Azathioprine in Combination with Steroids in the Treatment of Autoimmune Inner-Ear Disease

Abstract

A total of twelve patients with a relatively uncommon form of progressive sensorineural deafness (autoimmune inner-ear disease) were treated orally with 1 mg/kg azathioprine, once daily, and with 30 mg prednisolone, every other day, for 4 weeks. Statistically significant increases in the ability to hear pure tones or in discrimination on audiometry took place in 10/12 patients. This condition was initially described as 'sensorineural hearing loss', but it is now clear that the term 'autoimmune inner-ear disease' is more appropriate since the vestibular compartment as well as the cochlear compartment is involved. This relatively uncommon disease is one of the few forms of sensorineural deafness that can be successfully treated.

Treatment of Corticosteroid-Responsive Autoimmune Inner Ear Disease With Methotrexate

“…Subsequently, several reports proposed the use of less toxic agents for autoimmune inner ear disease (AIED), including methotrexate, 6,7 plasmapheresis, 8 azathioprine, [9][10][11] and intravenous gamma globulin. 12 Low-dose oral methotrexate (7.5 to 20 mg/wk) was reported to improve hearing and balance in patients with AIED and Meniere disease.…”

Progressive, reversible sensorineural hearing loss caused by azathioprine

“…Azathioprine has been described as being an effective treatment for autoimmune SNHL, although its use has only been reported in a small, uncontrolled observational study of 12 patients. 4 Azathioprine has also been described in case reports as a treatment of SNHL associated with systemic autoimmune conditions including autoimmune pancreatitis 5 propylthiouracil-induced antineutrophil cytoplasmic antibody associated vasculitis. 6 In addition, azathioprine was reported to be an unsuccessful treatment in a case of bilateral SNHL associated with Crohn's disease.…”

Autoimmune Inner Ear Disease: A Retrospective Review of Forty-Seven Patients

“…Although cyclophosphamide can be effective in a subset of patients, potentially severe side effects now limit its use in treating AIED. Several studies have used less toxic biological modifiers such as azathioprine, methotrexate and etanercept (a tumor necrosis factor inhibitor); however, the response of AIED to these agents is limited [Sarcaydin et al, 1993;Harris et al, 2003;Cohen et al, 2005]. Recently, small open-label studies have demonstrated certain benefits of an IT injection of infliximab (Remicade) and intravenous infusions of adalimumab and rituximab.…”