Tinnitus is a frequent and often debilitating condition. There is consensus in the scientific community that there exist various forms of tinnitus, which differ in their pathogenesis. Here we report a series of five cases where the onset of tinnitus was associated with viral infections. In all five patients elevated antibodies against Coxsackie B have been detected. This observation suggests that Coxsackie B Virus infections might be involved in the development of some cases of tinnitus and indicate that further systematic investigations are warranted.Fil: Langguth, Berthold. Universitat Regensburg; AlemaniaFil: Stadtlaender, Hans. An der Zuckerfabrik 2; AlemaniaFil: Landgrebe, Michael. Universitat Regensburg; AlemaniaFil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Coors, Hermann. Gaußstr 10; AlemaniaFil: Vielsmeier, Veronika. Universitat Regensburg; AlemaniaFil: Kleinjung, Tobias. Universitat Regensburg; Alemani

Coors, Hermann

Elgoyhen, Ana Belen

Kleinjung, Tobias

Landgrebe, Michael

Langguth, Berthold

Stadtlaender, Hans

Vielsmeier, Veronika

English

CONICET Digital

To cite this article: Neuroendocrinol Lett 2007; 28(5):554–555CASE REPORTNeuroendocrinology Letters Volume 28 No. 5 2007Tinnitus and Coxsackie B infections: A case seriesBerthold Langguth 1, Hans Stadtlaender 2, Michael Landgrebe 1,  Ana Belen Elgoyhen 3, Hermann Coors 4, Veronika Vielsmeier 5  & Tobias Kleinjung 5Department of Psychiatry, University of Regensburg, Germany, An der Zuckerfabrik 2, Wolfsburg, GermanyInstituto de Investigaciones en Ingeniería Genética y Biología Molecular, Buenos Aires, ArgentinaGaußstr 10, Wolfsburg, GermanyDepartment of Otorhinolaryngology, University of Regensburg, GermanyCorrespondence to: Berthold Langguth, MD.Department of Psychiatry and Psychotherapy, University of RegensburgUniversitaetsstrasse 84, 93053 Regensburg, Germany PHONE: +49-941-941-2099FAX: +49-941-941-2025EMAIL: berthold.langguth@medbo.deSubmitted: September 16, 2007  Accepted: September 28, 2007Key words: tinnitus; enterovirus infections; hearing loss; Coxsackie B; meningoencephalitisNeuroendocrinol Lett 2007; 28(5):554–555 PMID: 17984924  NEL280507A18 © 2007 Neuroendocrinology Letters • www.nel.eduAbstract Tinnitus is a frequent and often debilitating condition. There is consensus in the scientific community that there exist various forms of tinnitus, which differ in their pathogenesis. Here we report a series of five cases where the onset of tinnitus was associated with viral infections. In all five patients elevated antibodies against Coxsackie B have been detected. This observation suggests that Coxsackie B Virus infections might be involved in the development of some cases of tinnitus and indicate that further systematic investigations are warranted.1.2.3.4.5.InTroduCTIonTinnitus, the perception of a sound in the ab-sence of external acoustic stimulation is a common phenomenon disturbing millions of individuals worldwide [1]. Even if the pathophysiology of tin-nitus is not entirely known, there is considerable evidence that altered input from the peripheral au-ditory system can result in reorganization of central nervous system structures (auditory, but also limbic areas), which may lead to neuronal signals that cause phantom sensations [2]. Very often tinnitus is related to hearing disorders such as presbyacusis, noise trauma or sudden hearing loss. In addition, alterations of peripheral auditory function have also been shown to occur as a symptom of a wide range of viral infections [3–5] with best evidence for varizella zoster [6,7]. Support for a potential relationship between viral infections and tinnitus comes from clinical experience with a frequently reported temporal connection between onset of tinnitus and influenzal infections. Here we report a series of five cases which suggest the involvement of a viral infection with Coxsackie B in the pathogen-esis of subjective tinnitus. CASE rEporTSOne of the authors had suffered a viral meningo-encephalitis with pleocytosis in the cerebrosopinal fluid (CSF) more than 50 years ago. At that time neither serum nor CSF were investigated for specific antibodies. During the course of this meningoen-cephalitis a unilateral, narrow band high frequency 555Neuroendocrinology Letters Vol. 28 No. 5 2007 • Article available online: http://node.nel.eduTinnitus and Coxsackie Btinnitus developed, which worsened over the following decades. There was no subjective hearing impairement and audiological exams were normal. Several decades later an elevated titter of IgG antibodies against Coxsackie B was detected. During his work as a occupational health practitioner one of the authors (H.S.) witnessed the occurrence of tinnitus in four employees over a short period of time. These four employees worked