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Table of Contents
ORIGINAL ARTICLE
Year : 1998  |  Volume : 1  |  Issue : 1  |  Page : 35-40

Immunologic findings in meniere’s disease


ENT Department, Faculty of Medicine For Girls, Al-Azar University, Cairo, Egypt

Date of Web Publication16-Jun-2020

Correspondence Address:
MD Naema M Ismail
21 Mohamed Yousef Saleem Street, Near El-Hejaz Square, El-Nozha, Heliopolis, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.286854

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  Abstract 


Twenty-four patients with Meniere’s disease were studied for the possibility of autoimmune aetiology. Ten normal adults of matching age and gender distributionserved as controls. Both groups were subjected to a battery of laboratory tests performed to evaluate the immunologic status namely ESR, C-reactive proteins (CRP), serum immunoglobulin levels, serum complement levels and serum autoantibody levels (Rheumatoid factor, anti DNA antibody and antinuclear antibody). Also a clinical search for associated autoimmune abnormalities in both groups was performed. There was a significant increase in ESR, CRP, IgG and antinuclear antibody (ANA) levels in the study group compared to the control group. Associated autoimmune abnormality was present in two cases (8.3 %) of the Meniere’s disease group and none of the control group. Steroid treatment for selected cases of the Meniere’s disease group produced 40% improvement. These data support the opinion of an autoimmune pathogenesis of some cases of Meniere’s disease.

Keywords: Meniere’s disease, Autoimmunity, Laboratory, Cortisone


How to cite this article:
Ismail NM. Immunologic findings in meniere’s disease. Saudi J Otorhinolaryngol Head Neck Surg 1998;1:35-40

How to cite this URL:
Ismail NM. Immunologic findings in meniere’s disease. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 1998 [cited 2022 Nov 30];1:35-40. Available from: https://www.sjohns.org/text.asp?1998/1/1/35/286854




  Introduction Top


The aetiology of Meniere’s disease is still obscure. A multifactorial aetiology is probable. Several factors were suggested as probable causes. Among them are genetic predisposition, vascular pathophysiology , metabolic disorders and immune response against herpes simplex virus .[1],[2],[3],[4],[5]

An interesting aetiology that is recently extensively explored is the autoimmune aetiology where an autoimmune response was suggested to occur within the inner ear particularly in the endolymphatic sac towards some sort of a self (auto) antigen within the inner ear. Both cellular and humoral mechanisms were explored by several researches. [6],[7],[8],[9],[10],[11],[12],[13]

The aim of the present study is to explore the autoimmune pathogenesis as a possible factor in Meniere’s disease through studying three parameters namely associated autoimmune diseases, response to steroids and a group of laboratory tests directed towards studying humoral immunity.


  Materials and Methods Top


The material of this study consisted of 24 patients with Meniere’s disease, 10 females and 14 males with age range of 34 to 51 years. Ten normal adult subjectsof matching age and gender were used as controls. The control cases had no previous medical, ear, nose, throat or neurologic disease; no history of vertigo, tinnitus or hearing loss. Their mean hearing level was 15 dB at 250, 500, 1000, 2000, 4000 and 8000 Hz.

History included inquiries about recurrent attacks of rotatory dizziness, tinnitus, intermittent sense of fullness in the ears, hearing loss, previous treatment and history suggestive of other immune diseases. Neurological examination was performed including cranial nerve examination. Full ear ,nose and throat examination was also performed.

Conventional audiological tests were performed on both the study and control groups using Madesen OB40 clinical audiometer. It included pure tone audiometry, speech audiometry, both speech reception threshold (SRT) and discrimination score (DS) using Arabic phonetically balanced words.[14] Immittancemetry was also conducted including tympanometry and acoustic reflex using Madesen 25-77 NM. Special test battery was done in the form of suprathreshold adaptation’ test (STAT) ,tone decay, reflex decay, alternate binaural loudness balance (ABLB) and short increment sensitivity index (SISI) tests for recruitment whenever possible. Vestibularscreening test in form of occulocephalic response (OCR) was also done. Harvey and Wood (1996) [15] reported 97% specificity of OCR which showed good correlation to caloric testing.

Immune activity in both the study and control groups was assessed using four types of laboratory parameters:

  1. The erythrocyte sedimentation rate (ESR) and C-reactive proteins (CRP).
  2. Serum immunoglobulin levels (IgG, IgM IGA).
  3. Complement levels (C3, C4).
  4. Auto antibody levels [Rheumatoid factor (RF), anti DNA antibodies, antinuclear antibodies].


