Title:
Does a reduction of adhesion molecules by LDL-apheresis have a role in the treatment of sudden hearing loss?

Alfonso Ramunni¹ ;Alfonso Ramunni² ;Alfonso Ramunni¹ ;Alfonso Ramunni² ;Alfonso Ramunni³ ;Alfonso Ramunni⁶

University of Bari University of Bari ; 3. Section of Internal Medicine

E-mail address corresponding author:
a.ramunni@nephro.uniba.it

Background:
Sudden hearing loss (SHL) is a highly disabling affliction that can severely affect the subject’s social and relational life. Although the etiology of the complaint is still debated, it is thought that microcirculation disturbances conditioned by an endothelial dysfunction may be the main pathogenetic mechanism. Adhesion molecules favoring interaction between the leukocytes and the endothelial cells are early markers of endothelial damage.

Methods:
We describe a case of SHL on the right side that had no recovery of hearing after three days of standard treatment and that underwent a single session of LDL/fibrinogen apheresis with the Heparin Extracorporeal LDL Precipitation (HELP) system (BBraun)

Results:
A hearing test performed 12 hours after treatment showed recovery on the right, to a PTA of 47 dB HL from a right-sided hearing loss of 70-80 dB HL. Seventy-two hours after apheresis the patient showed normal right-sided hearing (PTA 23 dB HL) and normal speech discrimination (100% at 50 dB HL). In this patient, in addition to reducing LDL cholesterol and fibrinogen (57.6% and 51.4%, respectively), the circulating adhesion molecules (sE-selectin, sVCAM-1 and sICAM-1), previously present in higher than normal concentrations, were reduced by the treatment (29.5%, 12.6% and 19.7%, respectively).

Conclusion:
The resolution of the hearing loss resulting from one session of LDL/fibrinogen apheresis, together with a significant reduction of LDL cholesterol , fibrinogen and also of the circulating adhesion molecules suggest that all these components have a role in the genesis of the disturbance.

Subject:
New Technologies

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