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 Antiphospholipid Inner Ear Disease  treatment Guide

treatment by alternative  methods read our e-book.

 

Inner Ear Antiphospholipid inner ear syndrome

Mouadeb DA,

Department of Otolaryngology, University of California-Davis, Sacramento, California, USA.


OBJECTIVE: This study was initiated to clarify the possible association between antiphospholipid antibodies,  CONCLUSIONS: These data support the hypothesis that antiphospholipid antibodies are involved in the pathogenesis of some forms of inner ear dysfunction, presumably by causing microthrombus formation in the labyrinthine vasculature. Basic science studies are required to better understand the mechanisms by which antiphospholipid antibodies mediate inner ear dysfunction. Clinical studies to evaluate the efficacy of anticoagulation in this group of patients are also required.

 

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Autoimmune inner ear disease (AIED) was first described in 1979 and the disease has become more widely recognized over the last decade. Limited information is available regarding clinical features of the disease, disease course, and response to treatment.
OBJECTIVE:
To analyze data from 42 patients with documented immune mediated inner ear disease to further define this syndrome.
METHODS:
A retrospective chart review was conducted on all patients considered to have AIED by the Otolaryngology division physicians and on all patients positive for antibody testing to inner ear antigens from 1990 to 1999. Patients who were antibody positive with a clinical diagnosis of AIED were included in this review.
RESULTS:
Patients with AIED presented with rapidly progressive, frequently bilateral (79%), often fluctuating sensironeural hearing loss. Mean age at presentation was 50 years (22-80) with no gender predilection. Tinnitus (83%), vestibular complaints (79%), and Menieres (50%) were common concomitant symptoms along with hearing loss. Seven of 42 (17%) of the patients had evidence for other systemic autoimmune disorders. In 4 of the patients the onset of vestibuloauditory complaints preceded the diagnosis of autoimmune disorder. Thirty-three of 42 demonstrated antibodies to inner ear antigens but other autoantibodies were infrequent except in patients with systemic autoimmune disorders. Twenty-three of 33 (70%) of patients treated with corticosteroids improved clinically, often short-term. Sixteen patients received treatment with other immunosuppressive drugs including methotrexate, cyclophosphamide, azathioprine, mycophenolic mofetil, and intravenous immunoglobulin (IVIg) generally with a limited modest response. Using clinical trial criteria for response, only 5/35 (14%) demonstrated improvement over a mean 34.4 months follow-up.
CONCLUSIONS:
Immune-mediated inner ear disease is not a uniform disease with simple diagnosis or treatment. The course of the disease often results in significant long-term disability due to hearing loss and response to aggressive immunosuppression including corticosteroids is poor.



 
Osteoporosis mostly affects older women and can set the stage for fractures that can impair the quality of their lives, said Dr. Heckbert. “Careful judgment is required to weigh the risks and benefits of any medication for any individual patient,” she added. “For most women at high risk of fracture, alendronate’s benefit of reducing fractures will outweigh the risk of atrial fibrillation.”
However, said Dr. Heckbert, “women who are at high risk of fractures but also have risk factors for atrial fibrillation — such as heart failure, diabetes, or coronary disease — might want to discuss alternatives to alendronate with their health care providers.” Other medications that can lower the risk of fractures include estrogen, she said. But the Women’s Health Initiative, on which she has also served as an investigator, showed other heart risks from hormone therapy combining estrogen with progesterone.
The National Heart, Lung, and Blood Institute fund

Dr. Heckbert’s Atrial Fibrillation Study, which collects data on all Group Health patients as they are first diagnosed with atrial fibrillation. The study aims to find new factors that raise the risk of developing this quivering of the heart’s upper chambers (atria).
About one in 100 people — and nearly nine in 100 people over age 80 — have atrial fibrillation, said Dr. Heckbert. In many cases, atrial fibrillation has no symptoms, and it isn’t necessarily life threatening. But it can cause palpitations, fainting, fatigue, or congestive heart failure.

Heart issues


Atrial fibrillation can also make blood pool — and sometimes clot — in the atria, said Dr. Heckbert. When parts of clots break off and leave the atria, they can lead to embolic strokes, as happens in over 70,000 Americans a year. That’s why atrial fibrillation is often treated with the anticoagulant warfarin. Other results from her study have suggested that maintaining a healthy body weight may help protect people from atrial fibrillation.
“This study will help medical teams better inform their patients about the risks associated with Fosamax, helping us make the best treatment decisions for managing osteoporosis,” commented Christine Himes Fordyce, MD, a Group Health family practitioner. “Now with this increased understanding of potential irregular heartbeats, both physicians and their patients should be alert to any problems, report them immediately, and treat them appropriately.”