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Shah S, Chidarala S, Jeong S, Zhang K, Nguyen SA, Wilkinson R, Ward C, Rizk H. Secondary autoimmune immune ear disease (AIED): a systematic review and meta-analysis on vestibular manifestations of systemic autoimmune and inflammatory disorders. Clin Rheumatol 2023; 42:2747-2759. [PMID: 37380912 DOI: 10.1007/s10067-023-06674-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
Secondary autoimmune inner ear disease (AIED) is often bilateral and asymmetric in patients presenting with audiovestibular symptoms due to a systemic autoimmune disease. This systematic review and meta-analysis are aimed at identifying and highlighting patterns in prevalence of vestibular dysfunction, symptom presentation, and diagnostic methods in extant literature by combining clinical context from case reports with quantitative analyses from cohort studies. Screening of articles by title, abstract, and full text was completed by four reviewers (K.Z., A.L., S.C., and S.J.). In this study, we grouped secondary AIED and systemic autoimmune diseases by pathophysiologic mechanism: (1) connective tissue disease (CTD), (2) vasculitides (VAS), (3) systemic inflammatory disorders (SID), and (4) other immune-mediated disorders (OIMD). The search for AIED disease identified 120 articles (cohorts and case reports) that met the final inclusion criteria. All 120 were included in the qualitative review, and 54 articles were included for meta-analysis. Of these 54 articles, 22 included a control group (CwC). Ninety individual cases or patient presentations from 66 articles were included for analysis in addition to the 54 cohort articles. Secondary AIED does not have a diagnostic algorithm for managing vestibular symptoms. The management of audiovestibular symptoms requires close collaboration between otolaryngologists and rheumatologists to preserve end-organ function of the ear. To improve our ability to understand the impact on the vestibular system, vestibular clinicians need to develop a standardized reporting method. Clinical presentation should frequently be paired with vestibular testing to contextually investigate symptom severity and provide higher quality care.
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Affiliation(s)
- Sunny Shah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shreya Chidarala
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel Wilkinson
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Celine Ward
- Department of Rheumatology, Medical University of South Carolina, Charleston, SC, USA
| | - Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
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Effects of primary Sjögren's syndrome on hearing and vestibular systems. The Journal of Laryngology & Otology 2022; 136:1254-1258. [DOI: 10.1017/s0022215122000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
This study aimed to evaluate primary Sjögren's syndrome patients in terms of hearing and vestibular functions.
Methods
The patient group consisted of 35 individuals diagnosed with primary Sjögren's syndrome and a control group of 35 healthy individuals similar in terms of age and gender.
Results
The rate of hearing loss in the patient group was significantly higher than in the control group (p = 0.021). The N1 latency value for the ocular vestibular-evoked myogenic potentials test was significantly longer in the patient group than in the control group (p = 0.037). Additionally, the posterior semicircular canal and lateral semicircular canal vestibulo-ocular reflex gain values were significantly lower than in the control group (p = 0.022 and p < 0.001, respectively).
Conclusion
These results indicate subclinical vestibular involvement and hearing loss in primary Sjögren's syndrome patients. Vestibular-evoked myogenic potentials and video head impulse tests can be used to detect vestibular involvement in primary Sjögren's syndrome patients.
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Cervical vestibular evoked myogenic potential and high-frequency audiometry results in Behçet’s disease. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-020-00052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hearing is commonly impaired in Behçet’s disease (BD). Also, vestibular abnormalities as well as cochlear function affection have been found. The inflammatory process which leads to BD may be the cause of vestibular frequency audiometry abnormalities in those patients. The aim of this study is to assess hearing and vestibulo-colic reflex in Behçet patients using convential pure-tone audiometry (cPTA), high-frequency audiometry (HFA), and cervical vestibular evoked myogenic potential (cVEMP).
