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Immunologic and serologic testing in patients with Ménière's disease
Michael J Ruckenstein1, Anna Prasthoffer, Douglas C Bigelow
1Department of Otorhinolaryngology-Head and Neck Surgery and Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 Ravdin, Philadelphia, PA 19104, U.S.A. michael.ruckenstein@uphs.upenn.edu
Objective:
To establish the value of immunologic and serologic testing in patients with Ménière's disease.
Study Design:
Prospective cohort.
Setting:
University-based, tertiary care balance center.
Intervention:
Patients with active unilateral or bilateral Ménière's disease underwent testing, including antinuclear antibodies, anti-DNA antibodies, rheumatoid factor, complement levels, anti-Sjögren syndrome A and B antibodies, sedimentation rate, antiphospholipid antibodies, Western blot for anticochlear antibodies (anti-heat shock protein 70), microhemagglutination test for Treponema pallidum, and Lyme titers.
Outcome Measures:
Results of laboratory tests.
Results:
In patients with unilateral Ménière's disease (n = 40), 27% demonstrated elevated antiphospholipid antibody titers (population norm, 6-9%). The majority of these patients manifested negative assays on the other tests listed above. In patients with bilateral Ménière's disease (n = 18), elevations in antinuclear antibody titers (38%) were the most notable finding. As part of a broader study of patients with progressive hearing loss, four patients with positive syphilis titers were identified; however, none of these patients complained of vertigo.
Conclusion:
In general, the results of this study do not support the hypothesis that immune or infectious pathologies are involved in the pathogenesis of unilateral Ménière's disease. In particular, Lyme disease does not seem to cause labyrinthine disease. However, the potential role of the thrombogenic antiphospholipid antibodies must be further investigated. Patients with bilateral Ménière's disease may be more likely to have a systemic autoimmune process.