Autoimmune sensorineural hearing loss

Richard M Keating MD (Dr. Keating of Scripps Clinic/Scripps Green Hospital has no relevant financial relationships to disclose.)
Megan Lynch DO (Dr. Lynch of Scripps Clinic/Scripps Green Hospital has no relevant financial relationships to disclose.)
Monica Budianu MD (Dr. Budianu of Scripps Clinic/Scripps Green Hospital has no relevant financial relationships to disclose.)
Raymond P Roos MD, editor. (Dr. Roos of the University of Chicago owns stock in Amgen, Express Scripts, Isis, and Merck.)
Originally released April 26, 1996; last updated November 7, 2016; expires November 7, 2019

This article includes discussion of autoimmune sensorineural hearing loss, autoimmune inner-ear disease, immune-mediated sensorineural hearing loss, and steroid-responsive sensorineural hearing loss. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Autoimmune hearing loss is a potentially reversible form of hearing loss defined by rapidly progressive sensorineural loss and a characteristic recovery with immunosuppressive therapy. The pathogenesis of the disorder is uncertain, but damage to inner-ear structures is thought to occur through an immune-mediated process. In this article, the authors review the current understanding of the disorder. The authors also provide an update on treatments for autoimmune hearing loss.

Key points

 

• Autoimmune sensorineural hearing loss is a well-described clinical entity that has a complicated pathogenesis.

 

• Progress has been made in understanding the underlying pathophysiology, both in animal models and human patients.

 

• Treatment remains aimed at controlling a likely abnormal immune response to inner-ear antigens, and study data are reviewed in this article regarding specific agents and therapeutic management approaches.

 

• Classically, autoimmune sensorineural hearing loss improves with initiation of treatment, deteriorates with discontinuation of therapy, and recovers with reinstitution of treatment.

Historical note and terminology

Autoimmune sensorineural hearing loss is a well described clinical entity with an uncertain pathogenesis. Known also as "immune-mediated sensorineural hearing loss," "autoimmune inner-ear disease," and "steroid-responsive sensorineural hearing loss," this disorder is 1 of only a few forms of sensorineural hearing loss that can be treated.

A relationship between autoimmune diseases and hearing loss is well recognized, with descriptions of sensorineural loss seen in such systemic autoimmune diseases as systemic lupus erythematosus, polyarteritis nodosa, granulomatous polyangiitis (GPA) (former nomenclature – Wegener granulomatosis), and rheumatoid arthritis (Campbell et al 1983; Harris and Keithley 1993). In addition, reports have also described associations with celiac disease (Volta et al 2009), primary antiphospholipid syndrome (Cavallasca et al 2007; Wang et al 2009), Behcet disease (Erbek et al 2008), Sweet syndrome (Cheng and da Cruz 2010), ankylosing spondylitis (Adam et al 2008), systemic sclerosis (Maciaszczyk et al 2011), sclerouveitis in the setting of HLA-B27 positivity (Rao et al 2008), and Cogan syndrome (Migliori et al 2009). See Table 1 in the “Etiology” section for a complete listing of associated diseases.

A distinct immunologic response directed against the inner ear resulting in hearing loss was first described in 1979 (McCabe 1979). McCabe described sensorineural hearing loss in 18 patients with a variable presentation of progressive bilateral asymmetrical sensorineural hearing loss accompanied by vestibular symptoms. These patients showed negative serologic testing, with the notable exception of a positive response to inner-ear antigens. Treatment with dexamethasone and cyclophosphamide substantially improved hearing. The distinctive clinical course, laboratory findings, and clinical response to immune therapy raised the specter of this entity to being autoimmune mediated. Subsequent literature described a characteristic clinical presentation to include rapid onset (usually unilateral), as well as a more slowly progressing form of sensorineural hearing loss (McCabe 1987).

A condition referred to as "steroid-responsive bilateral sensorineural hearing loss" appeared in the literature in the 1980s (Kanzaki and Ouchi 1981). Several patients diagnosed with idiopathic sensorineural hearing loss showed improvement in audiologic measurements following steroid therapy and subsequent deterioration of auditory sensitivity on discontinuation of treatment. These patients also revealed elevated serum levels of immune complexes that responded to steroid treatment (Kanzaki et al 1994b). Earlier was described an immune complex-mediated disorder with features of vasculitis that targeted the inner ear and improved with glucocorticoids (Veldman et al 1984).

Although rigid diagnostic criteria for autoimmune sensorineural hearing loss are currently not defined, the hallmark features of progressive sensorineural hearing loss and steroid responsiveness are widely recognized.

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