Lack of association between hearing loss and glaucoma.

Some studies have suggested a relationship between glaucoma and sensorineural hearing loss. Others have found no evidence for an association. We performed a study to determine whether there is a significant difference in hearing between patients with glaucoma and a matched control population. Patients presenting themselves to a glaucoma clinic were grouped by type of glaucoma: uveitis, primary open-angle, pigmentary, pigmentary dispersion, congenital, or ocular hypertension. Patients older than 60 were excluded from the study, as were those who met certain carefully chosen exclusion criteria. Subjects included 40 men and 27 women, ranging in age from 15 to 60 years. Glaucoma was bilateral in all cases. Auditory thresholds at 0.5, 1.0, 2.0, and 3.0 kHz were measured bilaterally and statistically compared with American National Standards Institute (ANSI) normative values. Speech reception threshold and intelligibility were also assessed. When compared with speech ANSI values, there were no significant differences in mean thresholds at any frequency for any of the glaucoma types. Mean speech reception thresholds and intelligibility scores were all within normal limits and no subjects showed evidence of sensorineural hearing loss greater than expected for age. There were no differences between glaucoma groups, and we found no evidence of an association between glaucoma and hearing loss. There is disagreement about whether or not an association exists between glaucoma and hearing loss. Among those who do feel there is a relation, there is wide disagreement about what proportion of glaucomatous patients have a hearing loss. Rampoldi (1) first described an association between glaucoma and inner ear disease in 1889. Since that time, a number of reports have suggested such an association (2-4; 6-12). However, many of these studies are methodologically flawed. A few studies found no evidence of a relationship between glaucoma and sensorineural hearing loss (14, 15). There have been few reports since the 1970s, and the question remains unresolved. If there is, in fact, a relationship between glaucoma and inner ear disease, potentially much could be learned about certain forms of hearing loss from the study of glaucoma. In particular, surgical specimens (trabecular meshwork) could be obtained in those patients who undergo operations for their glaucoma. This tissue could be examined using current histopathological techniques. On the basis of the results, hypotheses might be made, by inference about which pathological processes are manifested in the inner ear. Therefore, we performed a study to evaluate whether there is a significant difference in hearing between patients with glaucoma and a matched control population.

Menière's disease: an immune complex-mediated illness?

The cause of Menière's disease is unknown. Recent clinical research suggests that one etiology is immune-mediated damage to the inner ear. The diagnosis of autoimmune Menière's syndrome is largely based on history, response to steroids, or results of nonspecific laboratory tests such as serological studies. Polyethylene glycol (PEG) assay was used to determine levels of circulating immune complexes (CIC) in 30 patients with Menière's disease and 20 control subjects. Patients with Menière's disease had a statistically significant elevation of serum circulating immune complexes when compared to the control group. This suggests that CICs may be involved in the pathogenesis of Menière's disease, either as a direct cause of damage, or as a by-product of an underlying autoimmune abnormality. Therapeutic implications include use of plasmapheresis to remove the complexes or CIC monitoring to serve as a marker for treatment efficacy.

Sex hormone receptors in acoustic neuromas.

We performed quantitative assays for estrogen, progesterone, and testosterone receptors in 19 acoustic neuroma specimens from ten men and nine women. No patient received preoperative or intraoperative glucocorticoids, mineralocorticoids, or sex hormones. All tumors were unilateral and removed by the translabyrinthine approach. No tumor specimen was positive for estrogen or testosterone receptors. Three of ten men and seven of nine women had tumors positive for progesterone receptors (10 fmol/mg cytosol protein or greater). This between-sex difference was of borderline significance by the Mann-Whitney U test (p = 0.08). This finding indicates the need for further investigations of endocrinologic therapy as a possible treatment of acoustic neuromas.

Sensorineural hearing loss associated with Takayasu's disease.

This is a case report of sensorineural hearing loss associated with Takayasu's disease. Also known as "pulseless disease" and "aortic arch syndrome," Takayasu's disease involves narrowing of the aortic arch and its branches. Although the etiology is unknown, it is suspected to be an autoimmune disorder. In the case presented, steroid therapy resulted in an improvement of hearing. On one relapse the hearing loss worsened before the sedimentation rate increased. We speculate that the hearing loss is due to an autoimmune process or an ischemia involving the inner ear. We further speculate that hearing loss may indicate subsequent worsening of the disease.