Sensorineural hearing loss in pediatric celiac patients S ¸ amil Hizli a, *, Hayriye Karabulut b , Osman O ¨ zdemir c , Baran Acar b , Ayhan Abaci c , Muharrem Dag ˘lı d , R. Murat Karas ¸ en b a Gaziantep University Faculty of Medicine Pediatric Gastroenterology Unit, Turkey b MH Ankara Kecioren Research and Training Hospital Ear Nose and Throat Clinic, Turkey c MH Ankara Kecioren Research and Training Hospital Pediatrics Clinic, Turkey d MH Ankara Diskapi Yildirim Beyazit Research and Training Hospital Ear Nose and Throat Clinic, Turkey 1. Introduction Celiac disease (CD) is a genetically determined immune- mediated enteropathy triggered by the ingestion of gluten. Celiac disease is one of the most common lifelong disorders affecting around 1% of the general population all over the world [1]. Typical findings of CD are manifested as chronic diarrhea, failure to thrive and abdominal complaints. CD is a multisystemic disease and also associated with atypical/extraintestinal findings such as short stature, anemia, liver dysfunction, osteoporosis, infertility, dental enamel defects, aphtous stomatitis and other autoimmune disorders [1–3]. Recent studies demonstrated that nervous system impairment in CD is more common and variable than previously reported and could be regarded as one of the most frequent extraintestinal presentations [4,5]. A diversity of neurologic disorders such as hypotonia, peripheral neuropathy, developmental delay, learning disorders, attention deficit hyperactivity disorder, cerebellar ataxia, epilepsy, migraine, headache and night blindness are also accepted to be among the extraintestinal findings of CD [3–5]. Sensorineural hearing loss (SNHL) is a neurological condition that may result in negative effects on speech and language acquisition, social, emotional and academic development deficits [6,7]. In US National Health and Nutrition Examination Survey (NHANES) III, bilateral SNHL prevalence has been found between 1.5 and 3% of normal school-aged children [8]. Histologically proven involvement of cerebellum in CD was first described in an adult postmortem study and in other animal and International Journal of Pediatric Otorhinolaryngology xxx (2010) xxx–xxx * Corresponding author at: Yeditepe Mah. U ¨ niversite Bul. No: 335, 4 S ¸ahinbey, Gaziantep, Turkey. Tel.: +90 342 360 60 60; fax: +90 342 360 39 10. E-mail address: shizli@yahoo.com (S ¸ . Hizli). ARTICLE INFO Article history: Received 5 May 2010 Received in revised form 1 October 2010 Accepted 5 October 2010 Available online xxx Keywords: Celiac disease Childhood Sensory neural hearing loss Complication Screening Speech discrimination ABSTRACT Objective: Celiac disease (CD) is an immune-mediated chronic inflammatory gluten-dependent intestinal disease affecting 0.5–1% of the general population worldwide. CD is underdiagnosed even with sophisticated health care; approximately 10% of people affected by CD are now diagnosed. The recognition of the atypical extra-intestinal manifestations, including neurological disorders increased the diagnosis of CD. At present, no data are available on the presence of sensorineural hearing loss in pediatric CD patients. The aim of this study was to determine the incidence and severity of sensorineural hearing loss (SNHL) in different frequencies in pediatric CD patients. Methods: A sample of 32 biopsies and serologically proven newly diagnosed pediatric CD patients (CD group) (64 ears) and 32 sex and age-matched healthy subjects (64 ears) as control group (C group) were included in this study. Anthropometric measurements, physical examinations including ear nose and throat and pure-tone audiometry at frequencies 250–8000 Hz were performed in all subjects in both groups. Slight/mild SNHL was defined as a loss of detection of sound within the 16–40 dB range. The mean age of patient and control group was 11.9 and 11.3, respectively (p > 0.05). Results: In CD group, sensorineural hearing loss was found in 13 (40.6%) patients (group A) as it was bilateral in six and unilateral in seven patients. In control group (group C), slight/mild SNHL was found in one (3.1%) subject. The frequency of hearing loss was significantly higher in CD group than in group C (p < 0.001). Conclusion: The present study showed a higher prevalence of sensory neural hearing loss in pediatric celiac patients than in healthy controls, suggesting an association between CD and SNHL. The findings of this study suggest that hearing impairment should be searched in newly diagnosed pediatric CD patients. Further longitudinal investigations on a larger sample size will be necessary to confirm the present data and to search the immunological processes which could be the basis of the association between CD and SNHL. ß 2010 Published by Elsevier Ireland Ltd. G Model PEDOT-5590; No. of Pages 4 Please cite this article in press as: S ¸ . Hizli, et al., Sensorineural hearing loss in pediatric celiac patients, Int. J. Pediatr. Otorhinolaryngol. (2010), doi:10.1016/j.ijporl.2010.10.009 Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2010 Published by Elsevier Ireland Ltd. doi:10.1016/j.ijporl.2010.10.009