Ten patients out of 24 Meniere’s disease patients were given oral Prednisolone tablets at a dose of 5mg four times daily for two weeks. Tapering of the dose was done on six weeks with no maintenance. The indication for steroid therapy was the presence of progressive abrupt hearing loss and/or frequent attacks of vertigo not responding to cerebral vasodilators. The control group was not given steroids.


  Results Top


[Table 1] shows the age and gender distribution for the Meniere’s disease group (M.D) and the control group as well as the audiological Findings in both groups. The Meniere’s disease group had a mean hearing level of 48 dB at 250, 500, 1000 Hz in comparison to 15dB for the control group. The Meniere’s disease patients had a positive recruitment in 13 patients (54.2%) and a positive occulocephalic response in seven patients (29.2%).
Table 1: Audiologic Findings in Meniere’s disease group and control group

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The results of the laboratory tests are shown in [Table 2]. The erythrocyte sedimentation rate, the C-reactive proteins, the IgG and the antinuclear antibody levels were significantly elevated in Meniere’s disease group as compared to the control group (P < 0.05).
Table 2: Comparison of the number of abnormal laboratory tests in the control group and the Meniere’s disease group

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[Table 3] shows the immunological criteria studied in the M.D. group compared to the control group. Abnormal laboratory results in general were observed significantly more frequently in M.D patients than the control group. Two patients of the M.D. group had associated autoimmune abnormality namely thyrotoxicosis and ulcerative colitis but none of the control group showed autoimune abnormality. The difference was statistically significant.
Table 3: Criteria for immunologic evaluation of Meniere’s disease patients compared to the control group

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Four patients (40%) out of ten patients who received steroid treatment showed a significant improvement of hearing level at an average of 15 dB or more, and a marked improvement of their dizziness and sense of fullness. Six patients (60%) did not improve on steroid treatment. [Figure 1] shows an audiogram of a patient with Meniere’s disease before and after steroid treatment with significant improvement after steroid therapy.
Figure 1: Audiogram of a patient with Meniere’s disease before and after steroid treatment

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  Discussion Top


The normal human endolymphatic sac has a local immune system with phagocytic cells, monocytes, macrophages, polymorphic leucocytes, T-lymphocytes and fenestrated blood vessels.[16] Immune challenge to the endolymphatic sac in experimental animals was found to produce vestibular dysfunction [17],as well as an immune response characterised by the formation of antibodies against the offending heterologus inner ear antigen used in the experiment as well as the development of an immune inflammatory reaction within the inner ear of the studied animals. [18],[19] The search for the exact offending antigen is still continuous.

The human inner ear antigen is the best for studying autoimmune inner ear diseases. However, this is not practical because of the limited resources, therefore much studies on experimental animals were performed. In Cao et al. (1996) [20] study, antigens from different locations within the inner ear of guinea pig couldbe extracted and purified for experimental use and were tested for reaction with sera of patients having Meniere’s disease using Immuno- electrophoresis techniques. Various bands corresponding to different tissues within the inner ear were identified and the same bands reacted with patient sera but results are still non conclusive.

An autoimmunity against type II collagen within the basement membrane of the inner ear was suggested by some authors [21] and denied by others. [22],[23] Therefore the exact offending antigen is still obscure.

About ten percent of patients with Meniere’s disease are thought to have an auto immune background. [10] This was supported by the hypergamma-globu 1inemia, the presence of immune inflammatory reaction within the inner ear samples obtained during surgery, the response to steroids and the association with other auto immune diseases. [6] Both cellular and humoral mechanisms were suggested but whether the immune disorder is mediated by either one or both of them is still unknown. [6],[12]

Tests for cellular autoimmune response include the lymphocyte transformation test and the lymphocyte migration inhibition test. These were used by some authors. [6],[24],[25],[26] However these tests are complicated and were not available to us.

