High Prevalence of Systemic Autoimmune Diseases in Patients with Menière's Disease

Irene Gazquez,Andres Soto-Varela,Sofia Santos,Gabriel Trinidad,Jose A Lopez-Escamez,Herminio Perez-Garrigues,Ismael Aran,Carlos Gonzalez-Oller,Angel Batuecas,Lourdes Acosta

doi:10.1371/journal.pone.0026759

Abstract

BackgroundAutoimmunity appears to be associated with the pathophysiology of Meniere's disease (MD), an inner ear disorder characterized by episodes of vertigo associated with hearing loss and tinnitus. However, the prevalence of autoimmune diseases (AD) in patients with MD has not been studied in individuals with uni or bilateral sensorineural hearing loss (SNHL).Methods and FindingsWe estimated the prevalence of AD in 690 outpatients with MD with uni or bilateral SNHL from otoneurology clinics at six tertiary referral hospitals by using clinica criteria and an immune panel (lymphocyte populations, antinuclear antibodies, C3, C4 and proinflammatory cytokines TNFα, INFγ). The observed prevalence of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) was higher than expected for the general population (1.39 for RA, 0.87 for SLE and 0.70 for AS, respectively). Systemic AD were more frequently observed in patients with MD and diagnostic criteria for migraine than cases with MD and tension-type headache (p = 0.007). There were clinical differences between patients with uni or bilateral SNHL, but no differences were found in the immune profile. Multiple linear regression showed that changes in lymphocytes subpopulations were associated with hearing loss and persistence of vertigo, suggesting a role for the immune response in MD.ConclusionsDespite some limitations, MD displays an elevated prevalence of systemic AD such as RA, SLE and AS. This finding, which suggests an autoimmune background in a subset of patients with MD, has important implications for the treatment of MD.

Highlights

Meniere’s disease (MD) is a chronic disorder affecting the inner ear characterized by fluctuating sensorineural hearing loss (SNHL), episodes of vertigo lasting from 20 minutes to hours, tinnitus, and aural fullness [1]
Despite some limitations, MD displays an elevated prevalence of systemic autoimmune diseases (AD) such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS)
The percentage of patients with bilateral SNHL was different in each center, they do not represent the real percentage of uni or bilateral MD observed in each clinics

Summary

Introduction

Meniere’s disease (MD) is a chronic disorder affecting the inner ear characterized by fluctuating sensorineural hearing loss (SNHL), episodes of vertigo lasting from 20 minutes to hours, tinnitus, and aural fullness [1]. The frequency of the attacks of vertigo is usually greater in the first few years of the disease, and it diminished at advances stages of MD [2,3], balance problems persist along the disease and may become severe if patients develop a bilateral vestibular hypofunction. Autoimmunity appears to be associated with the pathophysiology of Meniere’s disease (MD), an inner ear disorder characterized by episodes of vertigo associated with hearing loss and tinnitus. The prevalence of autoimmune diseases (AD) in patients with MD has not been studied in individuals with uni or bilateral sensorineural hearing loss (SNHL)

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