Audiological and vestibular evaluations in vitiligo patients.

Alessandra Manno,Valeria Rossetti,Roberta Polimeni,Antonino Maniaci,Giuseppe Magliulo,Annalisa Pace,Alessandro Milani,Salvatore Cocuzza,Giannicola Iannella

doi:10.17305/bjbms.2021.5703

Abstract

The aim of this paper was to investigate audiological abnormalities and potential vestibular injury in a sample of vitiligo subjects. Thirty-five patients with non-segmental vitiligo (NSV) were enrolled in the study. They underwent pure tonal audiometry (PTA), vestibular Fitzgerald-Hallpike caloric test, C-VEM, and ocular VEMP (O-VEMP) testing. The χ2 test and multiple regression analysis were performed. At PTA, 69% of patients presented with bilateral hearing loss, 8% monaural hearing loss, and 23% normal values. Bilateral caloric stimulations were performed and demonstrated that 14% of patients had a monolateral and 9% had a bilateral pathological response. VEMPs analysis showed that 20% of patients had no O-VEMPs response and 3% had no cervical VEMPS (C-VEMPs) response. Comparison between the normal values of healthy subjects and NSV patients showed an alteration of VEMPs in 44%. Multiple regressions showed no statistical differences. We propose a specific diagnostic protocol employing PTA, bithermal caloric tests, C-VEMP, and O-VEMP testing to evaluate audio-vestibular damage. Our data were concordant with the anatomic-physiological melanocytic distribution and their possible degeneration linked with NSV.

Highlights

Vitiligo is an acquired, sometimes familiar, depigmentary disease resulting from selective destruction of melanocytes with characteristic pearl-white skin patches of different shapes and sizes [1]
Since many studies have demonstrated that melanocytes are localized in different districts of the inner ear, contributing to labyrinth fluid homeostasis, some authors investigated the association between vitiligo and hearing loss [1] considering it as a potential pathogenic factor, damage of the otic melanocytes
One patient (3%) was taking systemic corticosteroids at the time of the evaluation, 6 (17%) patients were in treatment with phototherapy alone, 22 (63%) patients were being treated with local application of cream, and only 6 (17%) of them were not undergoing either pharmacological or phototherapy (Table 2)

Summary

Introduction

Sometimes familiar, depigmentary disease resulting from selective destruction of melanocytes with characteristic pearl-white skin patches of different shapes and sizes [1]. It is clinically classified as either segmental vitiligo (SV) or non-SV (NSV). Even though the posterior labyrinth presents melanin components, only two studies attempted to investigate the problem [2,3]. The latter only partially considered a possible deficit of the posterior labyrinth, since only Cervical Vestibular Evoked Myogenic Potentials or videonystagmography were performed. The VEMPs (ocular VEMPs [O-VEMPs] and cervical VEMPs [C-VEMPs]) are vestibular exams able to evaluate the otolith organs, investigating the utricular and saccular functions and differentiating, indirectly, superior, and inferior

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