Research Article: High Prevalence of Systemic Autoimmune Diseases in Patients with Menière’s Disease

Date Published: October 28, 2011

Publisher: Public Library of Science

Author(s): Irene Gazquez, Andres Soto-Varela, Ismael Aran, Sofia Santos, Angel Batuecas, Gabriel Trinidad, Herminio Perez-Garrigues, Carlos Gonzalez-Oller, Lourdes Acosta, Jose A. Lopez-Escamez, Robert E. Means.

Abstract: 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. 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).

We 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.

Despite 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.

Partial Text: 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]. Phenotypic heterogeneity is observed in patients with MD and it is difficult to define the outcome in early stages of the disease. Although 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.

The frequency of vertigo attacks and the SNHL are the most remarkable features of MD and they show a significant variability among patients. We have found an increased prevalence of systemic AD such as RA, SLE and AS in our series, and an association between migraine and AD not previously reported in patients with MD.