In addition, the interpretation of the results in this study was possibly affected by using the ELF from patients with AN as a control for a comparative analysis of the cytokine levels in the ELF in patients with MD, since an up-regulation of intracochlear levels of TNF-α secreted by tumors possibly present in patients with AN are presumed to result in AN-associated SNHL (53). Here, TNF is linked to Menkes disease.