Does the Serological Study for Viral Infection in Autoimmune Inner Ear Disease Make Sense?

Abstract

Viral infections of the labyrinth have been considered a major source of auditory and vestibular system pathology. However, the involvement of virus in the development of immune reactions responsible for immunomediated inner ear disease has not been studied enough. Following viral infection, an effector immune response, humoral (B cell) and/or cytotoxic (T cell) is directed against a virus and it might cross-react with self-protein or autoantigen, evoking an autoimmune response. Since clinically it can be very difficult to establish a viral etiology for such disorders, serologic studies can be used to confirm the suspected diagnosis. Patients affected by immunomediated inner ear disease that had presented an upper respiratory tract infection underwent an immunologic workup study including microbiological study. After the application of this diagnostic protocol, only one patient, that was subsequently diagnosed with Cogan’s syndrome, showed a positive serological test for viral infection. On the basis of the low efficacy of serological testing and due to the lack of evidence, we do not recommend to carry out serologic studies for viral infection.

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

“…Moreover, positive results of those tests are not predictive of improvement following steroid treatment [39]. Serology studies for viral infections are not recommended in AIED [48].…”

Can unilateral, progressive or sudden hearing loss be immune-mediated in origin?

“…When considering the immunological component of this inner ear disorder, one may recall that some evidence has been collected for the inner ear to be affected in a variety of non-organ-specific autoimmune diseases as a result of the interaction of genetic factors, environmental pathogens and immune system responses [14]. An autoimmune activity in idiopathic hearing loss has been documented in viral labyrinthine infections considered as the major causes of auditory and vestibular system pathologies, where the viral and bacterial infections may contribute to the development and exacerbation of autoimmune diseases [4,15,16]. The inner ear appears to be the target for an immune-mediated disease that can be organ or non-organ specific and the disease seems to have some analogy with rapidly progressive glomerulonephritis: if not treated, also often more quickly than 3 months, the pathology may progress to a severe and irreversible damage [15].…”