Study of audiovestibular dysfunction in children with systemic lupus erythematosus.

OBJECTIVE: Inner ear dysfunction in systemic lupus erythematosis patients has been reported but audiovestibular involvement is not well documented especially in pediatrics. This study was designed to evaluate silent audiovestibular dysfunction among SLE children. METHODS: Case control study examined in allergy and immunology clinic; pediatrics hospital and audiovestibular clinic; Ain Shams University from January 2009 to December 2010. Thirty-five systemic lupus erythematosus children (diagnosed according to American College of Rheumatology); age group 8-16 years, were randomly selected. Five of them were excluded due to one or more exclusion criteria (previous otitis media, stroke, lupus cerebritis, meningitis or encephalitis, audiovestibular symptom). Ten of them refused enrollment or could not complete full battery. Seventeen females and three males, mean age 12.9 ± 2.6 years, completed the study. Control group included 20 normal subjects, age and sex matched. Full clinical assessment, basic audiological evaluation and vestibular testing (videonystagmography VNG and computerized dynamic posturography CDP) were conducted for children included in the study. RESULTS: Five systemic lupus erythematosus patients had sensorineural hearing loss strongly associated with +ve antiphospholipid antibody and two had conductive hearing loss. Two children in control group had conductive hearing loss (p=0.05). Abnormal VNG findings was significantly higher among systemic lupus erythematosus children (40%) compared to controls (0%) and associated with +ve antiphospholipid antibodies (χ(2)=10, p=0.002, Fisher exact test=0.003). Twenty-five percentage of systemic lupus erythematosus children had abnormal CDP findings reflecting impaired balance function associated with positive antiphospholipid antibodies showing significant statistical difference compared to controls (0% affection) (χ(2)=5.7, p=0.017, Fisher exact test=0.047). CONCLUSION: Silent audiovestibular dysfunction is prevalent among systemic lupus erythematosus children especially those positive for antiphospholipid antibodies necessitating routine regular evaluation.

The role of atopy in otitis media with effusion among primary school children: audiological investigation.

The objective of this study was to evaluate the role of atopy in otitis media with effusion (OME) in children attending primary school in western Sicily focusing on the audiological characteristics among atopic and non-atopic subjects suffering from OME. A total of 310 children (5-6 years old) were screened by skin tests and divided into atopics (G1) and non-atopics (G2). The samples were evaluated for OME by pneumatic otoscopy, tympanogram and acoustic reflex tests. The parameters considered were: documented persistent middle ear effusion by otoscopic examination for a minimum of 3 months; presence of B or C tympanogram; absence of ipsilateral acoustic reflex and a conductive hearing loss greater than 25 dB at any one of the frequencies from 250 Hz through 4 kHz. A total of 56 children (18.06%) resulted to be atopics while 254 were non-atopics. OME was identified in 24 atopic children and in 16 non-atopic children for a total number of 40 children; the overall prevalence rate was 12.9% (42.85% for G1 and 6.30% for G2). OME was bilateral in 28 children (70%), with a significative difference between G1 (79.17%) and G2 (56.25%). The prevalence of B tympanogram was 70.59%, corresponding to 79.07% for G1 and 56% for G2. The mean air conduction pure tone was, respectively, 31.97 dB for G1 and 29.8 dB for G2. The prevalence value of OME in atopic children, also supported by the higher predominance of bilaterality, B tympanogram and hearing loss among this group, could suggest the important role of allergy in the pathogenesis of OME.