between the case and control groups (P>0.05). CONCLUSION Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment.
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Affiliation(s)
- Mohammadhossein Baradaranfar
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mohammadhossein Dadgarnia
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Vahid Zand
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Sedighe Vaziribozorg
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Fatemeh Sadat Mirzade
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mojtaba Mirzade
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Corresponding Author: Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel: 00983538224000, E-mail:
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