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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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Boumghit Y, Boucher S, Godey B, Michel G, Bakhos D. Speech reception after cochlear implantation for Cogan's syndrome: Case series following CARE guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:235-238. [PMID: 37479606 DOI: 10.1016/j.anorl.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Cogan's syndrome is a rare form of vasculitis mainly affecting young subjects of whatever gender, associating cochleovestibular and ophthalmological damage. Despite medical treatment, auditory prognosis is uncertain, with 50-60% of patients showing irreversible severe to profound hearing loss, thus being candidates for cochlear implantation. Following CARE guidelines, we report 10 cases of cochlear implantation in Cogan's syndrome, with assessment of speech reception threshold and maximum intelligibility after a minimum 1 year's experience with the implant. CASE SERIES Ten patients from 4 centers received cochlear implants (14 implants) for Cogan's syndrome between 2005 and 2020. After 1 year's experience, there was significant improvement in speech reception threshold (P=0.0002) and maximum intelligibility (P=0.0002). CONCLUSION-DISCUSSION Audiovestibular signs associated with ophthalmological manifestations should suggest Cogan's syndrome. Hearing impairment is usually irreversible. Cochlear implantation may be necessary and improves hearing performance.
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Affiliation(s)
- Y Boumghit
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - S Boucher
- Service ORL et chirurgie cervico-faciale, CHU d'Angers, 4, rue Larrey, 49000 Angers, France
| | - B Godey
- Service ORL et chirurgie cervico-faciale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Michel
- Service ORL et chirurgie cervico-faciale, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - D Bakhos
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1253, iBrain, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France; House Institute Foundation, Los Angeles, United States
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Rücklová K, von Kalle T, Koitschev A, Gekeler K, Scheltdorf M, Heinkele A, Blankenburg F, Kötter I, Hospach A. Paediatric Cogan´s syndrome - review of literature, case report and practical approach to diagnosis and management. Pediatr Rheumatol Online J 2023; 21:54. [PMID: 37291629 DOI: 10.1186/s12969-023-00830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Cogan´s syndrome is a rare, presumed autoimmune vasculitis of various vessels characterized by interstitial keratitis and vestibular impairment accompanied by sensorineural hearing loss. Due to the rarity of Cogan´s syndrome in children, therapeutic decision making may be challenging. Therefore, a literature search was performed to collect all published paediatric Cogan´s syndrome cases with their clinical characteristics, disease course, treatment modalities used and their outcome. The cohort was supplemented with our own patient. MAIN TEXT Altogether, 55 paediatric Cogan´s syndrome patients aged median 12 years have been reported so far. These were identified in PubMed with the keywords "Cogan´s syndrome" and "children" or "childhood". All patients suffered from inflammatory ocular and vestibulo-auditory symptoms. In addition, 32/55 (58%) manifested systemic symptoms with musculoskeletal involvement being the most common with a prevalence of 45%, followed by neurological and skin manifestations. Aortitis was detected in 9/55 (16%). Regarding prognosis, remission in ocular symptoms was attained in 69%, whereas only 32% achieved a significant improvement in auditory function. Mortality was 2/55. Our patient was an 8 year old girl who presented with bilateral uveitis and a history of long standing hearing deficit. She also complained of intermittent vertigo, subfebrile temperatures, abdominal pain with diarrhoea, fatigue and recurrent epistaxis. The diagnosis was supported by bilateral labyrinthitis seen on contrast-enhanced magnetic resonance imaging. Treatment with topical and systemic steroids was started immediately. As the effect on auditory function was only transient, infliximab was added early in the disease course. This led to a remission of ocular and systemic symptoms and a normalization of hearing in the right ear. Her left ear remained deaf and the girl is currently evaluated for a unilateral cochlear implantation. CONCLUSIONS This study presents an analysis of the largest cohort of paediatric Cogan´s syndrome patients. Based on the collected data, the first practical guide to a diagnostic work-up and treatment in children with Cogan´s syndrome is provided.
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Affiliation(s)
- Kristina Rücklová
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Thekla von Kalle
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Assen Koitschev
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Katrin Gekeler
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | | | - Anita Heinkele
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | | | - Ina Kötter
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Clinic for Rheumatology and Immunology Bad Bramstedt, Bad Bramstedt, Germany
| | - Anton Hospach
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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Cacco T, Castello E, Canevari FRM, Laborai A, Grillone A, Zanetti D, Peretti G. Cochlear Implantation as a Treatment for Sudden Autoimmune Sensorineural Hearing Loss in a Patient Affected by Eosinophilic Granulomatosis with Polyangiitis: A Case Report and A Review of Literature. Ann Otol Rhinol Laryngol 2020; 130:112-115. [PMID: 32613850 DOI: 10.1177/0003489420938827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report presentation, diagnostic process, management and outcome of a case of autoimmune inner ear disease (AIED) related with Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis (EGPA), treated with cochlear implantation, and review of relevant literature. CASE PRESENTATION AND MANAGEMENT A retrospective case report of AIED associated with EGPA treated with cochlear implantation was described. A multi-step approach for diagnosis and confirmation of AIED and hearing rehabilitation was conducted, eventually leading to left cochlear implantation. RESULTS The surgery was without complications and postoperative course was uneventful. Two years after surgery, pure-tone and speech soundfield audiometry with left cochlear implant switched on showed a good improvement in pure-tone threshold and a word recognition score of 50% at 60 dB nHL. Literature review does not report any previous case of AIED EGPA-related. CONCLUSIONS Cochlear implantation in AIED EGPA-related have been shown to be a viable treatment option in a stabilized phase of disease.
