To the Editor We praise the article by Bayoumy et al,1 who stressed the importance of oxygen supply for the amelioration of sudden sensorineural hearing loss (SSNHL). We reported that of patients with SSNHL attending an otorhinolaryngology clinic in Torino, Italy, 94.4% (odds risk, 13.6%) had an infection by a known ischemia inducing agent (ie, Helicobacter pylori).2 In addition, this pathogen may cause thrombosis via a number of mechanisms, the best known of which is antigenic mimicry (ie, the production of autoantibodies against a variety of human antigens that share an amino acid linear homology with bacterial epitopes). Particularly worthy of mention are autoantibodies against phospholipids, which will disappear after cure of the infection3; against platelets—with the known consequence of autoimmune thrombotic thrombocythemia4—and against endothelial cells5 that are also directly activated by the bacterium. In addition, H pylori elicits neutrophilic infiltration, a cause of neutrophilic extracellular traps because the bacterium secretes a neutrophilic-activating protein. Neutrophilic infiltration of vascular walls may lead to venous thrombosis. Detection and cure of this infection is not expensive and is available worldwide. We propose that the search of H pylori infection and treatment of positive cases could ameliorate SSNHL outcomes in many patients, at least in countries with high circulation of this pathogen.
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Ponzetto A, Cavallo G, Figura N. Sudden Sensorineural Hearing Loss. JAMA Otolaryngol Head Neck Surg. Published online November 27, 2019. doi:https://doi.org/10.1001/jamaoto.2019.3662
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