A Case Series of Granulomatosis With Polyangiitis Primarily Diagnosed by Otological Manifestations. (March 2019)

• Record Type: Journal Article
• Authors: Sahyouni, Ronald; Moshtaghi, Omid; Abouzari, Mehdi; Le, Phuonganh; Birkenbeuel, Jack; Cheung, Dillon; Lin, Harrison W.; Djalilian, Hamid R.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 128:Number 3(2019)
• Page Start: 263
• Page End: 266
• Publication Date: 2019-03
• Subjects: granulomatosis with polyangiitis -- Wegener's granulomatosis -- otology -- hearing loss -- ANCA associated vasculitis; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489418815517
• Languages: English
• ISSNs: 0003-4894

Abstract

Objective: To describe a case series of previously undiagnosed granulomatosis with polyangiitis (GPA) patients who presented primarily with otological manifestations. Method: We report a series of patients visited at a neurotology clinic who were eventually diagnosed with GPA based on their otologic complaints and had no prior knowledge of having this condition. Results: In this series, 10 (91%) patients presented with hearing loss (HL), more than half of which were bilateral (60%). Upon audiometric examination, all but 1 patient had mixed, conductive, or sensorineural HL. All patients presented with eustachian tube dysfunction (ETD), otitis media with effusion (OME), or both. Nasal endoscopy showed intranasal pathology in 3 (27%) patients. Otologic symptoms were improved in all patients after treatment with an average of 4 in-office follow-up appointments. Conclusion: GPA should be included in the differential diagnosis of adults with unexplained mixed hearing loss, new onset serous effusion, or acute otitis media in the absence of a previous history of ETD. Laboratory tests (ie, anti-neutrophil cytoplasmic autoantibody, erythrocyte sedimentation rate, and C-reactive protein) along with a urinalysis can aid in screening these patients. In cases in which the index of suspicion is high, repeated testing could reduce the risk of false negative findings.