Granulomatosis with polyangiitis presenting as isolated ear involvement: a case series and literature review| ACTA Otorhinolaryngologica Italica

Abstract

Objective
To describe the clinical characteristics and outcomes of patients affected by granulomatosis with polyangiitis (GPA) presenting with an isolated ear involvement.

Methods
A retrospective review of patients affected by GPA and treated at the University of Brescia, Italy, from 2002 to 2023 was conducted. Only patients with exclusive otologic manifestation as first presentation were included.

Results
Among 610 patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) diagnosed and followed at our Institution, 6 (0.8%) presented with exclusive ear involvement as first presentation, all affected by GPA. Most frequently patients presented with otitis media with effusion, sensorineural or mixed hearing loss and dizziness. Two patients developed systemic symptoms. All patients experienced at least a partial recovery of middle ear function after starting immunosuppressive therapy.

Conclusions
Rarely AAVs first present as isolated ear involvement, commonly as otitis media with hearing loss unresponsive to conventional therapy. Once AAVs is suspected, surgery should be avoided since further damage can be caused by local iatrogenic inflammation sustained by the underlying condition. Local improvement generally follows the start of immunosuppressive therapy.