Open trial of methotrexate as treatment for autoimmune hearing loss

Objective. To assess the efficacy of low-dose methotrexate (MTX) administer ed for the treatment of autoimmune hearing loss. Methods. This was a prospective, 12-month, open-label study of 17 patients with refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in one or both ears prior to enrollment despite tradit ional medical therapy. The MTX dose was 7.5-25 mg/week. Hearing loss and ve rtigo were evaluated at baseline and at completion of the study. Hearing im provement was defined as an improvement in pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%; worsening was defined as a decrease of >10 dB in PT or a decrease of >15% in SD in at least one ear. Results. MTX was well tolerated. Among patients with Meniere's disease, 5 o f 9 had improvement or resolution of vertigo. Equilibrium improved in all 3 patients with Cogan's syndrome and improved in 2 out of 3 patients with id iopathic hearing loss and this symptom. According to the parameters defined above, hearing improved in 11 patients (65%), was unchanged in 4 patients (23%), and worsened in 2 patients (12%). Conclusion. Long-term low-dose MTX therapy may be a useful therapy for at l east some patients who have hearing loss with a presumptively autoimmune-me diated component that is refractory to traditional therapies.