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Affiliation(s)
- Tommaso Cacco
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Eolo Castello
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Frank Rikki Mauritz Canevari
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Andrea Laborai
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Alessandra Grillone
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Diego Zanetti
- Department of Clinical Sciences and Community, IRCCS Ospedale Maggiore Policlinico Ca' Granda, Audiology Unit, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
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Cochlear implantation in patients with Cogan syndrome: long-term results. Eur Arch Otorhinolaryngol 2014; 272:3201-7. [PMID: 25367706 DOI: 10.1007/s00405-014-3376-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/25/2014] [Indexed: 10/24/2022]
Abstract
The objective of this study was to evaluate the long-term outcomes of patients with Cogan syndrome (CS) who have undergone cochlear implantation. Subjects consisted of 12 cochlear implant users with a typical form of CS. Measures included word and sentence recognition scores. The speech recognition performance was rated before cochlear implantation and at 1 and 5 years after implantation. The speech materials were presented in quiet only condition. The mean 12-month post-operative word and sentence recognition scores were 91.4 and 93.1%, respectively. Five years after implantation, the group means for word and sentence recognition tests were 94 and 96.3%, respectively. No patients in this series experienced flap complication or other local or systemic complications. This long-term study on 12 subjects with CS over 5 years of cochlear implant use reveals that cochlear implantation is safe in the long term and provides excellent and stable hearing results.
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Cogan syndrome — Pathogenesis, clinical variants and treatment approaches. Autoimmun Rev 2014; 13:351-4. [DOI: 10.1016/j.autrev.2014.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 01/09/2023]
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Vasileiadis I, Stratoudaki R, Karakostas E. Complete restoration of auditory impairment in a pediatric case of Cogan's syndrome: report of a rare case with long-term follow-up and literature review. Int J Pediatr Otorhinolaryngol 2012; 76:601-5. [PMID: 22370237 DOI: 10.1016/j.ijporl.2012.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 11/28/2022]
Abstract
Cogan's syndrome is characterized by interstitial keratitis, vestibular impairment and hearing loss, commonly bilateral. Many patients, especially children, experience a delay in proper diagnosis which may delay treatment and thus impact on prognosis of hearing restoration. Less than 10 pediatric cases of Cogan's syndrome have been reported in literature and only five of them were reported with long-term follow-up. We report an extremely rare pediatric case of Cogan's syndrome typical form with long-term follow-up and evaluation of hearing impairment. Cogan's syndrome must be familiar to otorhinolaryngologists, pediatricians and ophthalmologists because early diagnosis and rapid administration of the proper therapy increase the probability of recovering hearing loss.
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Affiliation(s)
- Ioannis Vasileiadis
- Department of Otolaryngology/Head and Neck Surgery, Venizeleio-Pananeio General Hospital, Herakleion, Crete, Greece.
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Bovo R, Ciorba A, Trevisi P, Aimoni C, Cappiello L, Castiglione A, Govoni M, Martini A. Cochlear implant in Cogan syndrome. Acta Otolaryngol 2011; 131:494-7. [PMID: 21171833 DOI: 10.3109/00016489.2010.535214] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Despite the need for special fitting strategies, improvements in speech discrimination tests support the use of cochlear implantation (CI) for patients with Cogan syndrome. Adequate preimplant counselling is mandatory, to prevent high expectations and to stress the necessity for bilateral implantation. OBJECTIVE In 60% of patients with Cogan syndrome, CI remains the only treatment option. Literature data agree that once the electrode array is properly inserted, functional outcomes are very good. Nevertheless, results may deteriorate due to progressive cochlear ossification. A few studies have documented the outcomes of CI in these patients, but none have reported the long-term results. METHODS This was a retrospective study describing the outcomes of 3 implanted patients with Cogan syndrome--among 300 adult patients who received a cochlear implant, 3 had become deaf due to Cogan syndrome. RESULTS In one patient the cochlear ossification advanced and the speech perception abilities worsened from the highest category to identification of words in closed set. The second patient complained of an abrupt reduction of loudness at 18 months post-implant, which required an increased electrical stimulation. The third patient reached the identification category probably due to auditory dyssynchrony, as an atypical consequence of the syndrome.
