Further, CD46 levels were positive only in 3.3% of otosclerosis cases in a British cohort [4], and Singh et al. [13] reported that otosclerosis is not commonly associated with systemic viral infections, such as measles, rubella, human cytomegalovirus, herpes simplex, varicella zoster, and Epstein–Barr virus by testing their IgM antibodies. Here, CD40LG is linked to viral infectious disease.