Immune‐mediated inner ear disease and parvovirus b19

Abstract

Human parvovirus B19 (HP-B19), the etiologic agent of the common childhood illness erythema infectiosum, has been implicated in systemic immune disorders. Patients presenting with sensorineural hearing loss and/or dizziness, not readily categorized, were evaluated for immune-mediated inner ear disease. Appropriate serologic studies including parvovirus B19 antibody titers were conducted. Thirty patients with suspected immune-mediated inner ear disease were treated with corticosteroid trial for 5 to 7 days, then reexamined with repeat audiogram and/or vestibular testing. Seventeen patients with clinical response were treated with long-term corticosteroids and cyclophosphamide. Six patients had positive HP-B19 immunoglobulin M (IgM) titers and 8 patients had positive parvovirus immunoglobulin G (IgG) titers. All 14 patients responded to therapy. Parvovirus B19, therefore, is a possible etiology of immune-mediated inner ear disease.

Adult Human Parvovirus-B19 Infection Presenting with Hearing Difficulty and Dizziness

“…In adults, HPV-B19 causes a variety of clinical manifestations, although about 75% of infected individuals have non-specific flu-like symptoms or are completely asymptomatic (Woolf et al 1989;Hayakawa et al 2002). For HPV-B19 infection, however, since there has been only one report about inner ear symptoms (Cotter et al 1994), our patient may represent a rare case given the hearing difficulty and dizziness. In the present patient, hearing levels were within normal limits by pure-tone audiometry.…”

“…However, ear symptoms (hearing difficulty and dizziness) are not usually categorized as HPV-B19 associated symptoms. Concerning the ear symptoms of HPV-B19 infection, to our knowledge there has been only one report (Cotter et al 1994).…”

“…Inner ear disorders cause symptoms such as hearing difficulty or vestibular function loss (Cotter et al 1994;Lindblom et al 2005). These symptoms have been recognized to be induced by autoimmune inner ear disease (Cotter et al 1994;Lindblom et al 2005).…”

“…These symptoms have been recognized to be induced by autoimmune inner ear disease (Cotter et al 1994;Lindblom et al 2005). It is possible that autoantibody formation and circulating immune complex deposition cause the symptoms (Cotter et al 1994). On the other hand, viral infections are assumed to be the primary cause of hearing loss and vestibular neuritis.…”

Do Viruses Cause Inner Ear Disturbances?

“…Failure to detect HSV, varicella zoster virus (VZV) and cytomegalovirus (CMV) in the vestibular ganglion of Ménière's disease could not rule out a potential viral etiology of Mé-nière's disease, because vestibular ganglion cells are not the pathological site of the disease [7] . It has been reported that some viruses have the ability to modulate the immune system and induce autoimmune inner ear disease and change the patient's response to corticosteroids [8] . Recently, experimental models have been developed to investigate how some viral infections can prime for, and trigger, autoimmune responses, whereas others ameliorate the pathway leading to clinical disease [9,10] .…”