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Affiliation(s)
- Roberto Bovo
- Audiology Department, University of Ferrara, Ospedale S.Anna, Corso Giovecca 203, Ferrara, Italy.
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Wang JR, Yuen HW, Shipp DB, Stewart S, Lin VYW, Chen JM, Nedzelski JM. Cochlear implantation in patients with autoimmune inner ear disease including cogan syndrome: a comparison with age- and sex-matched controls. Laryngoscope 2011; 120:2478-83. [PMID: 21082747 DOI: 10.1002/lary.21060] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the characteristics and outcomes of patients with autoimmune inner ear disease (AIED) who have undergone cochlear implantation (CI) and compare post-CI performance in AIED to matched controls. STUDY DESIGN Retrospective case control study. METHODS Study cohort was comprised of 25 adult implantees (AIED [n = 18], Cogan syndrome [n = 7]). The AIED group was defined by rapidly progressive bilateral sensorineural hearing loss leading to unusable hearing within weeks to months. Patients with Cogan syndrome, the archetypal inner ear autoimmune disease, were also examined and used for within-cohort comparison. Clinical and operative records were reviewed. Post-CI performance was assessed using open-set sentence tests. Age- and sex-matched individuals deafened by other postlingual causes were used as controls. RESULTS Of 25 patients, 24 had uneventful, full electrode insertions. One AIED patient had partial insertion due to cochlear ossification and did not achieve open-set speech perception post-CI. Mean open-set sentence scores for study patients with uneventful insertions were 92.8%, 97.3%, and 96.4% at 6 months, 1 year, and ≥ 2 years, respectively. Compared to matched controls, patients deafened by autoimmune causes had significantly higher post-CI performance at all postoperative test intervals (P < .05). There was no significant difference in postimplantation performance between Cogan syndrome and AIED patients. CONCLUSIONS To our knowledge this was the largest study of cochlear implantation in AIED and Cogan syndrome patients. In our experience, both groups generally attained high levels of post-CI speech perception and performed above average. Cochlear ossification affecting implantation in Cogan syndrome patients was not observed in our series, contrary to some reports.
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Affiliation(s)
- Jenny R Wang
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Murphy G, Sullivan MO, Shanahan F, Harney S, Molloy M. Cogan's syndrome: present and future directions. Rheumatol Int 2009; 29:1117-21. [PMID: 19471934 DOI: 10.1007/s00296-009-0945-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 04/28/2009] [Indexed: 11/30/2022]
Abstract
Cogan's syndrome, typified by the combination of interstitial keratitis and immune-mediated sensorineural hearing loss, is a rare condition, and commonly associated with a diagnostic delay. Using a standard search protocol, we review the literature to date, focusing on a number of key areas pertaining to diagnosis, presentation and treatment. Using a case illustration of atypical disease which led to fulminant aortic regurgitation, we highlight the need for continued and collaborative research in order to identify negative prognostic factors and thus tailor therapeutic regimens. Atypical Cogan's syndrome is more commonly associated with systemic manifestations than typical disease, and may be refractory to immunosuppressive treatment. We discuss the application of laboratory (e.g antibodies targeting inner ear antigens) and radiological (PET-CT) aids to disease confirmation and detection of sub-clinical vascular inflammation. As illustrated by the included case description, some patients remain refractory to intense immunosuppression and delineation of adverse prognostic factors which may direct treatment, perhaps including the use of PET-CT, will contribute in the future to improving patient outcomes.
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Affiliation(s)
- Grainne Murphy
- Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland.
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Vishwakarma R, Shawn TJ. Cochlear implant in Cogan's syndrome. Eur Arch Otorhinolaryngol 2007; 264:1121-4. [PMID: 17639443 DOI: 10.1007/s00405-007-0362-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 05/23/2007] [Indexed: 11/26/2022]
Abstract
Post-lingual deafness is a stressful condition which is rendered even more painful by the sudden emotional isolation that the patient suffers. Cogan's syndrome is a rare autoimmune cause for post-lingual deafness characterized by non-syphilitic interstitial keratitis, bilateral audio vestibular deficiencies and systemic vasculitis. World over very few cases of Cogan's syndrome have been reported. Cochlear implant surgery in such a patient is a challenging but highly satisfactory experience due to the multitude of clinical problems the patient faces. This demands a proper work up, meticulous surgery and stringent post-operative follow-up. Here we present a patient with atypical Cogan's syndrome, diabetes mellitus and hypothyroidism. She went into a major depression with suicidal tendency following the complete loss of hearing. We performed cochlear implant surgery in this patient, but not before facing several clinical obstacles, helped by a dedicated team consisting of a rheumatologist, endocrinologist, neurophysician, psychiatrist, anaesthetists and audiologist. The results are extremely satisfying for the patient and all the people involved. This case underlines the prime importance of hearing in maintaining the psychological well being of a human being.