Results
This study included 25 patients with BD (group I), whose age ranged from 21 to 45 years, with a mean age of 34.24 ± 7.07 years. The control group (group II) comprised 20 normal adults whose ages are between 21 and 45 years, with a mean age of 30.8 ± 8.02 years. The measured cVEMP parameters which include the mean peak latency of P13 and the mean peak latency of N23 were statistically significantly different between the patients suffering from BD and the control groups. All BD patients had high-frequency sensorineural hearing loss (SNHL) starting from 4 up to 12.5 kHz. The mean thresholds of the audiometry were significantly higher in the diseased group.
Conclusion
cVEMP testing can be used for the evaluation of the vestibulo-colic reflex in BD patients. The occurrence of hearing loss especially in high-frequency regions is a common finding in patients suffering from BD, and a HFA may be a valuable tool in early exploration of hearing loss in patients with BD.
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Ertugrul O, Mutlu A, Zindanci I, Cam OH, Ozluoglu L. Audiological and vestibular measurements in Behçet’s disease. Eur Arch Otorhinolaryngol 2019; 276:1625-1632. [DOI: 10.1007/s00405-019-05403-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/20/2019] [Indexed: 01/09/2023]
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Auditory involvement in Behcet’s disease: relationship with demographic, clinical, and therapeutic characteristics. Clin Rheumatol 2016; 36:445-449. [DOI: 10.1007/s10067-016-3367-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 12/17/2022]
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Bayram A, Doğan M, Koç A, Kalkan M, Akçadağ A, Özcan İ. Cervical and ocular vestibular evoked myogenic potentials in Behcet's disease. Am J Otolaryngol 2015; 36:503-8. [PMID: 25920586 DOI: 10.1016/j.amjoto.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/31/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate vestibular evoked myogenic potentials combined with audiologic status in Behcet's disease (BD) and to compare the results with normal healthy subjects. METHODS Cervical vestibular evoked myogenic potential (cVEMP) test, ocular vestibular evoked myogenic potential (oVEMP) test, Dix-Hallpike test, conventional pure tone audiometry (cPTA) and high frequency audiometry (HFA), and 226 and 1000Hz tympanometry were performed to each subject of the study. Cranial magnetic resonance imaging (MRI) with contrast enhancement was also performed to evaluate the central nervous system (CNS) in patients with BD. RESULTS VEMP parameters including the mean peak latencies of p13-n23 and n10-p15, AR values and thresholds were not statistically different both in cVEMP and oVEMP between the BD and control groups. Except for 250Hz, mean audiological thresholds were significantly higher in the BD group. Five of the 20 patients had pathological cranial MRI findings that may be compatible with central nervous system involvement. CONCLUSION To our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with MRI findings in patients with BD. The presence of high frequency hearing loss is a common finding in BD and HFA may help early detection of hearing loss in patients with BD when combined with cPTA.
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Somuk BT, Özer S, Soyalıc H, Sapmaz E, Goktas G, Admis A, Gurbuzler L. Vestibular evoked myogenic potentials in pediatric patients with familial Mediterranean fever. Int J Pediatr Otorhinolaryngol 2015; 79:879-882. [PMID: 25851176 DOI: 10.1016/j.ijporl.2015.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to investigate whether the chronic autoinflammatory process in familial Mediterranean fever (FMF), which affects numerous systems, results in vestibular dysfunction in pediatric patients being followed up for diagnosis of FMF using VEMP recordings. METHODS 30 patients (60 ears) diagnosed with FMF and 20 (40 ears) healthy volunteers were included in the study. Following routine ear, nose, and throat examination, transient-evoked otoacoustic emissions (TEOAE) and vestibular-evoked myogenic potential (VEMP) tests were performed. RESULTS A total of 30 FMF pediatric patients (13 male, 17 female) and 20 controls (8 male, 12 female) were included in the study. The mean age of FMF patients was 12.13 ± 2.88 years, while that of the controls was 12.90 ± 2.80 years. All of the otoacoustic emission results of the patient and control groups were "pass VEMP recordings received in both ears of patients with FMF (60 ears) and both ears of controls (40 ears). There was no statistically significant difference for latencies or amplitudes for either patients or controls (p > 0.05). CONCLUSION In order to research the effect of FMF on vestibular functions, we measured VEMP. However, we did not detect alterations of VEMP in FMF patients.
