DIAGNOSTIC AND THERAPEUTIC DILEMMAS IN RAPIDLY PROGRESSIVE SENSORINEURAL HEARING-LOSS AND SUDDEN DEAFNESS - A REAPPRAISAL OF IMMUNE REACTIVITY IN INNER-EAR DISORDERS

Sera from 76 patients with a clinical diagnosis of idiopathic rapidly progressive sensorineural hearing loss (SNHL) (n = 15), sudden deafnes s (n = 31) and with other etiologies of their hearing loss (n = 30) we re analysed by western blot assay. Seventy-three percent of the cases with rapidly progressive SNHL had cross-reacting antibodies (27, 45, 5 0, 68 kD). The overall response to immunoprogressive therapy was effec tive in only 50% of cases. Sixty-five percent of the patients with sud den deafness also had cross-reacting antibodies (27, 45, 50, 80 kD). I n these cases steroid therapy was more effective in re-establishing th e hearing than no treatment, regardless of the western blot outcome. S pontaneous recovery occurred in approx. 50% of cases, but only in thos e with a positive assay. The antigenic epitopes detected with immunobl otting were not cochlea specific; they were also found in protein extr acts of other organs (cranial nerves, kidney, brain).