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Affiliation(s)
- Rajesh Vishwakarma
- Department of Otorhinolaryngology and Head and Neck Surgery, B J Medical College and Civil Hospital, Ahmedabad, India.
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Im GJ, Jung HH. Side selection for cochlear implantation in a case of Cogan's syndrome. The Journal of Laryngology & Otology 2007; 122:310-3. [PMID: 17524175 DOI: 10.1017/s0022215107008742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractCogan's syndrome is a rare clinical entity that is characterised by non-syphilitic interstitial keratitis and audiovestibular symptoms. The cause of Cogan's syndrome is considered to be autoimmune disease, which is supported by the resolution of hearing loss after steroid treatment, and the association with other autoimmune diseases. The sensorineural hearing loss of Cogan's syndrome is progressive over a few months, and sudden, bilateral deafness often occurs, which may be an indication for cochlear implantation. This paper presents the case of a young woman suffering from Cogan's syndrome and sudden, bilateral deafness. With reference to this case, we describe problems regarding cochlear implantation for Cogan's syndrome and radiological findings aiding selection of cochlear implantation side.
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Affiliation(s)
- G J Im
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
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Pasanisi E, Vincenti V, Bacciu A, Guida M, Berghenti T, Barbot A, Orsoni JG, Bacciu S. Cochlear implantation and Cogan syndrome. Otol Neurotol 2003; 24:601-4. [PMID: 12851552 DOI: 10.1097/00129492-200307000-00012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate outcomes and issues pertaining to cochlear implantation in a group of subjects affected by Cogan syndrome. STUDY DESIGN Prospective cohort. SETTING Department of Ophthalmology and Otorhinolaryngology, University of Parma. PATIENTS Five postlingually deafened adults suffering from a typical form of Cogan syndrome who underwent cochlear implantation. MAIN OUTCOME MEASURES Benefit from cochlear implantation as measured by word and everyday sentence recognition tests. Surgical issues and postoperative complications were also evaluated. RESULTS In two cases, intracochlear electrodes were inserted into the scala vestibuli because of the ossification of the scala tympani. Two patients experienced a recurrence of keratitis the day after surgery. To date, with a follow-up of 1 to 4 years, no patient has experienced flap complications or other local or systemic complications. At the 12-month postoperative evaluation, all patients had gained useful open-set speech perception, achieving a mean score of 91% and 95% on word and everyday sentence recognition tests, respectively. CONCLUSIONS Patients deafened by Cogan syndrome demonstrated high levels of speech understanding after undergoing cochlear implantation. Obliteration of the cochlea may complicate electrode implantation, requiring modifications of the surgical technique. Stress consequent to the surgical procedure may instigate an acute phase of the basic illness.
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Affiliation(s)
- Enrico Pasanisi
- Department of Ophthalmology and Otorhinolaryngology, University of Parma, Parma, Italy.
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Abstract
Cogan's syndrome is a rare, chronic inflammatory disorder that typically targets the eyes and vestibuloauditory apparatus, but it may also involve other organs. Three pediatric cases of Cogan's syndrome (ages 5, 13, and 18 years) are reported with long-term follow-up and complete and regular cochleovestibular functional evaluation and ophthalmologic and neurologic examinations. One case was a typical form (characterized by an interstitial keratitis and cochleovestibular impairment), whereas the other 2 cases were atypical forms with uveitis and polyarthritis. In all 3 cases, the first clinical sign was nonspecific eye redness misdiagnosed as a banal conjunctivitis, initially or secondarily associated with bilateral endocochlear sensorineural hearing loss and complete bilateral peripheral vestibular deficit. During the acute phase, early steroid treatment (prednisone, 1 mg/kg/day) was effective in treating the ocular lesions (3 of 3 cases) and improving hearing (2 of 3 cases) but less effective for the vestibular loss (2 of 3 cases). Adverse effects and dependence on the steroid occurred in 2 cases, and immunosuppressive drugs were necessary to avoid recurrences in 1 case. Over the long-term, the disease was controlled in 2 cases but continued to progress in the other. Cogan's syndrome in childhood should be suspected in cases of conjunctivitis associated with inner-ear symptoms; a prompt steroid treatment can avoid progressive impairment of multiple sensorineural functions (vision, balance, hearing). Long-term management involves limiting disease recurrences by adaptive therapies, screening for complications (aortitis in particular), and planning rehabilitation for the sensorial deficits.
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Affiliation(s)
- Issa C Ndiaye
- Otorhinolaryngology Department, Robert Debré Pediatric Hospital, Paris, France
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