Henoch-Schönlein purpura (HSV) is a leukocytoclastic vasculitis with unknown etiology, involving the skin, joints, gastrointestinal system, kidneys, and rarely other organs. No specific pathogenesis has been identified for HSV. In the active period of the disease, cytokines such as tumor necrosis factor-alpha, interleukin-6 were held responsible. Several hypotheses have been introduced for the pathogenesis of vasculitis. [9, 10]. Widespread accumulation of IgA in vessels suggests that the autoimmunity response related to IgA may play a role in the pathogenesis of the disease [11–14].
HSV can be because of parenchyma damage by vasculitic pathways. Cochlear association might occur possibly in this way. It is known that the continuity of normal blood supply is vital for the normal cochlear function [15]. When an inflammatory condition occurs, IL-1β and TNF-α are secreted in the early period. These proinflammatory cytokines may lead to a pathway that produces various chemoattractants that could activate inflammatory cells and could break down neighboring vascular endothelial cells of the cochlea. This state is like a vicious circle that increases inflammatory cell trafficking from circulation to inflammatory sites [16].
As far as we know, there is no research for the cochlear and vestibular association of HSV in current literature. When the literature was searched for vasculitis in terms of hearing-balance disorders, only Cogan syndrome and Behçet's disease were identified as related to this condition[7, 17].
DPOAEs are simply suitable and extra worthy for identifying the cochlear component of hearing impairment and show accurately little differences in the cochlea correlated to other audiological methods. An audiometry may show initial findings of cochlear injury and is beneficial for the evaluation of the subjects at risk of hearing impairment. [8, 18].
For the evaluation of the vestibular system, the clinician provides important information from the combination of subjective and objective tests to establish an accurate diagnosis. Thus, the cVEMP test is one of the simplest, quick, non-invasive methods for evaluating the saccule function, inferior vestibular nerve, and vestibulocolic reflex arcs from otolithic organs [19].
In our study, by using audiometry, we proved hearing levels of HSV patients in 250 Hz and 8000 Hz frequencies decreased compared to the control group as displayed in Table 2, in Table 2, proposing a cochlear association. Also, our study revealed that the amplitude difference between cVEMP p1-n1 in patients with HSV in both ears decreased compared to the control group as displayed in Table 5, suggesting vestibular involvement. We assumed that autoimmune causes may be similar in pathogenesis for this condition like Cogan syndrome and Behçet's disease. As a result; our study is the first study to indicate clear and objective cochlear and vestibular involvement in children with HSV.