Use of methotrexate for autoimmune hearing loss

To assess the efficacy of low-dose methotrexate (MTX) given long-term for t he treatment of autoimmune hearing loss, we performed a prospective open-la bel study of 11 patients with treatment-refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in 1 or both ears b efore enrollment despite traditional medical therapy. The MTX dose was 7.5 to 17.5 mg/wk. Hearing loss and vertigo were evaluated at baseline and at c ompletion of the study. Hearing improvement was defined as an improvement i n the pure tone threshold (PT) average of >10 dB or an increase in speech d iscrimination (SD) of >15%, whereas worsening was defined as a worsening of >10 dB in PT or a decrease of >15% in SD in at least 1 ear. The MTX was we ll tolerated. Among the 6 patients with Meniere's disease, 4 had improvemen t or resolution of vertigo, while 2 had no improvement. Disequilibrium impr oved in all 3 patients with Cogan's syndrome. According to the parameters d efined above, hearing improved in 9 patients (82%), was unchanged in 1 pati ent (9%), and worsened in 1 patient (9%). Long-term low-dose MTX therapy ma y be a useful therapy for some patients who have hearing loss with a presum ptively autoimmune-mediated component that is refractory to traditional the rapies.