Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-3079-2
Otology
Sensorineural hearing loss in pediatric patients with celiac disease Nafiye Urganci · Derya Kalyoncu · Asli Batur Calis
Received: 8 February 2014 / Accepted: 26 April 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Sensorineural hearing loss (SNHL) as an extraintestinal manifestation of celiac disease (CD) has been reported in several studies. The aim of this study was to determine presence of subclinical sensorineural hearing loss associated with CD in pediatric patients. Otoscopy, tympanometry and pure tone audiometry were performed in 44 patients with CD and 20 healthy age and sex-matched controls. Pure tone audiometry did not show significant sensorineural hearing loss over all frequencies in patients with CD compared with controls (P > 0.05). SNHL was detected in only three (6.8 %) patients with CD. In conclusion, subclinical sensorineural hearing loss was demonstrated in adult patients with CD; therefore, we recommend to perform audiometric examinations in pediatric patients for recognizing hearing loss early during the course of the disease.
Introduction Celiac disease (CD) is an immune-mediated disease triggered by an environmental agent, gluten, in genetically predisposed individuals. Gluten induces the production of specific autoantibodies directed against tissue transglutaminase not only in the small intestine but also in extraintestinal tissues. A relationship between autoimmune diseases and hearing loss is well established, and sensorineural hearing loss (SNHL) has been reported in autoimmune disorders such as Sjögren’s syndrome, systemic lupus erythematosus and inflammatory bowel diseases [1–6]. Subclinical SNHL associated with CD has been investigated in several studies [7–12] where incidence of SNHL has varied from 8.5 [7] to 47.1 % [8]. We aimed to identify whether pediatric patients with CD have a higher incidence of subclinical SNHL than healthy children in this prospective controlled study.
Keywords Sensorineural hearing loss · Celiac disease · Children Materials and methods
N. Urganci Division of Pediatric Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey D. Kalyoncu Department of Pediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey D. Kalyoncu (*) Istinye State Hospital, Istinye Street No:98, 34465 Sariyer, Istanbul, Turkey e-mail: [email protected] A. B. Calis Department of Otorhinolaryngology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
Forty-four children with CD diagnosed and followed up between 2000 and 2012 at Division of Pediatric Gastroenterology of Sisli Etfal Training and Research Hospital (Istanbul, Turkey) and 20 healthy age and sex-matched controls were referred and evaluated for audiological assessment. A questionnaire assessing risk factors for hearing loss was administered for all patients and controls. Disease parameters including type and duration of disease, disease activity, history of medication including duration and doses, coexisting other associated extraintestinal manifestations were determined. Demographic and clinical characteristics of study patients and control group are shown in Table 1. None of the patients had a history of head trauma or noise exposure, exposure to ototoxic drugs, family history of hearing loss or CD.
13
Eur Arch Otorhinolaryngol
Table 1 Demographic and clinical features of CD patients and controls
Age (years) Gender (male/female) BMI (kg/m2) Duration of disease (mean ± SD, years) Clinical presentation Typical Atypical Compliance to GFD Compliant Non-compliant
Patient group (n = 44)
Control group (n = 20)
8.8 ± 4.54 0.62:1 (17/27) 18.5 ± 3.97 3.1 ± 2.57
9.35 ± 2.4 0.8:1 (9/11) 23.3 ± 3.5
23 (52.2 %) 21 (47.7 %) 27 (61.3 %) 17 (38.6 %)
The diagnosis of CD was based on ESPGHAN criteria [13]. The histopathological changes of small intestinal biopsies were graded according to a modified Marsh classification [14]. Informed consents were obtained from all of the parents before the procedures. During follow-up, dietary compliance to GFD was evaluated on every visit by the same physician and celiac disease activity was monitored by measurement of antibodies against transglutaminase and endomysium. Control subjects were also tested for the presence of anti-gliadin antibody, anti-endomysial antibody, and anti-tissue transglutamine antibody. A family history of autoimmune diseases was determined among first-degree relatives of all patients and controls. Audiological evaluation included otoscopy, tympanometry and pure tone audiometry thresholds at frequencies from 250 to 8,000 Hz (Kamplex AC4 Audiometer, P.C.Worths, London, UK). Air and bone conduction thresholds were measured separately for both right and left ear in all patients and controls and the highest one of these four values was accepted as representative hearing level for each cases. Patients who had values higher than 20 decibel were accepted having SNHL. Statistical analyses Statistical analysis was performed using SPSS 11.0 software (SPSS Inc, Chicago, IL, USA). Results were expressed as mean ± SD for quantitative variables and proportions and as percentage. A value of P
Otology
Sensorineural hearing loss in pediatric patients with celiac disease Nafiye Urganci · Derya Kalyoncu · Asli Batur Calis
Received: 8 February 2014 / Accepted: 26 April 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Sensorineural hearing loss (SNHL) as an extraintestinal manifestation of celiac disease (CD) has been reported in several studies. The aim of this study was to determine presence of subclinical sensorineural hearing loss associated with CD in pediatric patients. Otoscopy, tympanometry and pure tone audiometry were performed in 44 patients with CD and 20 healthy age and sex-matched controls. Pure tone audiometry did not show significant sensorineural hearing loss over all frequencies in patients with CD compared with controls (P > 0.05). SNHL was detected in only three (6.8 %) patients with CD. In conclusion, subclinical sensorineural hearing loss was demonstrated in adult patients with CD; therefore, we recommend to perform audiometric examinations in pediatric patients for recognizing hearing loss early during the course of the disease.
