Acute effect of rheopheresis on peripheral endothelial dysfunction in patients suffering from sudden hearing loss

Single low density lipoprotein (LDL) fibrinogen apheresis has shown beneficial effects in the treatment of patients with sudden sensorineural hearing loss (SSHL). Pathophysiologically, a microcirculatory disorder of the inner ear, probably caused by disturbed endothelial function, is discussed as a final common pathway of a variety of SSHL etiologies. Thus, we carried out a prospective pilot study on the efficacy of Rheopheresis on vascular function in these patients, embedded into an ongoing randomized controlled multicenter trial investigating the efficacy of Rheopheresis for the treatment of SSHL. Potential modulation of systemic endothelial dysfunction by Rheopheresis was examined by measuring flow-associated vasodilatation of the brachial artery (according to the criteria of the American College of Cardiology) in a small group of patients suffering from SSHL (N = 6, 5m/1f, mean age 11 years) within the last 3 days. At baseline, five of the six patients with acute hearing loss showed endothelial dysfunction as evidenced by diminished flow-mediated vasodilatation (FMD < 5%). After a single Rheopheresis treatment, flow-mediated vasodilatation improved significantly (from 3.9 +/- 3.6 % to 7.2 +/- 2.4 %, P = 0.05, mean SD, two-sided paired T-test). This was paralleled by a reduction in fibrinogen (364 +/- 216 mg/dL to 142 +/- 96 mg/dL, P = 0.03), total cholesterol (228 +/- 23 to 98 +/- 10, P < 0.0001) and LDL cholesterol levels (153 8 mg/dL to 83 23 mg/ dL, P < 0.01). Based on this case series we conclude that single Rheopheresis treatment might have an acute beneficial effect on endothelial dysfunction in patients suffering from SSHL.