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Rzymski P, Zarębska-Michaluk D, Flisiak R. Could chronic HBV infection explain Beethoven's hearing loss? Implications for patients currently living with hepatitis B. J Infect 2023; 87:171-176. [PMID: 37302659 DOI: 10.1016/j.jinf.2023.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
The cause of Ludwig van Beethoven's health deterioration, i.e., hearing loss and cirrhosis, have been subject to various studies. The genomic analysis of his hair indicates infection with the hepatitis B virus (HBV) at least 6 months prior to death. However, considering his first documented case of jaundice in the summer of 1821, second jaundice months prior to his death, and increased risk of hearing loss in HBV-infected patients, we offer an alternative hypothesis of chronic HBV infection as a cause of deafness and cirrhosis. According to it, HBV was acquired early, progressed from immune-tolerant to an immune-reactive phase, and triggered Beethoven's hearing issues when aged 28. Later, HBV infection entered the non-replication phase with at least two episodes of reactivation in the fifth decade of life accompanied by jaundice. More studies examining hearing loss in patients with chronic HBV infection are encouraged to better understand their potential otologic needs.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland.
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases and Allergology, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
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Audiovestibular Symptoms in Systemic Autoimmune Diseases. J Immunol Res 2018; 2018:5798103. [PMID: 30211232 PMCID: PMC6120292 DOI: 10.1155/2018/5798103] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/11/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Abstract
Immune-mediated inner ear disease can be primary, when the autoimmune response is against the inner ear, or secondary. The latter is characterized by the involvement of the ear in the presence of systemic autoimmune conditions. Sensorineural hearing loss is the most common audiovestibular symptom associated with systemic autoimmune diseases, although conductive hearing impairment may also be present. Hearing loss may present in a sudden, slowly, rapidly progressive or fluctuating form, and is mostly bilateral and asymmetric. Hearing loss shows a good response to corticosteroid therapy that may lead to near-complete hearing restoration. Vestibular symptoms, tinnitus, and aural fullness can be found in patients with systemic autoimmune diseases; they often mimic primary inner ear disorders such as Menière's disease and mainly affect both ears simultaneously. Awareness of inner ear involvement in systemic autoimmune diseases is essential for the good response shown to appropriate treatment. However, it is often misdiagnosed due to variable clinical presentation, limited knowledge, sparse evidence, and lack of specific diagnostic tests. The aim of this review is to analyse available evidence, often only reported in the form of case reports due to the rarity of some of these conditions, of the different clinical presentations of audiological and vestibular symptoms in systemic autoimmune diseases.
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De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, Martellucci S, de Vincentiis M. Polyarteritis nodosa: A contemporary overview. Autoimmun Rev 2016; 15:564-70. [PMID: 26884100 DOI: 10.1016/j.autrev.2016.02.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
Abstract
Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis predominantly targeting medium-sized arteries. PAN is a rare form of vasculitis, and the precise frequency of this disease is difficult to determine. The major environmental factor associated with PAN is HBV infection. The pathogenesis of "idiopathic PAN" remains enigmatic, although the clinical responses to immunosuppressive therapy support the concept that immunological mechanisms play an active pathogenic role. The spectrum of disease ranges from involving a single organ to polyvisceral failure. Any organ might be affected; however, for reasons that are not understood, PAN does not affect the lungs. In addition to the systemic idiopathic form, called "idiopathic generalized PAN," there are 2 clinical variants of this disease: "cutaneous PAN" and "hepatitis B virus (HBV)-associated PAN". Diagnosis requires the integration of clinical, angiographic, and biopsy findings. The overall prognosis of this disease has been improved in recent decades, primarily reflecting early diagnosis and more effective treatments. Idiopathic generalized PAN should be treated with a combination of glucocorticoids and cyclophosphamide. The treatment of HBV-associated PAN involves a different approach, centered on the use of an antiviral agent to control the infection. The therapy for cutaneous PAN requires a less aggressive approach based on the administration of non-steroidal anti-inflammatory drugs over short periods of time.
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Affiliation(s)
- Armando De Virgilio
- Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Viale del Policlinico 155, 00100 Roma, Italy; Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonio Greco
- Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Viale del Policlinico 155, 00100 Roma, Italy
| | - Giuseppe Magliulo
- Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Viale del Policlinico 155, 00100 Roma, Italy
| | - Andrea Gallo
- Department of Medico-Surgical Sciences and Biotechnologies, Otorhinolaryngology Section "Sapienza" University of Rome, Corso della Repubblica, 79, 04100 Latina, (LT), Italy
| | - Giovanni Ruoppolo
- Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Viale del Policlinico 155, 00100 Roma, Italy
| | - Michela Conte
- Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Viale del Policlinico 155, 00100 Roma, Italy.
