Theoretical and practical implications for plasmapheresis in autoimmune inner ear disease

Immune-mediated inner ear disease, by convention called autoimmune inner ear disease (AIED), has established clinical profile guidelines for diagnosis. Treatment consists of steroid and/or cytotoxic drug immunosuppression. The role of plasmapheresis (PMP) in the treatment of AIED has not been defined. Lack of a precise serological marker prevents accurate immunological understanding. Definition is, of course, difficult in a disease whose natural history is not well delineated. Successful use of PMP in one steroid and cytotoxic drug intolerant patient with AIED led to its use in a total of eight patients. The rationale for PMP was based on its known effectiveness in other autoimmune diseases and thus, its potential use in AIED. Improved auditory function occurred in 6 of the 8 patients, 3 of whom have been followed for over 3 years. Three of the six no longer require immunosuppressant medication. PMP can be used as an alternative or adjunctive therapy in AIED. These preliminary results suggest PMP can stabilize or improve auditory and vestibular symptoms in selected patients. Its use as a first line therapy followed by cytotoxic immunosuppressants bears consideration.