Abstract
Background: Cytomegalovirus (CMV) and T. gondii are two common causes of SNHL (Sensorineural hearing loss) in Iranian children. Immune-mediated vascular damage induced by endothelial cell antibodies may have a prominent role in sensorineural hearing loss. Objectives: To determine the serum CMV and T. gondii antibodies against endothelial cell in children with profound SNHL and cochlear implant surgery. Materials & Methods: A cross sectional study was performed on 76 cases with severe SNHL (mean age 32 ± 30.6 months) at cochlear implant ward of Rasoul hospital, Tehran Iran (2008-2010). The titers of antibodies against endothelial cell (Indirect immunofluorescence assay); were determined in sera of 66 cases. Specific antibodies (IgG & IgM) against T. gondi, CMV (Enzyme linked immunosorbent assay) determined in Idiopathic SNHL cases. Results: Idiopathic type of SNHL was diagnosed in 28.8% (19/66) of younger cases (mean age=20 months; PV=0.05). Positive AECAs was detected in 14.4% (11/76) of cases (with mean age 50 vs. 32 months in cases with negative test; P value=0.047). Positive AECAs had not significant differences between Idiopathic and Non idiopathic type of SNHL [10.5% vs. 9%; PV=0.1]. Positive AECAs were more frequent in cases with known postnatal infections (e.g. mumps, meningitis, chicken pox, etc.) in comparison with non-infection cases (P-value=0.05). Positive T. gondii -IgM (recent infection) was found in 8 /19 (%42); 1 case also had positive T. gondii -IgG. Positive CMV-IgM I 17/19 (%89) respectively. A meaningful correlation was observed between positive AECAs and those infections (Toxo, CMV) in Idiopathic (and unclassified) SNHL cases. Conclusion: Idiopathic type of SNHL with a poor outcome is common (28.8%) in children with cochlear implant surgery Positive AECAs cases had not differences between 2 type of SNHL but were more frequent in older cases with known postnatal infections (meningitis, mumps, chicken pox etc.). A good correlation (p=0.05) between the positive AECAs and known infections determined in studied cases. In contrast, those younger cases ( 2 year old) with Idiopathic SNHL and concomitant positive AECAs.
Highlights
The incidence of unilateral hearing loss in children was approximately 0.1 %
A meaningful correlation was observed between positive anti endothelial cell antibodies (AECAs) and those infections (Toxo, CMV) in Idiopathic Sensory neural hearing loss (SNHL) cases
Immunosuppressive therapy is only recommended in older cases (>2 year old) with Idiopathic SNHL and concomitant positive AECAs
Summary
The incidence of unilateral hearing loss in children was approximately 0.1 %. The etiology of most of these cases remains unknown Neither children nor their parents can precisely determine the time of its appearance, especially when it is not accompanied by other symptoms, such as dizziness or tinnitus [2]. Children with unilateral hearing loss have a greater percentage of inner ear anomalies than children with bilateral SNHL [5]. SNHL in children can be caused by autoimmune disorders localized to the inner ear or secondary to systemic immune diseases. Many studies established the non-specific auto-antibodies vs the inner ear, such as anti endothelial cell antibodies (AECAs). Cytomegalovirus (CMV) and T. gondii are two common causes of SNHL (Sensorineural hearing loss) in Iranian children. Immune-mediated vascular damage induced by endothelial cell antibodies may have a prominent role in sensorineural hearing loss
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