Autoimmune Disease of the Inner Ear Workup http://emedicine.medscape.com/article/857511-workup#c6 Antigen-nonspecific tests are useful in routine screening for evidence of systemic immunologic dysfunction, yet specifically are not known to correlate with a diagnosis of immune-mediated inner ear disease. Antigen-nonspecific tests are as follows: • Levels of circulating immune complexes • Complement levels (C3, C4) • Antinuclear antibody levels • Rheumatoid factor • Acute phase reactants - Erythrocyte sedimentation rate, C-reactive protein A study by Dayal et al discovered that patients with autoimmune ear disease having no systemic autoimmune illness often show high levels of antinuclear antibodies (with a speckled pattern) and also sometimes have high levels of rheumatoid factor. The positive yield of other detailed tests was low.[6] A study by Svrakic et al indicated that tumor necrosis factor (TNF) levels can be used diagnostically and prognostically in immune-mediated inner ear disease. The study, which involved 85 patients with clinical and audiometric characteristics of immune-mediated SNHL, as well as 11 controls, found that patients with immune-mediated SNHL who were nonresponsive to steroids had a higher mean baseline plasma level of TNF (27.6 pg/mL), as derived from peripheral venous blood, than did those who were responsive to steroids (24.1 pg/mL), and that both had higher TNF levels than did the controls (14.4 pg/mL). According to the investigators, a baseline plasma TNF level of more than 18.8 pg/mL from the peripheral circulation has a positive predictive value for immune-mediated SNHL of more than 97%.[7] Svrakic and colleagues also found evidence that in non-steroid-responsive patients with immune-mediated SNHL, peripheral blood mononuclear cells (PBMCs) respond differently to in vitro stimulation with dexamethasone than do those of steroid-responsive patients, with the mean TNF level secreted by the PBMCs slightly increasing (from 11.2 pg/mL to 11.7 pg/mL) with stimulation instead of decreasing.[7] Antigen-specific tests are as follows: • Migration inhibition assay: The patient's lymphocytes are placed in a capillary tube with serum containing inner ear antigens present on one end. If the patient's lymphocytes previously have been sensitized to the inner ear antigen, migration inhibition factor is released and impedes dispersion of lymphocytes from the tube. This assay is a gross test of immune reactivity. • Lymphocyte transformation test (LTT): The LTT measures the response of the patient's sensitized lymphocytes to known inner ear antigens. The patient's lymphocytes are exposed to serum containing inner ear antigens. A proliferative response occurs and is compared to that of known negative control lymphocytes. Measurement is made by recording the incorporation of tritiated thymidine into new DNA as cell synthesis occurs. Sensitivity of the LTT is reported to be 50-80% when symptoms are active in an immunocompetent patient. • Western blot analysis for antibodies to inner ear antigen ◦Harris and Sharp used bovine inner ear extract as antigen in Western blot assays and detected antibody to a 68-kd inner ear antigen in 19 of 54 patients (35%) with progressive SNHL. Recent update includes a cohort of 279 patients with rapidly progressive SNHL, of whom 90 (32%) had positive results of Western blot analysis for the 68-kd antibody. ◦Animals with experimentally induced SNHL possessed autoantibodies to the identical component of the inner ear antigenic isotope to which patients' sera reacted. ◦Moscicki et al confirmed the finding of circulating antibodies against a 68-kd protein, which was found in 42 of 72 patients (58%) with IPBSNHL.[8] Patients with positive test results for the antibody were more likely than those with negative results to have hearing loss that responded to steroid treatment (75% vs 18%). This study is the first to show a correlation between Western blot 68-kd positivity and steroid responsiveness. ◦Rauch subsequently identified the 68-kd protein as heat shock protein 70 (HSP 70).[9] Heat shock proteins are constitutively produced by host and pathogens and usually are up-regulated in response to infection or other stresses. ◦Antibodies to HSP 70 were detected in 47% of 30 patients with Ménière disease, thus identifying a subset of patients with Ménière disease with an immune basis for their symptoms. ◦The LTT and Western blot immunoassay must be performed in specialized immunology laboratories, often on a send-out basis. ◦Control populations vary from persons with normal hearing to those with systemic autoimmune diseases. The 68-kd positivity in these control populations averages 5%. This specificity of approximately 95% appears fairly high but is rather insensitive when used in the general population. ◦Gong et al found that 2 subcomponents of crude inner ear antigen (the 31 kD protein and the 60 kD protein) may induce autoimmune inner ear disease independently in the guinea pig cochlea.[10] The 31 kD protein may correspond to the 30 kD protein identified by Cao et al as myelin protein zero (P0), which is derived from the acoustic nerve and spiral ganglion.[11] The 31 kD protein may be of use in the future for early diagnosis of autoimmune inner ear disease (AIED).
