系統性評估慢性疲勞綜合症、纖維肌痛和其他相關症候群中耳部異常的研究
最近臨床看到一個很特別的患者, 他的主訴是"一坐下來就心跳加快, 臉部發熱, 頭暈, 注意力不集中...
本文系統性回顧了耳部異常在慢性疲勞綜合症(CFS)、纖維肌痛(FM)、COVID-19、長期COVID(PCS)、和自體免疫/炎症綜合症(ASIA)等疾病中的常見性,並討論了其潛在的病理機制與臨床意義。
耳部異常在慢性疲勞綜合症、纖維肌痛、COVID-19及其他相關疾病中的系統性評估
根據《Ear abnormalities in chronic fatigue syndrome (CFS), fibromyalgia (FM), Coronavirus-19 infectious disease (COVID) and long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/inflammatory syndrome induced by adjuvants (ASIA)》的系統性回顧研究(詳見文獻),耳部異常症狀如耳鳴、眩暈和聽力減退,在慢性疲勞綜合症(CFS)、纖維肌痛(FM)、COVID-19、長期COVID(PCS)、病態建築症候群(SBS)、體位性心動過速症候群(PoTS)和疫苗引起的自體免疫/炎症綜合症(ASIA)等多種疾病中普遍出現。研究探討了這些耳部異常的成因,並指出自律神經失衡和自體免疫反應在疾病進展中可能發揮重要作用。
耳部症狀與自體免疫性疾病的共通特徵
慢性疲勞綜合症、纖維肌痛及COVID-19後遺症等疾病的共同特徵包括疲勞、散發性疼痛、認知障礙、心悸、焦慮、抑鬱、以及自律神經功能失調。在此基礎上,耳部症狀如耳鳴、頭暈、眩暈和聽力喪失的發生也較為普遍。該系統回顧涵蓋了1990年至2024年間的相關研究,篩選出了172篇關於上述疾病和耳部症狀的文獻進行綜合分析。結果顯示,在CFS、FM、PCS及ASIA等疾病中,耳蝸性問題(如耳鳴和聽力減退)比前庭性問題(如平衡障礙和頭暈)更為常見,但各類症狀的發生頻率存在顯著變異。
這些疾病的耳部症狀和神經系統問題的表現,可能由自體免疫和神經炎症驅動。具體而言,自律神經系統功能失調(包括自主神經和免疫系統的異常反應)可能是耳部症狀的觸發因素。與此同時,受病毒、免疫系統異常反應和氧化應激的影響,聽覺系統受損的情況尤為明顯。例如,與自體免疫相關,引起過度的免疫反應,導致耳部的炎症和神經損傷。
耳部異常的潛在病理機制
研究指出,這些耳部異常症狀可能涉及多方面的病理機制。首先,病毒對內耳的直接損傷可能是耳蝸和前庭異常的原因之一。COVID-19病毒可能進入內耳,造成局部神經及血管結構的損傷,導致耳鳴、眩暈和聽力減退。此外,COVID-19引起的高氧化應激水平,也可能對聽覺系統和前庭系統產生不利影響。第二,血管灌流不足也是造成耳部異常的重要因素。在這些疾病中,耳蝸和前庭系統可能因缺乏足夠的血液供應而受到損害,影響聽力和平衡功能。
研究還提出,自體免疫反應可能導致耳部異常。在COVID-19感染及其疫苗接種後,一些人產生了針對自身聽覺系統的自體免疫反應。這種免疫攻擊可能涉及對耳部細胞和組織的錯誤辨識,進而導致聽力下降、耳鳴或其他相關症狀。此外,DNA甲基化和表觀遺傳變化在一些病例中被認為是耳部異常的病理基礎。這些分子和基因的改變可能引發局部的神經和免疫反應,進而影響耳部健康。
氧化應激也被認為在耳部症狀的發生中扮演重要角色。慢性炎症和氧化損傷可加劇耳部的組織退行性變化。實驗顯示,抗氧化劑治療可在一定程度上緩解相關症狀,這表明氧化應激在此類耳部異常中的作用不容忽視。
臨床應用與建議
本次系統回顧研究建議,對於患有CFS、FM、PCS、ASIA及相關疾病的患者,如果出現耳部症狀(如耳鳴、聽力減退和眩暈),應及早安排耳鼻喉科專業檢查。由於上述耳部異常可能為更廣泛的自體免疫失調和神經炎症的反映,醫師應考慮進行聽力測試(如聽力測定)以評估具體病情。這樣的早期檢測和診斷對於建立適當的治療計劃至關重要。
耳部異常與自體免疫性疾病間的密切關聯,表明耳部症狀的存在可能預示著疾病的加重或並發症的出現。因此,系統性的耳鼻喉檢查不僅可以幫助醫師制定更個性化的治療方案,還有助於減少長期神經損傷的風險。
Review
Autoimmun Rev
. 2024 Oct;23(10):103606. doi: 10.1016/j.autrev.2024.103606. Epub 2024 Aug 28.
Ear abnormalities in chronic fatigue syndrome (CFS), fibromyalgia (FM), Coronavirus-19 infectious disease (COVID) and long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/inflammatory syndrome induced by adjuvants (ASIA): A systematic review
Thelma L Skare 1, Jozélio Freire de Carvalho 2, Italo Roberto Torres de Medeiros 3, Yehuda Shoenfeld 4
Affiliations Expand
PMID: 39209013
Abstract
Chronic fatigue syndrome (CFS), fibromyalgia (FM), silicone breast implants (SBI), Coronavirus-19 infectious disease (COVID), COVID-19 vaccination (post-COVIDvac-syndrome), Long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/ inflammatory syndrome induced by adjuvants (ASIA) are a cluster of poorly understood medical conditions that have in common a group of ill-defined symptoms and dysautonomic features. Most of the clinical findings of this group of diseases are unspecific, such as fatigue, diffuse pain, cognitive impairment, paresthesia, tachycardia, anxiety, and depression. Hearing disturbances and vertigo have also been described in this context, the underlying pathophysiologic process for these conditions might rely on autonomic autoimmune dysbalance. The authors procced a literature review regarding to hearing and labyrinthic disturbances in CSF, FM, SBI, COVID, post-COVIDvac-syndrome, PCS, SBS, POTS, and ASIA. The PRISMA guidelines were followed, and the literature reviewed encompassed papers from January 1990 to January 2024. After the initial evaluation of the articles found in the search through Pubmed, Scielo and Embase, a total of 172 articles were read and included in this review. The prevalence of hearing loss, dizziness, vertigo and tinnitus was described and correlated with the diseases investigated in this study. There are great variability in the frequencies of symptoms found, but cochlear complaints are the most frequent in most studies. Vestibular symptoms are less reported. The main pathophysiological mechanisms are discussed. Direct effects of the virus in the inner ear or nervous pathways, impaired vascular perfusion, cross-reaction or autoimmune immunoreactivity, oxidative stress, DNA methylation, epigenetic modifications and gene activation were implicated in the generation of the investigated symptoms. In clinical practice, all patients with these autoimmune conditions who have any audiological complaint an ENT consultation followed by an audiometry are needed.
Keywords: Autoimmune/inflammatory syndrome induced by adjuvants; COVID-19; Chronic fatigue syndrome; Coronavirus-19 infectious disease; Fibromyalgia; Long-COVID syndrome; Post-orthostatic tachycardia syndrome ear abnormalities; Sick-building syndrome.
Copyright © 2024. Published by Elsevier B.V.