From the Guidelines
Autoimmune testing should be considered for patients experiencing severe vertigo, tinnitus, and headaches when these symptoms suggest an autoimmune inner ear disease, as recommended by the most recent guidelines 1. The recommended initial tests include:
- Anti-nuclear antibody (ANA)
- Rheumatoid factor (RF)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Anti-heat shock protein 70 (HSP70) antibodies More specific tests may include:
- Anti-cochlear antibodies
- Anti-68kD inner ear protein antibodies
- Anti-phospholipid antibodies A complete blood count, comprehensive metabolic panel, and thyroid function tests should also be performed to rule out other causes, as suggested by 1 and 1. These tests are particularly important if symptoms are bilateral, progressive, or don't respond to standard treatments. MRI imaging of the brain and inner ear structures is often necessary to exclude structural causes like vestibular schwannoma, as recommended by 1 and 1. If autoimmune involvement is suspected, a trial of corticosteroids (typically prednisone 60mg daily for 2-4 weeks with gradual taper) may be both diagnostic and therapeutic, as suggested by 1. Patients often need referral to both neurotology and rheumatology specialists for comprehensive evaluation and management, as recommended by 1 and 1. Autoimmune inner ear disease is suspected because these conditions can trigger inflammation in the delicate structures of the inner ear, disrupting balance and hearing mechanisms, while also causing headaches through related inflammatory processes or vascular changes, as explained by 1, 1, and 1.
From the Research
Autoimmune Testing for Severe Vertigo, Tinnitus, Headaches
- The relationship between migraines and vestibular symptoms such as vertigo, motion sickness, and gait instability is well-documented 2.
- Migraine-related vasospasm can damage the inner ear, resulting in symptoms like sudden sensorineural hearing loss and tinnitus 2.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used laboratory markers of systemic inflammation 3, 4, 5.
- These tests can be used to diagnose and monitor pathological conditions, but should be used in combination with clinical history and physical exam due to their lack of sensitivity and specificity 3.
- CRP is considered a better indicator of inflammation than ESR, as it is more sensitive and responds more quickly to changes in the clinical situation 4, 5.
- The diagnostic accuracy of ESR and CRP can vary depending on the condition being diagnosed, but combined use of both tests can yield higher diagnostic accuracy 5.
- In the context of autoimmune testing for severe vertigo, tinnitus, and headaches, ESR and CRP tests may be useful in detecting underlying inflammatory conditions, but their results should be interpreted in conjunction with clinical history and physical exam 3, 4, 5.