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To the Editor: Dr Harris and colleagues¹ found that methotrexate treatment failed to maintain the hearing improvement achieved with high dose glucocorticoid treatment in patients with autoimmune inner ear disease (AIED). Several of these authors have previously written about the association between AIED and a serum antibody to a 68-kDa bovine inner ear protein (subsequently identified as inducible heat shock protein 70 (HSP70).^2-3 It would be of interest to know how many of the patients who underwent the prednisone challenge had this serum antibody, and whether responsiveness to glucorticoid was related to presence of the antibody, as previously reported.³ Similarly, the authors should report the prevalence of the antibody among patients in the methotrexate and placebo groups.

Kurt J. Bloch, MD
Department of Medicine
Massachusetts General Hospital
Boston

1. Harris JP, Weisman MH, Derebery JM, et al. Treatment of corticosteroid-responsive autoimmune inner ear disease with methotrexate: a randomized controlled trial. JAMA. 2003;290:1875-1883. FREE FULL TEXT 2. Harris JP, Sharp PA. Inner ear autoantibodies in patients with rapidly progressive sensorineural hearing loss. Laryngoscope. 1990;100:516-524. ISI | PUBMED 3. Moscicki RA, San Martin JE, Quintero CH, Rauch SD, Nadol JB Jr, Bloch KJ. Serum antibody to inner ear proteins in patients with progressive hearing loss: correlation with disease activity and response to corticosteroid treatment. JAMA. 1994;272:611-616. ABSTRACT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:303.

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