Other inflammatory markers ought to be kept in mind when assessing the mean platelet volume in clinical practice

Abstract

We have intentionally read the article ‘‘Increased levels of mean platelet volume (MPV): a possible relationship with idiopathic sudden hearing loss (ISHL)’’ by Ulu et al. [1] with interest. In that well-presented study, the authors aimed to investigate the relationships between the MPV and ISHL. They demonstrated that that MPV and platelet distribution width (PDW) levels were significantly higher in patients with ISHL than the control group. ISHL is one of the most common otologic emergencies, presenting frequently as an acute unilateral deafness with an abrupt onset of hearing loss more than 30 dB at three consecutive frequencies. Sudden sensorineural hearing loss is a symptom of cochlear injury. Potential aetiologies are vascular diseases, viral infections, allergic reactions, autoimmune disorders, use of medications [2] and traumatic rupture of the intralabyrinthine membrane. An impaired cochlear perfusion seems to be an important etiopathogenetic event in ISHL. Recently, oxidative stress has been proposed as risk factors of microvascular damage. As oxidative stress is a key determinant in endothelial dysfunction, our findings could suggest vascular impairment involvement in ISHL etiopathogenesis [3]. Although steroids are the only proven drugs in the treatment for idiopathic sudden sensorineural hearing loss, hyperbaric oxygen therapy shows a significant additional effect in combination with steroid therapy for ISHL, particularly in patients with severe hearing loss [4]. A complete blood count is routine, simple, easy and inexpensive examination technique that gives information about the patient’s formed blood contents: the red and white cells, platelets, the counts and dimensions of subgroups of cells, and parameters like the distribution widths, mean platelet volume. MPV is one of the most widely used laboratory markers related to the platelet function based on inflammatory condition. MPV roughly indicates better platelet function, which is central to processes that are involved in coronary heart disease pathophysiology and endothelial dysfunction [5]. Platelet parameters can be affected by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome [6]. On the other hand, elevated MPV is linked with peripheral artery disease and stroke, all of which are related to atherosclerosis on the basis of inflammation [7]. It can also be affected by thyroid and rheumatic diseases [8], malignancy and medications such as anticoagulant therapy, statins. So, if the authors had mentioned these factors, it might be useful. In conclusion, MPV may be affected by many factors, the routine clinical usage of these parameters may not be reasonable yet. After that, not only MPV but also interleukin 6, tumor necrosis factor, high-sensitivity CRP neutrophil lymphocyte ratio, red cell distribution width, a gamma-glutamyltransferase and uric acid are easy methods to assess in patients with ISHL [9]. These might be useful in clinical practice [10]. MPV itself alone without other inflammatory markers may not give information to clinicians about the inflammatory condition of the patient. So, we think that MPV should be evaluated together with other serum inflammatory markers. S. Balta (&) S. Demirkol Z. Arslan M. Unlu T. Celik Department of Cardiology, Gulhane Medical Academy, Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey e-mail: drsevketb@gmail.com