http://www.childrensmn.org/manuals/lab/Serology/020739.pdf Lab Dept: Serology Test Name: INNER EAR ANTIGEN General Information Lab Order Codes: IEA Synonyms: Anti-68kD (hsp-70) antibodies; 68kD (hsp-70); Heat Shock Protein 70; Anti-cochlear antibody CPT Codes: 84182 – Protein; Western blot, with interpretation and report, blood or other body fluid, immunological probe for band identification Test Includes: 68kD (hsp-70) reported as positive or negative. Logistics Test Indications: Sensorineural hearing loss (SNHL), commonly referred to as nerve deafness, may be caused by genetic factors, acquired factors (ie, infections) or can be immunologically mediated. In the majority of cases, no cause of SNHL is apparent. Such cases are referred to as idiopathic SNHL. A subgroup of idiopathic SNHL cases is treatable with immunosuppressive therapy. The laboratory studies used to identify these cases should include serum antibody tests to 68kD (hsp-70) inner ear antigen. Twenty-two percent of patients with bilateral rapidly progressive SNHL have antibodes that react with the 68kD antigen. Anti-68kD(hsp-70) antibodies also occur in approximately 60% of patients with bilateral Meniere’s disease, 35% of patients with unilateral Meniere’s disease and 37% of patients with contralateral delayed endolymphatic hydrops. Lab Testing Sections: Serology - Sendouts Referred to: Mayo Medical Laboratories (MML Test: F68KD) forward to Immco Diagnostics, Inc (Immco Test: 340) MIN Phone Numbers: Lab: 612-813-6280 STP Lab: 651-220-6550 Test Availability: Daily, 24 hours Turnaround Time: 3 to 18 days; performed twice per week Special Instructions: N/A Specimen Specimen Type: Blood Container: Red top tube Draw Volume: 9 mL (Minimum: 6 mL) blood Processed Volume: 3 mL (Minimum: 2 mL) serum Collection: Routine venipuncture Special Processing: Lab Staff: Centrifuge specimen, remove aliquot and store and ship at frozen temperatures. Forward promptly. Patient Preparation: None Sample Rejection: Mislabeled or unlabeled specimens Interpretive Reference Range: Qualitative test: Positive or Negative Antibodies to inner ear antigen (68kD) occur in approximately 70% of patients with autoimmune hearing loss. The antibody tests to this 68kD antigen parallel with disease activity. In addition, a majority of patients positive for antibodies to 68kD are responsive to corticosteroid treatment. (Hirose et al: The Laryngoscope 109: 1769 – 1999) Critical Values: N/A Limitations: N/A Methodology: Line Blot Immco Diagnostics References: July 2015 Mayo Medical Laboratories Web Page July 2015 Updates: 12/9/2013: Updated method and reference range. Method previously listed as Western Blot.
Very helpful information, Vicki. I will see if my ENT can order the testing. Thanks so much for all of your research. You are a blessing to all of us!
This seems to be the territory of ‘he who shall not be named’. So successful has that edict been, that I had nearly forgotten the name of ‘he who shall not be named’.
LOL Yellow, the thing is, I don't think all MM is autoimmune, immune system dysfunction yes, but if I understand correctly having an immune system dysfunction doesn't mean its autoimmune.. or am I wrong? Which could be why antivirals help many but not all (HSV causes the immune system to dysfunction..maybe... since HSV can be found in gut, ears, lungs, all over our bodies.) and the others it doesn't help would do better on steroids than antivirals if their MM/hearing loss etc is autoimmune, . Thinking out loud, but I could be way off. Would like to hear input.
I dunno girl. I remain sceptical of any one size fits all cure to MM. It seems so multi-facetted and so idiosyncratic. But equally I do think that he was onto something. His treatment has been up and running for long enough now to draw some conclusions on its efficacy. However his self-imposed veil of secrecy combined with the forum imposed suppression of his self-marketing doesn’t help that analysis. His disciple Angelea hasn’t posted on her blog since 04/06/2015. I personally believe that a change of lifestyle towards healthier living and eating has positive benefits, but then that is true whatever your state of health.
well I do know a few that it has helped only somewhat after a year of that treatment. I read somewhere his success rate is somewhere in the 80's% I agree I don't believe there is a 1 size fits all and afaik many of the people that go on his treatment go as a last resort, those that antivirals, and other treatments have not worked. I doubt anyone uses it as a first resort so IMO his clients are mostly limited to those who have tried everything and got no relief, which I conclude is not a good sample of all people with MM... But since there is no documentation of anything..who knows (waves.. to he who cannot be mentioned)
So that is a similar success rate to JOH. Although if you are one of the 20% you are a whole lot more out of pocket in the attempt, which can only add to your stress, which in turn can only have a negative impact on your MM. A veritable double whammy!
so far afaik antivirals success rate is the highest by a little more than 90% and not only from Dr G but a few others. but as we both agree its not a 1 size fits all answer and having more than one approach including antifungals too is probably a good thing.