| | - Salvatore Martellucci
- Department of Medico-Surgical Sciences and Biotechnologies, Otorhinolaryngology Section "Sapienza" University of Rome, Corso della Repubblica, 79, 04100 Latina, (LT), Italy
| | - Marco de Vincentiis
- Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Viale del Policlinico 155, 00100 Roma, Italy
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Rubin F, Tran Khai Hoan N, Bonfils P. Sudden bilateral hearing loss revealing polyarteritis nodosa. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:265-6. [DOI: 10.1016/j.anorl.2014.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/27/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
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A case of MPO-ANCA-positive polyarteritis nodosa complicated by exudative otitis media, mononeuritis multiplex, and acute renal failure. Clin Exp Nephrol 2011; 15:754-760. [PMID: 21611757 DOI: 10.1007/s10157-011-0457-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 05/02/2011] [Indexed: 12/22/2022]
Abstract
In December 2008, a 69-year-old Japanese woman was admitted to the Department of Otorhinolaryngology because of hearing impairment due to bilateral exudative otitis media, and was discharged without complete recovery despite conventional treatment. Two weeks later, she was readmitted for worsened deafness, numbness, gait disturbance, and general fatigue. She was referred to our department for general investigation. On admission, laboratory examination revealed severe inflammatory signs and active nephritic urinary sediments. Cranial computed tomography (CT) revealed progressive exudative otitis media and sinusitis. Initially, Wegener's granulomatosis was suspected. Nasal cavity biopsy, however, showed no granuloma formation or vasculitis. Serology revealed high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA), suggestive of microscopic polyangitis (MPA). However, contrast CT identified stenosis of a celiac artery, and renal biopsy showed tubulointerstitial changes with minor glomerular abnormalities. Therefore, polyarteritis nodosa (PAN) was suspected and treatment with intravenous methylprednisolone was initiated. However, a lacunar infarct developed followed by cerebral hemorrhage, and the patient died 19 days after readmission. Autopsy revealed fibrinoid necrosis, neutrophilic infiltration, and giant cell reaction in small to medium-sized arteries in multiple organs. These findings led to diagnosis of systemic vasculitis anatomically compatible with PAN. This was a rare case of a patient with MPO-ANCA-positive PAN who may have developed bilateral exudative otitis media and hearing loss as the initial manifestation of PAN.
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Joglekar S, Deroee AF, Morita N, Cureoglu S, Schachern PA, Paparella M. Polyarteritis nodosa: a human temporal bone study. Am J Otolaryngol 2010; 31:221-5. [PMID: 20015749 DOI: 10.1016/j.amjoto.2009.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 01/21/2009] [Accepted: 02/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Polyarteritis nodosa is one of the common forms of vasculitis with multiorgan involvement. Hearing loss may be the presenting symptom of this disease. The aim of this histopathologic study was to evaluate temporal bone changes in polyarteritis nodosa and assess the correlation between otologic manifestations and histopathologic findings. MATERIALS AND METHODS A retrospective human temporal bone analysis was performed at an otopathology laboratory in a tertiary academic medical center. Three cases (5 temporal bones) with pathologically confirmed diagnosis of polyarteritis nodosa were selected for study. The processed temporal bone sections were studied under light microscopy. RESULTS Two of the 3 cases presented with hearing loss, and one of them had facial palsy. Audiometric data available for one patient demonstrated a bilateral, rapidly progressive, mixed hearing loss. Histopathologically, we found generalized vasculitis involving small- and medium-sized arteries in all cases. Of the 5 temporal bones available for study, 3 had chronic otitis media and 2 had serous otitis media. Arteritis was seen in all middle ears. There was disruption of the organ of Corti and spiral ganglion cells in 4 temporal bones. One temporal bone showed fibrosis and osteogenesis in the scala tympani of the basal turn. Vasculitis of stylomastoid and branches of labyrinthine artery were also found in temporal bones. CONCLUSIONS Significant temporal bone findings were seen in patients with polyarteritis nodosa, including otitis media, cochlear damage, neo-osteogenesis, and middle and inner ear vasculitis. This temporal bone series also suggests an interesting relationship between sensorineural hearing loss and labyrinthine vasculitis.
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Amor Dorado JC, Barreira Fernández MDP, Regueiro Villarin S, González-Gay MA. [Audiovestibular manifestations in systemic vasculitis]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 60:432-42. [PMID: 19909720 DOI: 10.1016/j.otorri.2009.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 01/13/2009] [Indexed: 10/20/2022]
Abstract
Systemic vasculitides constitute a heterogeneous group of diseases with frequent overlapping in their clinical findings and the size of the vessels involved. They may be primary or secondary to other diseases. Their common characteristic is the inflammation of blood vessels, giving rise to ischaemia. In the present article, we have reviewed the most common audiovestibular features that may be observed in patients with systemic vasculitides. Audiovestibular manifestations may be the first symptom of a systemic vasculitis. Audiological manifestations include sudden hearing loss and progressive sensorineural hearing loss. Vertigo and nystagmus are vestibular symptoms that may be observed in several systemic vasculitides. Vestibular loss in caloric test, abnormal head-shaking nystagmus, head thrust test and positioning test (benign paroxysmal positioning vertigo) may also be found. Improvement of audiovestibular function is frequently observed in patients with giant cell arteritis following corticosteroid therapy.
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Amor Dorado JC, del Pilar Barreira Fernández M, Regueiro Villarin S, González-Gay MÁ. Audiovestibular manifestations in systemic vasculitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009. [DOI: 10.1016/s2173-5735(09)70171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Polyarteritis nodosa presenting as bilateral sudden onset cochleo-vestibular failure in a young woman. J Laryngol Otol 1990; 104:562-4. [PMID: 1974585 DOI: 10.1017/s0022215100113179] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sudden onset sensorineural hearing loss is an otological emergency. Although deafness is recognised as being associated with polyarteritis nodosa (PAN) only very rarely does it herald the disease. We describe a case of bilateral, sudden onset vestibulo-cochlear failure which with thorough investigation proved to be the presenting complaint of PAN. This diagnosis enabled definitive management of a multi-system disorder and resulted in an improvement of the initial symptom with the chemotherapeutic regime discussed. We review the involvement of PAN in deafness and hope this case will remind otolaryngologists of the need for full investigation of the above mentioned emergency, in an attempt to discover and hence direct management towards a specific underlying pathology.
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Vathenen AS, Skinner DW, Shale DJ. Treatment response with bilateral mixed deafness and facial palsy in polyarteritis nodosa. Am J Med 1988; 84:1081-2. [PMID: 2897790 DOI: 10.1016/0002-9343(88)90317-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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