Neuro-otological manifestations in Fabry disease-a retrospective single center study

Background: Fabry disease (FD) is one of the X-linked lysosomal storage diseases that can affect any organ. They have a specific lysosomal dysfunction in common, which results in substrate accumulation in lysosomes instead of metabolite degradation. Due to the deficiency/absence of a-galactosidase, globotriaosylceramides (Gb3) are deposited in lysosomes of the organs. In addition to acroparesthesia, angiokeratomas, autonomic dysfunction, vortex keratopathies, ischemic cerebral or cardiac complications and chronic renal failure, also vestibulocochlear dysfunctions with sudden or progressive asymmetric hearing loss, tinnitus and vertigo may be observed. Patients and methods: In this retrospective study, 33 patients (men= 16 and women= 17) with FD were evaluated. All patients presented to us in interdisciplinary cooperation as part of routine examinations by the specialized center for lysosomal storage diseases of the in-house department of nephrology. This presentation is carried out as a screening examination independent of neuro-otological symptoms. Results: The mean age at diagnosis was 34.76 (+/- 11.55) years. The first presentation in our ENT department was at 40.45 (+/- 11.71) years. We were able to demonstrate a significant correlation between neurological symptoms or apoplexy and hearing loss (p= 0.001) and between cardiac manifestations and hearing loss (p= 0.024). Conclusion: Hearing loss is a potential symptom of Fabry disease and is not limited to the classicmale phenotype. Due to possible positive correlations with neurological and cardiologicalmanifestations of the disease, routine ENT screening examinations should be carried out to be able to identify and treat neuro- otological deficits at an early stage. In addition, FD should also be considered and tested as a differential diagnosis, especially in younger patients with sudden unilateral or bilateral hearing loss and a family history.