Tests for humoral autoimmune response depended on testing patient’s blood for erythrocyte sedimentation rate, C-reactive proteins, Immunoglobulins (IgG, IgM, IgA), complement (C3, C4), autoanti-bodies (Rheumatoid factor RF, anti DNA antibody and antinuclear antibody and circulating immune complexes (CICs). [6],[7],[8],[25], [9],[10], [12],[13] One study histologically proved the deposition of CICs in the subepithelial vasculature of some of the endolymphatic sac biopsies obtained during surgery for Meniere’s disease. [11]

In our study Meniere’s disease was diagnosed by history and clinical examination including audiological evaluation. The immunological evaluation of the patients depended on three parameters namely the laboratory tests, the response to steroids and the association with other autoimmune disorders. The laboratory tests used in our study included testing the patient’s blood for erythrocyte sedimentation rate, C-reactive proteins, serum immunoglobulins IgG, IgM, IgA levels, serum level of complement C3 and C4 , Rheumatoid factor, anti DNA antibody and antinuclear antibody levels. Some of the Meniere’s disease patients showed abnormal laboratory tests. Comparing the Meniere’s disease group to the control group showed statistically significant abnormal results regarding the ESR, CRP, IgG and ANA.

[Figure 2] shows the laboratory findings in Meniere’s disease in the present study compared to other studies.[7].[8],[10],[12],[13 An increased ESR, IgG and antinuclear antibodies levels was in common with these studies.
Figure 2: Autoimmune disease associated with Meniere’s disease in the present study compared to several other studies

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The association of Meniere’s disease with other autoimmune diseases was observed by several authors at a range of 3 - 30 percent. [27],[9],[10],[12] In this study 2 patients (8.3%) had associated autoimmune diseases [Figure 3].
Figure 3: Autoimmune disease associated with Meniere’s disease in the present study compared to several other studies

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The response to steroids was reported by several authors. [10],[12],[26],[28] at a rate of 10- 75% according to the criteria of patient selection [Figure 4]. In the present study four patients out of ten selected patients (40%) showed good response to steroids.
Figure 4: Response to Steroids in the present study compared to several other studies

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  Conclusion Top


Our results support the opinion that some cases of Meniere’s disease may have an autoimmune background. Further research is still required in this area to disclose the exact pathogenesis of this disease.



 
  References Top

1.
Koyoma S, Mitsuishi Y, Bibee K, Watanabe I.Terasaki PI. HLA Associations with Meniere’s Disease. Acta Otolaryngol (Stockh) 1993; 113: 575 -578.  Back to cited text no. 1
    
2.
Morrison AW. Anticipation in Meniere’s Disease. J Laryngol Otol 1995; 109: 499- 502.  Back to cited text no. 2
    
3.
Parker W. Meniere’s Disease. Arch Otolaryngol Head Neck Surg 1995; 121: 377-382.  Back to cited text no. 3
    
4.
Brookler KH, Glenn MB. Meniere’s Syndrome: An Approach to Therapy. ENT J. 1995; 74(8): 534- 542.  Back to cited text no. 4
    
5.
Bergestrom T, Edstrom S, Tjellstrom A, Vahlne A. Meniere’s Disease And Antibody Reactivity to Herpes Simplex Virus Type I Polypeptides. Am J Otolaryngol 1992; 13 (5): 295 - 300 (Abstract).  Back to cited text no. 5
    
6.
Hughes GB, Kinney SE, Barna BP, Calabrese LH. Autoimmune Reactivity in Meniere’s Disease: A Preliminary Report. Laryngoscope 1983; 93: 410-417.  Back to cited text no. 6
    
7.
Arnold W., Pfaltz R, Altermatt HJ. Evidence of Serum Antibodies Against Inner Ear Tissues in the Blood of Patients with Certain Sensorineural Hearing Disorders. Acta Otolaryngol, (Stockh) 1985;99:437-444.  Back to cited text no. 7
    
8.
Brookes, GB. Circulating Immune Complexes in Meniere’s Disease. Arch Otolaryngol Head Neck Surg 1986; 112: 536-540.  Back to cited text no. 8
    
9.
Derebery MJ, Rao VS, Siglock TJ, Linthicum FH, Nelson R. Meniere’s Disease: An Immune Complex - Mediated Illness? Laryngoscope 1991; 101: 225-229.  Back to cited text no. 9
    
10.
Suzuki M, Kitahara M. Immunologic Abnormality in Meniere’s Disease. Otolaryngol Head Neck Surg 1992; 107(1): 57-62.  Back to cited text no. 10
    
