A.R. Javer, St. Paul’s Sinus Centre, Vancouver, BC, Canada.
1. Cain R, Lal D. Update on the management of chronic rhinosinusitis.
Infect Drug Resist. 2013;6:1-14.
2. Lee JY, Lee SW, Lee JD. Comparison of the surgical outcome between
primary and revision endoscopic sinus surgery for chronic rhinosinusi-
tis with nasal polyposis. Am J Otolaryngol. 2008;29:379-384.
3. Litvack JR, Griest S, James KE, Smith TL. Endoscopic and quality-of-
life outcomes after revision endoscopic sinus surgery. Laryngoscope.
4. Jiang RS, Hsu CY. Revision functional endoscopic sinus surgery. Ann
Otol Rhinol Laryngol. 2002;111:155-159.
5. Gore MR, Ebert CS, Zanation AM, Senior BA. Beyond the “central
sinus”: radiographic findings in patients undergoing revision functional
endoscopic sinus surgery. Int Forum Allergy Rh. 2013;3:139-146.
6. Khalil H, Eweiss A, Clifton N. Radiological findings in patients under-
going revision endoscopic sinus surgery: a retrospective case study
series. BMC Ear Nose Throat Disord. 2011;11:4.
7. Bradley D, Kountakis S. The role of agger nasi air cells in patients
requiring revision endoscopic frontal sinus surgery. Otolaryngol Head
Neck Surg. 2004;131:525-527.
8. Bewick J, Egro FM, Masterson L, Javer AR, Philpott CM. Anatomic
findings in revision endoscopic sinus surgery: case series and review
of contributing factors. Allergy Rhinol. 2016;7:e151-e157.
9. Masterson L, Egro FM, Bewick J, et al. Quality-of-life outcomes after
sinus surgery in allergic fungal rhinosinusitis versus nonfungal
chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30:e30-e35.
10. Soyka MB, Holzmann D. Correlation of complications during endo-
scopic sinus surgery with surgeon skill level and extent of surgery.
Am J Rhinol. 2005;19:274-281.
Accepted: 12 October 2017
Is there a relationship between melanocytes and
sensorineural hearing loss? Clinical evaluation of 51 patients
with alopecia areata
Alopecia areata (AA) is considered as an autoimmune disease which
affects hair follicles and consequently results in hair loss. The preva-
lence of autoimmune diseases associated with other studies has
been recorded at 12%. Autoimmune thyroid diseases, psoriasis, per-
nicious anaemia and vitiligo may frequently occur with alopecia
areata. Several studies have provided evidence that follicular mela-
nocytes might be a significant target in this autoimmune process.
The underlying mechanism of damage to melanocytes in the skin
can also affect other organs, including the inner ear. For example,
vitiligo can cause audial issues by affecting all active melanocytes.
Hypoacusis in vitiligo was reported to be between 4% and 37%.
Loss of epidermal melanocytes is believed to be in etiopathogenesis
of vitiligo. In vitiligo, melanocytes in the inner ear may result in sen-
sorineural hearing damage through the loss of their primary function,
and preparing the ground for the damaging effects of environmental
Melanocytes play a key role in the auditory stimuli trans-
duction and modulation in the inner ear. Furthermore, past studies
have contended that melanocytes may have a practical and struc-
tural function for the auditory system, and this mechanism may be
damaged in vitiligo. Recently in very few studies, it has been shown
that AA might be associated with sensorineural hearing loss via the
autoimmunity against follicular melanocyte loss hypothesis.
may influence the hearing function by affecting the melanocytes in
the inner ear with a similar mechanism. The aim of this study was
to demonstrate the relationship between AA and sensorineural hear-
MATERIALS AND METHODS
Our research was conducted as a prospective case-control study
with the approval of the local ethical committee of our hospital
(ethics committee No. 2016-90).
The study was comprised of 51 patients with an AA diagnosis in the
Dermatology Clinic of our hospital (the AA group), and a further 50
healthy volunteers who attended the hospital for routine health
screening. Symptoms were present in all patients with AA for a mini-
mum of 1 month.
CORRESPONDENCE: OUR EXPERIENCE