Systematic screening for nonspecific autoantibodies in idiopathic sensorineural hearing loss: no association with steroid response.
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.
Hervier
Baptiste
B
Department of Internal medicine, Hôtel Dieu, Place Alexis Ricordeau, France. bhervier@yahoo.fr
Bordure
Philippe
P
Audrain
Marie
M
Calais
Catherine
C
Masseau
Agathe
A
Hamidou
Mohamed
M
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
D001323:Autoantibodies; D005938:Glucocorticoids; D011241:Prednisone