11.
Dornhoffer JL, Waner M , Arenberg IK, Montague D. Immunoperoxidase Study of the Endolymphatic Sac in Meniere’s Disease.Laryngoscope 1993;103:1027- 1034.  Back to cited text no. 11
    
12.
Tomoda K.Suzuka Y,Iwai H.Yamashita T,Kumazawa T. Meniere’s Disease and Autoimmunity : Clinical Study and Survey. Acta Otolaryngol (Stockh) 1993; Suppl. 500:31-34.  Back to cited text no. 12
    
13.
Gutierrez F, Moreno PM,Sainz M. Relationship Between Immune Complex and Total Hemolytic Complement in Endolymphatic Hydrops. Laryngoscope 1994; 104(12): 1495 - 8 (Abstract).  Back to cited text no. 13
    
14.
Soliman S. Speech Discrimination Audiometry Using Arabic Phonetically Balanced Words. Ain Shams Med J 1976; 27: 27-30.  Back to cited text no. 14
    
15.
Harvey SA, Wood DJ. The Oculocephalic Response in the Evaluation of the Dizzy Patient. Laryngoscope 1996; 106: 6-9.  Back to cited text no. 15
    
16.
Wackym PA, Friberg U, Linthicum FH, Sjoback DB, Bui HT,Hofman F,Andersen HR.Human Endolymphatic Sac: Morphologic Evidence of Immunologic Function. Ann Otol Rhinol Laryngol 1987;96:276 -281.  Back to cited text no. 16
    
17.
Tomiyama S, Nonaka M, Gotoh Y, Ikezono T, Yagi T. Immunological Approach to Meniere’s Disease: Vestibular Immune Injury Following Immune Reaction of the Endolymphatic Sac. J Otorhinolaryngol Relat Spec 1994; 56: 11-18 (Abstract).  Back to cited text no. 17
    
18.
Harris JP. Immunology of the Inner Ear: Evidence of Local Antibody Production. Ann Otol Rhinol Laryngol 1984; 93:157- 162.  Back to cited text no. 18
    
19.
Harris JP. Experimental Autoimmune Sensorineural Hearing Loss. Larygoscope 1987; 97 : 63-76.  Back to cited text no. 19
    
20.
Cao MY, Deggouji N, Gersdorff M, Tomasi JP. Guinea Pig Inner Ear Antigens: Extraction and Application to the Study of Human Autoimmune Inner Ear Disease. Laryngoscope 1996; 106-: 207-212.  Back to cited text no. 20
    
21.
Yoshino K. Serum Antibodies to Type II Collagen and Immune Complex in Cases of Meniere’s Disease. Nippon Jibiinkoka Gakkai Kaiho 1994; 97 (5): 887-97 (Abstract).  Back to cited text no. 21
    
22.
Herdman RC, Morgan K, Holt PJ, Ramsden RT. Type II Collagen Autoimmunity and Meniere’s Disease.J Laryngol Otol 1993; 107(11): 94-8.  Back to cited text no. 22
    
23.
Fattori B.Ghilardi PL,Casani A,Migliorini P,Riente L. Meniere’s Disease: Role of Anitbodies Against Basement Membrane Antigens. Laryngoscope 1994; 104 (10): 1290-4 (Abstract).  Back to cited text no. 23
    
24.
Hughes GB, Barna BP, Kinney SE Calabrese LH, Nalepa NL. Predictive Value of Laboratory Tests in “Autoimmune” Inner Ear Disease: Preliminary Report Laryngoscope 1986; 96: 502-505.  Back to cited text no. 24
    
25.
Luetje CM. Theoretical and Practical Implications for Plasmapheresis in Autoimmune Inner Ear Disease Laryngoscope 1989; 99: 1137-1146.  Back to cited text no. 25
    
26.
Hughes GB, Moscicki R, Barna BP, San Martin JE. Laboratory Diagnosis of Immune Inner Ear Disease. Am J Otol 1994; 15: 198-202 (Abstract).  Back to cited text no. 26
    
27.
Hughes GB, Kinney SE, Barna BP, Calabrese LH. Practical Versus Theoretical Management of Autoimmune Inner Ear Disease. Laryngoscope 1984; 94: 758 -67.  Back to cited text no. 27
    
28.
Shea JJ. Autoimmune Sensorineural Hearing Loss as an Aggravating Factor in Meniere’s Disease. Adv Otorhinolaryngol 1983; 30: 254-7.  Back to cited text no. 28
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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