title: Methotrexate management of immune-mediated cochleovestibular disorders.
abstract: Immune-mediated cochleovestibular disorders continue to present a management challenge to the otolaryngologist. The traditional treatment of these disorders, corticosteroids and/or cyclophosphamide (Cytoxan), has been associated with serious and occasionally life-threatening complications. In this study we report our experience in treating 25 patients with immune-mediated cochleovestibular disorders with methotrexate, a less toxic immunosuppressive agent that has been used extensively in patients with rheumatoid arthritis. Mean duration of treatment was 12.9 months, and adverse reactions were acceptable and reversible. Hearing improved in 69.6% of patients, and vestibular symptoms subsided or improved in 80% of patients. The results of this study suggest that methotrexate treatment is effective in a substantial number of patients with immune-mediated cochleovestibular disorders and has acceptable adverse reactions. A prospective, randomized study is needed to compare the efficacy of methotrexate with that of other immunosuppressive agents.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical College of Virginia/Virginia Commonwealth University, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sismanis
authors.forename: C M
authors.initials: CM
authors.lastname: Wise
authors.forename: G D
authors.initials: GD
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D001302:Audiometry, Speech; D001327:Autoimmune Diseases / Q000188:drug therapy*; D015834:Cochlear Diseases / Q000188:drug therapy* / Q000276:immunology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy* / Q000276:immunology; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D016896:Treatment Outcome; D015837:Vestibular Diseases / Q000188:drug therapy* / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate