2015 Volume 25 Issue 3 Pages 284-291
A retrospective five years' review was conducted in 71 patients (110 impaired hearing ears and 23 patients with vertigo) who considered to have steroid unresponsive autoimmune inner ear disease (AIED) and all patients were positive for antibody for a 68kDa bovine inner ear antigen. Pure tone average (PTA), speech discrimination score (SDS) and the maximal slow phase velocity of the caloric nystagmus (Max. spv) were used as objective measure of outcome. The patients were treated with cyclophosphamide (CPM). At the end of study, 37 of 110 impaired ears (34%) improved, 62 ears (56%) stabilized and 11 ears (10%) worsened in PTA. Recurrence hearing loss was seen in 50 patients (79 impaired ears). PTA of the patients demonstrated with those normal recoveries and marked recovery was significantly low level as compared with those patients who resulted in better, stable and worsened hearing. The SDS of the patients with positive response to therapy was significantly high as compared with those of unresponsive to therapy. Patients with rotatory vertigo and floating vertigo were significantly recovered. 15 out of 17 patients with vertigo showed bilateral impairment of vestibular function whose Max. spv before CPM therapy were bilaterally under 20°/sec. Max. spv of post CPM therapy significantly improved as compared with those of pre CPM therapy. In conclusion, intermittent low dose of CPM therapy for five years to patients with steroid unresponsive AIED maintained the same improvement with the result of previous study and showed significant improvement in Max. spv, though 50 patients (79 impaired ears) had reacted in five years.
