Sodium enoxiparin in the treatment of idiopathic sudden sensorineural hearing loss

The audiovestibular system can be affected by an immunological etiology; the presence of immune mediated sensorineural hearing loss (IMSNHL) as part of or in combination with other autoimmune diseases is well documented in the literature. Hearing loss can be caused by autoimmune disorders localized to the inner ear or secondary to systemic immune diseases (Cogan's syndrome, juvenile chronic arthritis, ulcerative colitis, Wegener's granulomatosis, scleroderma, pulseless disease, and SLE). A systemic autoimmune disorder can be present in fewer than one-third of cases The clinical presentation of immune inner-ear disease is extremely variable and depends on the type of immune reaction and on the site of injury within the inner ear. IMSNHL typically presents with an idiopathic, progressive unilateral and successive bilateral rapidly progressive sensorineural hearing loss; the course of the hearing loss occurs over weeks to months and is most common in middle-aged women; it may be accompanied by tinnitus and vertigo and is almost always unilateral. IMSNHL is still a diagnostic and therapeutic dilemma, and predicting recovery from it is very difficult. Different factors may influence a prognosis: e.g., severity of hearing loss, duration of symptoms before treatment, presence of vertigo, type of audiogram, and age of patients. The therapeutic approaches normally used for this pathological condition include the systemic and local administration of cortisone, vasoactive agents, anticoagulants, vitamin complexes, a cytotoxic agent and plasmapheresis. These drugs can be effective in reversing such hearing loss, although at the cost of occasionally severe side effects. Currently, evaluating the importance of an autoimmune phenomenon in the genesis of inner-ear disease is difficult because the clinical and biological criteria of autoimmune deafness have not yet been well defined. A positive response to treatment is a criterion for the diagnosis of immune inner-ear disease. This chapter aims to assess the effect of sodium enoxaparin on the recovery of hearing in patients affected by ISSNHL. Sodium enoxaparin was administered subcutaneously at a dose of 4,000 IU once a day for 10 days. Sodium enoxaparin is a particular kind of heparin with a low molecular weight (LMWH) and is endowed with a high antithrombotic activity. The literature does not report any therapeutic protocols for autoimmune IMSNHL treatment with sodium enoxaparin or other kinds of unfractionated heparin. Our decision to use enoxaparin was based both on the pathogenesis of this condition and on evaluation of the other classes of drugs currently used.