Introduction Celiac disease (CD) is an immune-mediated disease triggered by an environmental agent, gluten, in genetically predisposed individuals. Gluten induces the production of specific autoantibodies directed against tissue transglutaminase not only in the small intestine but also in extraintestinal tissues. A relationship between autoimmune diseases and hearing loss is well established, and sensorineural hearing loss (SNHL) has been reported in autoimmune disorders such as Sjögren’s syndrome, systemic lupus erythematosus and inflammatory bowel diseases [1–6]. Subclinical SNHL associated with CD has been investigated in several studies [7–12] where incidence of SNHL has varied from 8.5 [7] to 47.1 % [8]. We aimed to identify whether pediatric patients with CD have a higher incidence of subclinical SNHL than healthy children in this prospective controlled study.
Keywords Sensorineural hearing loss · Celiac disease · Children Materials and methods
N. Urganci Division of Pediatric Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey D. Kalyoncu Department of Pediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey D. Kalyoncu (*) Istinye State Hospital, Istinye Street No:98, 34465 Sariyer, Istanbul, Turkey e-mail: [email protected] A. B. Calis Department of Otorhinolaryngology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
Forty-four children with CD diagnosed and followed up between 2000 and 2012 at Division of Pediatric Gastroenterology of Sisli Etfal Training and Research Hospital (Istanbul, Turkey) and 20 healthy age and sex-matched controls were referred and evaluated for audiological assessment. A questionnaire assessing risk factors for hearing loss was administered for all patients and controls. Disease parameters including type and duration of disease, disease activity, history of medication including duration and doses, coexisting other associated extraintestinal manifestations were determined. Demographic and clinical characteristics of study patients and control group are shown in Table 1. None of the patients had a history of head trauma or noise exposure, exposure to ototoxic drugs, family history of hearing loss or CD.
13
Eur Arch Otorhinolaryngol
Table 1 Demographic and clinical features of CD patients and controls
Age (years) Gender (male/female) BMI (kg/m2) Duration of disease (mean ± SD, years) Clinical presentation Typical Atypical Compliance to GFD Compliant Non-compliant
Patient group (n = 44)
Control group (n = 20)
8.8 ± 4.54 0.62:1 (17/27) 18.5 ± 3.97 3.1 ± 2.57
9.35 ± 2.4 0.8:1 (9/11) 23.3 ± 3.5
23 (52.2 %) 21 (47.7 %) 27 (61.3 %) 17 (38.6 %)
The diagnosis of CD was based on ESPGHAN criteria [13]. The histopathological changes of small intestinal biopsies were graded according to a modified Marsh classification [14]. Informed consents were obtained from all of the parents before the procedures. During follow-up, dietary compliance to GFD was evaluated on every visit by the same physician and celiac disease activity was monitored by measurement of antibodies against transglutaminase and endomysium. Control subjects were also tested for the presence of anti-gliadin antibody, anti-endomysial antibody, and anti-tissue transglutamine antibody. A family history of autoimmune diseases was determined among first-degree relatives of all patients and controls. Audiological evaluation included otoscopy, tympanometry and pure tone audiometry thresholds at frequencies from 250 to 8,000 Hz (Kamplex AC4 Audiometer, P.C.Worths, London, UK). Air and bone conduction thresholds were measured separately for both right and left ear in all patients and controls and the highest one of these four values was accepted as representative hearing level for each cases. Patients who had values higher than 20 decibel were accepted having SNHL. Statistical analyses Statistical analysis was performed using SPSS 11.0 software (SPSS Inc, Chicago, IL, USA). Results were expressed as mean ± SD for quantitative variables and proportions and as percentage. A value of P
