Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss

Abstract

Summary. Background: In recent years there has been a significant increase in the diagnosis of sudden sensorineural hearing loss (SSHL) in western, countries with an incidence of 20 of 100 000 people affected every year. No clear causes for this disease have been found thus far, but cochlear ischemia has been hypothesized in patients in whom an infectious episode or acoustic neurinoma have been excluded. Objectives: The aim of this case-control study was to investigate a number of acquired and inherited thrombophilic risk factors [antithrombin, protein C and S; factor V (FV) Leiden, FII polymorphism; lupus anticoagulant (LA); anticardiolipin (aCL) antibodies; fasting homocysteine (Hcy); lipoprotein(a) (Lp(a)); plasminogen activator inhibitor-1 (PAI-1)] in addition to cardiovascular risk factors in patients with idiopathic SSHL (ISSHL). Patients and methods: We investigated 155 patients (67 male/88 female; age: 55 (range 19-79 years) with a diagnosis of ISSHL within 30 days from the onset of symptoms, and 155 controls (67 male/ 88 female; age 54 (range 19-78 years). Fasting Hcy levels were significantly higher in patients than in controls [11.6 (6.7-60) lmol/L vs. 8.7 (5.0-24) lmol/L] as well as PAI-1 levels [19 (2-95) mg/dL vs. 14.5 (4.0-87) mg/dL]. Lupus anticoagulant was present in 13 of 155 (8.4%) patients; 20 patients (12.9%) had positivity of aCL (four IgM and 16 IgG). In no patient was a deficiency of physiological clotting inhibitors antithrombin, protein C and protein S found. No significant differences between patients and controls were observed for Lp(a) plasma levels [111 (1-1146) mg/L vs. 103 (11-695) mg/L] and for the presence of FV Leiden (4.5% vs. 4.5%) and FII variant G20210A (3.8% vs. 3.2%). Results and conclusions: Independent risk factors for ISSHL at the multivariate analysis (adjusted for age, sex and the traditional cardiovascular risk factors) were the positivity of aCL: OR 5.6 (95% CI 2.0-15.3); cholesterol levels within the second and third tertiles (with respect to the first tertile): T2 ¼ OR 4.8 (95% CI 1.9-12.6)/T3 ¼ OR 19 (95% CI 7-50.1); PAI-1 and Hcy levels within the third tertile (with respect to the first tertile): OR 20 (95% CI 7.8-78) and OR 4.0 (95% CI 2.0-8.1), respectively. These preliminary data suggest that hypercholesterolemia, hyperhomocysteinemia, elevated PAI-1 levels and anticardiolipin antibodies are associated with ISSHL, so indirectly supporting the hypothesis of a vascular occlusion in the pathogenesis of the disease.

Lipid Lateral Mobility in Cochlear Outer Hair Cells: Regional Differences and Regulation by Cholesterol

“…Directly altering membrane cholesterol levels in OHCs also reversibly shifted the nonlinear capacitance (NLC), the electrical signature associated with prestin function and electromotility (Santos-Sacchi 2003), suggesting that cholesterol levels dynamically tune prestin to operate at maximal gain near the OHC resting potential . These results are important in the context of other reports that hypercholesterolemia may be linked to hearing loss in both animal models and humans (Morizono and Paparella 1978;Morizono et al 1985;Saito et al 1986;Sikora et al 1986;Preyer et al 2001;Marcucci et al 2005). However, the biophysical mechanisms by which cholesterol affects prestin function and hearing are unknown.…”

Vascular and connective tissue features in 5 Italian patients with homocystinuria

“…Controls were selected among apparently healthy Italian subjects with no history of sudden death, without venous thrombosis, cardiovascular, skeletal or eyes Marfan or homocystinuric manifestations. Biochemical and genetic factors predisposing to thrombotic events were evaluated as previously reported [9][10][11][12]. Genomic DNA mutation analysis of CBS gene (Table 1) was performed [13].…”

Stan słuchu u chorych we wczesnym okresie udaru niedokrwiennego mózgu

“…Badania kliniczne wskazują na rolę hiperfibrynogenemii jako czynnika rozwoju niedosłu-chu czuciowo-nerwowego [48,70,79,120,204]. Einer i wsp.…”