Safety of High-Dose Corticosteroids for the Treatment of Autoimmune Inner Ear Disease

Alexander, Thomas; Weisman, Michael H.; Derebery, Jennifer; Espeland, Mark A.; Gantz, Bruce J.; Gulya, A. Julianna; Hammerschlag, Paul E.; Hannley, Maureen; Hughes, Gordon B.; Moscicki, Richard A.; Nelson, Ralph A.; Niparko, John K.; Rauch, Steven D.; Telian, Steven A.; Brookhouser, Patrick E.; Harris, Jeffrey P.

doi:10.1097/mao.0b013e3181a52773

Cited by 62 publications

(45 citation statements)

References 36 publications

(30 reference statements)

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“…147 Most serious side effects, however, occur with chronic use, and adverse events are usually acceptable and manageable for the short 10-to 14-day course of steroids recommended for SSNHL. Alexander et al 148 reviewed the safety of high-dose steroids taken for up to 22 weeks for autoimmune inner ear disease and found that most patients completed the course, with the most frequent adverse events being hyperglycemia and weight gain. There is also evidence that osteonecrosis and fractures occur more commonly in patients with preexisting bone or joint problems in conditions such as systemic lupus erythematosis and rheumatoid arthritis.…”

Section: Benefits Vs Risks Of Oral Corticosteroid Therapy For Individmentioning

confidence: 99%

Clinical Practice Guideline

Stachler

Chandrasekhar

Archer

et al. 2012

Otolaryngol.--head neck surg.

772

361

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Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL.Purpose. The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients.Results. The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals,...

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Section: Benefits Vs Risks Of Oral Corticosteroid Therapy For Individmentioning

confidence: 99%

Clinical Practice Guideline

Stachler

Chandrasekhar

Archer

et al. 2012

Otolaryngol.--head neck surg.

772

361

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“…In some cases, the duration of the treatment can be prolonged. The long-term oral prednisone treatment can cause potentially serious side effects such as aseptic necrosis of the femur, psychosis and stomach ulcers [Alexander et al, 2009]. Cytotoxic agents such as cyclophosphamide have also been used to treat AIED [McCabe, 1989].…”

Section: Discussionmentioning

confidence: 99%

“…The current standard AIED treatment is an initial course of high-dose prednisone (60 mg/day), generally for 4 weeks [Alexander et al, 2009]. Responding patients are slowly tapered to the lowest dose that maintains hearing.…”

Section: Introductionmentioning

confidence: 99%

Autoimmune Inner Ear Disease: A Retrospective Review of Forty-Seven Patients

Matsuoka¹,

Harris

2013

Audiol Neurotol

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The purpose of this retrospective study was to characterize and further define autoimmune inner ear disease (AIED) using the Harris AIED classification. A retrospective review was conducted at two tertiary medical centers for 47 patients who were diagnosed with AIED. The overall patient response rate to oral prednisone treatment was 69.7%. The sensitivity of the test for a serum antibody against heat-shock protein 70 (HSP70) was 54.5% and the specificity was 42.9%. Therefore, the clinical utility of the HSP70 antibody test appeared to be limited with respect to the diagnosis of AIED. Vertigo, tinnitus and aural fullness improved significantly with both of the newly developed adalimumab (Humira®) and rituximab (Rituxan®). However, hearing loss did not improve in the present study.

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“…In addition, prolonged use of high-dose corticosteroids (>4 weeks) carries risk of serious adverse events, including hyperglycemia and weight gain (7). In steroid-dependent patients, hearing immediately worsens if the dose declines (8).…”

Section: Introductionmentioning

confidence: 99%

Screening of genes associated with inﬂammatory responses in the endolymphatic sac reveals underlying mechanisms for autoimmune inner ear diseases

Zhang

Wang

2018

Exp Ther Med

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The current study analyzed gene expression profiles of the endolymphatic sac (ES) in rats and identified expressed genes, present in the human and rat ES, to reveal key hubs for inflammatory responses. Microarray data (accession no. E-MEXP-3022) were obtained from the European Bioinformatics Institute database, including three biological replicates of ES plus dura tissues and three replicates of pure dura tissues form rats. Differentially expressed genes (DEGs) were screened using the Linear Model for Microarray data method and a protein-protein interaction (PPI) network was constructed using data from the Search Tool for the Retrieval of Interacting Genes/Proteins database followed by a module analysis via Clustering with Overlapping Neighborhood Expansion. Function enrichment analysis was performed using the Database for Annotation, Visualization and Integrated Discovery online tool. A total of 612 DEGs were identified, including 396 upregulated and 216 downregulated genes. Gene ontology term enrichment analysis indicated DEGs were associated with cell adhesion, including α5-integrin (Itga1) and secreted phosphoprotein 1 (Spp1); T cell co-stimulation, including C-C chemokine ligand (Ccl)21 and Ccl19; and the toll-like receptor signaling pathway, including toll-like receptor (Tlr)2, Tlr7 and Tlr8. These conclusions were supported by Kyoto Encyclopedia of Genes and Genomes pathway analyses revealing extracellular matrix-receptor interaction, including Itga1 and Spp1; leukocyte transendothelial migration, includingclaudin-4 (Cldn4); and malaria, including Tlr2. The hub roles of Itga1, Cd24 and Spp1 were revealed by calculating three topological properties of the PPI network. Ccl21, Ccl19 and Cldn4 were demonstrated to be crucial following significant module analysis according to the corresponding threshold, which revealed they were enriched in inflammation pathways. Tlr7, Tlr2, granzyme m and Tlr8 were common genes associated with inflammatory responses in rat and human ES. In conclusion, abnormal expression of the aforementioned inflammation-associated genes may be associated with the development of autoimmune inner ear diseases.

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Safety of High-Dose Corticosteroids for the Treatment of Autoimmune Inner Ear Disease

Cited by 62 publications

References 36 publications

Clinical Practice Guideline

Clinical Practice Guideline

Autoimmune Inner Ear Disease: A Retrospective Review of Forty-Seven Patients

Screening of genes associated with inﬂammatory responses in the endolymphatic sac reveals underlying mechanisms for autoimmune inner ear diseases

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