The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss

Document Type: Original


1 Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2 Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.


In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL).
Materials and Methods:
This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group.
There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P<0.05). However, differences in mean CRP, anti-Ds DNA, Hb, anti-CCP, white blood cells (WBC), neutrophils, lymphocytes, eosinophils, and platelets were not statistically significant between the case and control groups (P>0.05).
Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment.


Main Subjects

1. Amiridavan M, Sonbolestan S, OkhoLvvat S, Nemati S. Evaluation Of Some Epidemiologic Parameters, Risk Factors, Clinical And Audiological Characteristics Of 48 Patients With Sudden Sensorineural Hearing Loss. Tehran University Med J TUMS Publications.2006; 64:37–44.

2. Fetterman BL, Luxford WM, Saunders JE. Sudden bilateral sensorineural hearing loss. Laryngoscope.1996; 106:1347–50.

3.Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, et al. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg. 2012; 146:1–35.

4. Yimtae K, Srirompotong S, Kraitrakul S. Idiopathic sudden sensorineural hearing loss. J Med Assoc Thai. 2001; 84:113–9.

5. Heigl F, Hettich R, Suckfuell M, Luebbers CW, Osterkorn D, Osterkorn K, et al. Fibrinogen/LDL apheresis as successful second-line treatment of sudden hearing loss: a retrospective study on 217 patients. Atheroscler Suppl. 2009;10:95–101.

6. Cho SH, Chen H, Kim IS, Yokose C, Kang J, Cho D, et al. Association of the 4 g/5 g polymorphism of plasminogen activator inhibitor-1 gene with sudden sensorineural hearing loss. A case control study. BMC Ear, Nose and Throat Disorders. 2012;12:5.

7.Schweinfurth JM, Cacace AT, Parnes SM. Clinical applications of otoacoustic emissions in sudden hearing loss. Laryngoscope. 1997; 107: 1457–63.

8. Tlumak AI, Kileny PR. Parameters that affect the measurement of otoacoustic emissions. CurrOpinOtolaryngol Head Neck Surg. 2001; 9: 279–83.

9. Nosrati-Zarenoe R, Arlinger S, Hultcrantz E. Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database. ActaOtolaryngol. 2007;127:1168–75.

10. Klingel R, Heibges A, Uygun-Kiehne S, Fassbender C, Mösges R. Rheopheresis for sudden sensorineural hearing loss. Atheroscler Suppl. 2009;10:102–6.

11. Schreiber BE, Agrup C, Haskard DO, Luxon LM. Sudden sensorineural hearing loss. Lancet. 2010;375:1203–11.

12.Loveman DM, de Comarmond C, Cepero R, Baldwin DM. Autoimmune sensorineural hearing loss: clinical course and treatment outcome. Seminars in arthritis and rheumatism. 2004; 34: 538-43

13. Süslü N, Yılmaz T, Gürsel B. Utility of anti‐HSP 70, TNF‐α, ESR, antinuclear antibody, and antiphospholipid antibodies in the diagnosis and treatment of sudden sensorineural hearing loss. Laryngoscope. 2009;119:341–6.

14. Chang N-C, Ho K-Y, Kuo W-R. Audiometric patterns and prognosis in sudden sensorineural hearing loss in southern Taiwan. Otolaryngol Head Neck Surg. 2005;133:916–22.

15. Göde S, Turhal G, Kaya İ, Mavili Hİ, Kirazlı T. Evaluation of Procalcitonin and hs-CRP Levels in Sudden Sensorineural Hearing Loss. J Int Advanced Otol. 2018;14:44–47.

16. Masuda M, Kanzaki S, Minami S, Kikuchi J, Kanzaki J, Sato H, et al. Correlations of inflammatory biomarkers with the onset and prognosis of idiopathic sudden sensorineural hearing loss. OtolNeurotol. 2012;33:1142–50.

17. Rajati M, Azarpajooh MR, Mouhebati M, Nasrollahi M, Salehi M, Khadivi E, et al. Is Sudden Hearing Loss Associated with Atherosclerosis? Iran J Otorhinolaryngol. 2016;28:189.

18. Kastanioudakis I, Ziavra N, Politi EN, Exarchakos G, Drosos AA, Skevas A. Hearing loss in progressive systemic sclerosis patients: a comparative study. Otolaryngol Head Neck Surg. 2001;124:522–5.

19. Di Leo E, Coppola F, Nettis E, Vacca A, Quaranta N. Late recovery with cyclosporine-A of an auto-immune sudden sensorineural hearing loss. ActaOtorhinolaryngol Ital. 2011;31:399–401.

20. Lobo FS, Dossi MO, Batista L, Shinzato MM. Hearing impairment in patients with rheumatoid arthritis: association with anti-citrullinated protein antibodies. ClinRheumatol. 2016;35:2327–32.

21. Schieffer KM, Chuang CH, Connor J, Pawelczyk JA, Sekhar DL. Association of Iron Deficiency Anemia with Hearing Loss in US Adults. JAMA Otolaryngol Head Neck Surg. 2017;143:350–4.

22. Almuhawas FA, Hagr AA. Cochlear implant for bilateral profound sensorineural hearing loss in an adolescent with sickle cell anemia. Ann Saud Med. 2014;34:167–70.

23. Cho CH, Jung BS, Jung JH, Lee JH, Lee JH. Expression of autoantibodies in patients with sudden sensorineural hearing loss. Ann OtolRhinolLaryngol. 2013;122:131–4.

24. Andonopoulos A, Naxakis S, Goumas P, Lygatsikas C. Sensorineural hearing disorders in systemic lupus erythematosus. A controlled study. ClinExperRheumatol. 1995;13:137–41.