Autoimmune inner ear disease: A systematic review of management. Issue 6 (28th November 2020)

• Record Type: Journal Article
• Authors: Breslin, Nathaniel K.; Varadarajan, Varun V.; Sobel, Eric S.; Haberman, Rex S.
• Is Part Of: Laryngoscope investigative otolaryngology. Volume 5:Issue 6(2020)
• Page Start: 1217
• Page End: 1226
• Publication Date: 2020-11-28
• Subjects: autoimmune inner ear disease; Otolaryngology -- Periodicals; Laryngoscopy -- Periodicals; Otolaryngology; Otolaryngology; Periodicals; Periodicals; 617.51
• DOI: 10.1002/lio2.508
• Languages: English
• ISSNs: 2378-8038

Abstract

Abstract: Objectives: The study systematically reviewed the existing literature on the management of autoimmune inner ear disease (AIED). Study Design: Systematic review. Methods: We performed a literature search of Embase, NCBI, Cochrane, and Web of Science databases from April 1990 to April 2020. Inclusion criteria included studies that were retrospective or prospective in nature evaluating the treatment of AIED with audiometric data measuring hearing outcomes during treatment. Hearing improvement was the primary study outcome and improvement in vestibular symptoms was the secondary study outcome. Results: Sixteen of 412 candidate articles were included in our study. Systemic steroid treatment is most commonly described. Alternative treatment modalities included intratympanic steroid treatment, methotrexate, cyclophosphamide, azathioprine, infliximab, etanercept, adalimumab, golimumab, methylprednisolone, rituximab, and anakinra. Conclusion: Systemic corticosteroids are the first line treatment of AIED. Intratympanic steroids are a potential adjuvant or alternative treatment for patients who cannot tolerate or become refractory to steroid treatment. Steroid nonresponders may benefit from biologic therapy. Alternative treatment modalities including nonsteroidal immunosuppressants and biologics have been studied in small cohorts of patients with varying results. Prospective studies investigating the efficacy of biologic and nonsteroidal therapy are warranted. Level of Evidence: 2. Abstract : Autoimmune inner ear disease is an uncommon inner ear disorder characterized by progressive and often fluctuating sensorineural hearing loss. Currently, there are no consensus treatment recommendations for management of AIED. In this systematic review, we review published treatment paradigms, and create a novel treatment protocol based on existing evidence.