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Autoimmune vertigo: an update on vestibular disorders associated with autoimmune mechanisms

  • Francesca Yoshie Russo
  • Massimo Ralli
  • Daniele De SetaEmail author
  • Patrizia Mancini
  • Alessandro Lambiase
  • Marco Artico
  • Marco de Vincentiis
  • Antonio Greco
Review

Abstract

The role of the immune system in mediating cochleovestibular pathologies has received increasing attention in recent years. Autoimmune vertigo may be an invalidating condition and may worsen the quality of life of affected patients, especially in the cases of delayed diagnosis. Since the etiopathogenesis is still not clear, also the treatment is not yet completely delineated. According to the clinical presentation, autoimmune vertigo can present as an isolated disorder or in association with systemic autoimmune diseases. The main feature in autoimmune vertigo is the presence of an abnormal immune response, in either absence or presence of systemic autoimmune disease, directed against delicate components of the inner ear. This may determine a functional or anatomical alteration, with an inflammatory reaction often devastating for hearing and balance. Being the exact pathogenesis unknown, the diagnosis of autoimmune vertigo is based either on clinical criteria or on a positive response to steroids. The earlier the diagnosis is made, the sooner the therapy can be installed, giving a chance to the recovery of inner ear damages. Corticosteroids represent the most effective and universally accepted treatment, even if other immunomodulatory drugs are now having a more extensive use.

Highlights

  • Vertigo is relatively frequent in autoimmune diseases; however, it is often misdiagnosed or attributed to central nervous system alterations rather to specific inner ear involvement.

  • Vertigo and other audiovestibular symptoms may be the first manifestation of an autoimmune disease and if correctly addressed could significantly contribute to early diagnosis of the underlying autoimmune disease.

  • Early diagnosis of immune-related vertigo can lead to prompt initiation of targeted therapy with elevate chances of preventing irreversible damages to the inner ear.

  • The presence of alternating phases of well-being and disabling symptoms in patients with vertigo should always been considered, as they could suggest an underlying autoimmune condition.

Keywords

Vertigo Autoimmunity Multiple sclerosis Inner ear Thyroditis Menière disease 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Francesca Yoshie Russo
    • 1
  • Massimo Ralli
    • 1
  • Daniele De Seta
    • 2
    Email author
  • Patrizia Mancini
    • 1
  • Alessandro Lambiase
    • 1
  • Marco Artico
    • 1
  • Marco de Vincentiis
    • 2
  • Antonio Greco
    • 1
  1. 1.Department of Sense OrgansSapienza University of RomeRomeItaly
  2. 2.Department of Oral and Maxillo-facial SurgerySapienza University of RomeRomeItaly

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