closely together in the same building and all of them reported that tinnitus occurred after they had suffered an influenza with headache, muscle aches and fever. None of the patients complained about hearing loss. Serological screening revealed typical findings of an acute Coxsackie B infection with elevated antibody titters in all four patients. In none of them tin-nitus improved during the following weeks, in spite of inpatient treatment in the local ENT department.dISCuSSIonHere we report the occurrence of tinnitus associated with influenzal infections in four patients which worked closely together and one case of tinnitus occurring after viral meningoencephalitis. In all five patients elevated antibodies against Coxsackie B have been detected. We are aware that a causal relationship between the infection with Coxsackie B and tinnitus cannot be proofed by this observation. Furthermore, the polymerase chain reaction (PCR) technique for the detection of enterovirus gene sequences was not available at that time.Nevertheless it is highly probable, that all five patients experienced tinnitus as a consequence of a Coxsackie B infection. Recently, sudden deafness has been reported as a symptom of enterovirus meningitis [8]. A systematic study which used PCR for virus detection in 55 consecu-tive patients with sudden hearing loss, revealed positive diagnosis of enterovirus infection in 22 patients, among them 13 with Coxsackie B. In the majority of these pa-tients sudden hearing loss was associated with tinnitus [9]. In all five cases which we describe here, tinnitus occurred without detectable hearing loss. However, it is conceivable that a viral infection, which can cause hear-ing loss by infection of the cochlea or the auditory nerve, might also cause an alteration of neuronal functioning of the peripheral auditory system, resulting in tinnitus without hearing loss. In addition, a possible hearing defi-cit in the high frequency range, not detected by routine audiological methods, cannot be precluded. A potential relationship between Coxsackie B and tinnitus is further supported by the expression of Coxsackie adenovirus receptors in the cochlea [10]. These could represent the structural substrate underlying the effects of Coxsackie B on the auditory system. Even if at this stage the assumption of a relationship between Coxsackie B Virus infections and the develop-ment of tinnitus is largely hypothetical, our findings suggest that further systematic investigations are war-ranted. The possibility that enterovirus infections may be associated not only with sudden hearing loss, but also with some hitherto “idiopathic” cases of tinnitus, should be recognized. The availability of highly sensitive PCR techniques, together with the recent development of pleconaril, which may be used as a specific therapy for enterovirus infections [11,12], highlights the importance of early diagnosis of enteroviruses as the cause of other-wise idiopathic tinnitus. REfERENcEscoles RR. Epidemiology of tinnitus: (1) prevalence. J Laryngol Otol suppl 1984; 9: 7–15.Moller AR. Pathophysiology of tinnitus. Otolaryngol clin North Am 2003; 36: 249–66.shian WJ, chi cs. sudden hearing loss caused by Epstein-Barr vi-rus. Pediatr Infect Dis J 1994; 13(8): 756–758.Yoshida Y, Yamauchi s, shinkawa A, Horiuchi M, sakai M. Immu-nological and virological study of sudden deafness. Auris Nasus Larynx 1996; 23: 63–68.Garcia B, Jr., Ramirez-camacho R, Portero f, Vargas JA. Role of vi-ral and Mycoplasma pneumoniae infection in idiopathic sudden sensorineural hearing loss. Acta Otolaryngol 2000; 120(7): 835–839.Adour KK. Otological complications of herpes zoster. Ann Neurol 1994; 35 Suppl: s62–s64.sweeney cJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neuro-surg Psychiatry 2001; 71(2): 149–154.schattner A, Halperin D, Wolf D, Zimhony O. Enteroviruses and sudden deafness. cMAJ 27–5–2003; 168(11): 1421–1423.Mentel R, Kaftan H, Wegner U, Reissmann A, Gurtler L. Are enter-ovirus infections a co-factor in sudden hearing loss? J Med Virol 2004; 72(4): 625–629.Venail f, Wang J, Ruel J, Ballana E, Rebillard G, Eybalin M, Arbones M, Bosch A, Puel JL. coxsackie adenovirus receptor and alpha nu beta3/alpha nu beta5 integrins in adenovirus gene transfer of rat cochlea. Gene Ther 2007; 14(1): 30–37.Rotbart HA, Webster AD. Treatment of potentially life-threaten-ing enterovirus infections with pleconaril. clin Infect Dis 15-1-2001; 32(2): 228–235.Romero JR. Pleconaril: a novel antipicornaviral drug. Expert Opin Investig Drugs 2001; 10(2): 369–379.1 2 3 4 5 6 7 8 9 10 11 12 

Tinnitus and Coxsackie B infections: A case series

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Tinnitus and Coxsackie B infections: A case series

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