title: Systematic screening for nonspecific autoantibodies in idiopathic sensorineural hearing loss: no association with steroid response.
abstract: OBJECTIVE
  An autoimmune pathogenesis has been suggested for idiopathic sensorineural hearing loss (iSHL). Specific tests have been developed to detect inner ear autoantibodies and have been shown to correlate with treatment outcome. However, the disease is rare, and specific tests are not easily available. We aimed to analyze the correlation between positive systemic autoimmune test results and steroid treatment outcome in patients with iSHL.
  
  
  METHODS
  Prospective, single-center, open trial.
  
  
  METHODS
  All patients younger than 60 years seen in the ENT department from 1999 to 2007 and fulfilling the criteria for iSHL were tested for systemic autoimmunity.
  
  
  METHODS
  Patients were classified into 2 groups, according to the presence or absence of autoimmunity.
  
  
  METHODS
  : Clinical evaluation and audiologic tests.
  
  
  METHODS
  The outcomes of steroid treatment were compared between these 2 groups.
  
  
  RESULTS
  Forty-nine patients were included; the mean age at iSHL onset was 36.1 years. Hearing loss was often bilateral (89.8%). Tinnitus and vertigo were present in 75.5% and 51%, respectively. On audiograms, disease severity was correlated with disease duration. Nine patients (18.4%) had positive autoimmune tests: anti-neutrophil cytoplasmic antibody (n = 1), antinuclear antibody (n = 3), rheumatoid factor (n = 3), and antiphospholipid (n = 2). Twenty-five courses of oral steroids were evaluated after 1 month: 52% of cases experienced some improvement. There were no differences in outcome associated with autoimmune status (p = 0.85).
  
  
  CONCLUSIONS
  The results of this study suggest that positive autoimmune tests in patients with iSHL are not predictive of improvement after a 1-month steroid course. Therefore, systematic screening does not seem to be useful, and specific inner ear autoantibody tests need to be developed.
authors.affiliation: Department of Internal medicine, Hôtel Dieu, Place Alexis Ricordeau, France. bhervier@yahoo.fr
authors.forename: Baptiste
authors.initials: B
authors.lastname: Hervier
authors.forename: Philippe
authors.initials: P
authors.lastname: Bordure
authors.forename: Marie
authors.initials: M
authors.lastname: Audrain
authors.forename: Catherine
authors.initials: C
authors.lastname: Calais
authors.forename: Agathe
authors.initials: A
authors.lastname: Masseau
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hamidou
mesh_terms: D000328:Adult; D001299:Audiometry; D001323:Autoantibodies / Q000276:immunology*; D015551:Autoimmunity / Q000276:immunology*; D007758:Ear, Inner / Q000276:immunology; D005938:Glucocorticoids / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D005938:Glucocorticoids; D011241:Prednisone