|Year : 1998 | Volume
| Issue : 1 | Page : 35-40
Immunologic findings in meniere’s disease
Naema M Ismail
ENT Department, Faculty of Medicine For Girls, Al-Azar University, Cairo, Egypt
|Date of Web Publication||16-Jun-2020|
MD Naema M Ismail
21 Mohamed Yousef Saleem Street, Near El-Hejaz Square, El-Nozha, Heliopolis, Cairo
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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 .,,,,
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. ,,,,,,,
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|| |
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. 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)  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:
- The erythrocyte sedimentation rate (ESR) and C-reactive proteins (CRP).
- Serum immunoglobulin levels (IgG, IgM IGA).
- Complement levels (C3, C4).
- 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|| |
[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|| |
The normal human endolymphatic sac has a local immune system with phagocytic cells, monocytes, macrophages, polymorphic leucocytes, T-lymphocytes and fenestrated blood vessels. Immune challenge to the endolymphatic sac in experimental animals was found to produce vestibular dysfunction ,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. , 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)  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  and denied by others. , 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.  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.  Both cellular and humoral mechanisms were suggested but whether the immune disorder is mediated by either one or both of them is still unknown. ,
Tests for cellular autoimmune response include the lymphocyte transformation test and the lymphocyte migration inhibition test. These were used by some authors. ,,, 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). ,,,, ,, , 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. 
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..,,,[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. ,,, 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. ,,, 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|| |
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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]