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Affiliation(s)
- Battal Tahsin Somuk
- Department of Otorhinolaryngology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey.
| | - Samet Özer
- Department of Pediatry, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Harun Soyalıc
- Department of Otorhinolaryngology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Emrah Sapmaz
- Department of Otorhinolaryngology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Goksel Goktas
- Department of Otorhinolaryngology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Ayhan Admis
- Department of Oudiology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Levent Gurbuzler
- Department of Otorhinolaryngology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
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Morales-Angulo C, Vergara Pastrana S, Obeso-Agüera S, Acle L, González-Gay MÁ. Otorhinolaryngological Manifestations in Patients With Behçet Disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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White AS, Taylor RL, McNeill C, Garsia R, Welgampola MS. Behçet's disease presenting as a peripheral vestibulopathy. J Clin Neurosci 2013; 21:1060-3. [PMID: 24559656 DOI: 10.1016/j.jocn.2013.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 08/06/2013] [Accepted: 08/10/2013] [Indexed: 11/17/2022]
Abstract
Prolonged acute spontaneous vertigo can be secondary to acute vestibular neuritis or posterior circulation ischaemia. We present a 66-year-old man who first developed an acute vestibular syndrome with profound unilateral hearing loss 34 years ago. First treated as vestibular neuritis, he subsequently developed manifestations of Behçet's disease, including mouth ulcers, genital ulcers and erythema nodosum over a period of 10 years. Subsequently, sudden sensorineural hearing loss affecting his only hearing ear responded to immunomodulation, confirming an autoimmune cause for the audiovestibular symptoms. This report serves as a reminder that vestibular neuritis seldom causes hearing loss; ischaemic, infective and autoimmune causes should be sought when an acute vestibular syndrome is accompanied by hearing impairment.
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Affiliation(s)
- Alison S White
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Missenden Road, Camperdown, NSW 2050, Australia
| | | | - Celene McNeill
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Roger Garsia
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Missenden Road, Camperdown, NSW 2050, Australia
| | - Miriam S Welgampola
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Missenden Road, Camperdown, NSW 2050, Australia.
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Morales-Angulo C, Vergara Pastrana S, Obeso-Agüera S, Acle L, González-Gay MÁ. [Otorhinolaryngological manifestations in patients with Behçet disease]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:15-21. [PMID: 24094428 DOI: 10.1016/j.otorri.2013.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Behçet disease (BD) is a systemic immune-mediated vasculitis of unknown origin characterised by recurrent orogenital ulceration, ocular inflammation and skin lesions. The aim of our study was to identify ear, nose and throat (ENT) manifestations associated with BD. PATIENTS AND METHODS Retrospective review of the medical records of all patients diagnosed with BD who attended a tertiary public hospital in Cantabria (Spain) over a period of 22 years. Clinical manifestations, in particular those concerning ENT, were retrieved from medical records. A medical literature review of ENT manifestations was conducted. RESULTS Thirty-three patients (age range: 17-64 years) were included in the study. Most of them presented oral ulcers (97%). Eight patients (24%) presented oropharyngeal ulcers and 5 patients (15%) experienced audiovestibular symptoms (high frequency sensorineural hearing loss, vertigo and bilateral vestibular hypofunction). One patient had symptoms compatible with vestibular neuronitis as the presentation manifestation of Neuro-Behçet. In 4 patients (12%) the presence of odynophagia secondary to the presence of oropharyngeal lesions, initially interpreted as acute or recurrent tonsillitis, was the first manifestation of the disease, alone or associated with cutaneous or ocular lesions. CONCLUSIONS In addition to the characteristic oral ulcers present in most patients with BD, ulcers in the oropharynx, occasionally interpreted as acute pharyngitis, are also common in these patients. Audiovestibular manifestations frequently appear during the course of the disease and may be the first symptom of central nervous system involvement.
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Affiliation(s)
- Carmelo Morales-Angulo
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Sandra Vergara Pastrana
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Sergio Obeso-Agüera
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Leticia Acle
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, España
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