A case of Churg–Strauss syndrome with refractory otitis media

Focus on audiologic impairment in eosinophilic granulomatosis with polyangiitis

“…From a clinical point of view, our experience teaches us that the most typical otological manifestations of EGPA is chronic granulomatous otitis with chronic, thick aural discharge, which is responsible for conductive hearing loss. Our limited experience confirms that the mucous in the middle ear generally contains eosinophils, 8,11 which are the main proponents of EGPArelated tissue damage. Furthermore, our experience shows that middle ear involvement is a self-sustaining disease, with no direct correlation with the nasal counterpart.…”

“…Instead, in patients with OME and no SNHL, the pathogenic mechanism is probably due to eosinophilic infiltration, thick secretions, and mucosal edema that may block the functioning of the Eustachian tube, and consequently middle ear ventilation. This hypothetical mechanism found its base on the findings of the altered middle ear impedance, in the quick amelioration after high doses of steroids and/or after ventilation tube insertion (in 4 patients of our group and in 1 patients of the Ishiyama's series), and in the demonstration of eosinophils in the middle ear secretions …”

“…This hypothetical mechanism found its base on the findings of the altered middle ear impedance, in the quick amelioration after high doses of steroids and/or after ventilation tube insertion (in 4 patients of our group and in 1 patients of the Ishiyama's series 8 ), and in the demonstration of eosinophils in the middle ear secretions. 11 As far as facial functioning is concerned, the facial nerve is rarely involved by EGPA, with only four cases described in literature (2 in Hattori et al, 12 1 in Bacciu et al, 7 1 in Byun et al 13 ). In such cases, FP tends to be unilateral, peripheral, and slowly progressive.…”

Churg–Strauss Syndrome

“…More rarely, nasal pain with a purulent or bloody nasal discharge can be observed, but these features are more typical of Wegener's granulomatosis (WG) (Chakravarty 1997;Noth et al 2003;Guillevin et al 2004). Some patients (14%) have otological symptoms with a conductive deafness related to either a refractory otitis media with effusion rich in eosinophils filling the middle ear cavity or a sensorineural hearing loss due to a seventh nerve neuritis in advanced cases (Saka et al 2009). …”

“…The temporal bones may show soft tissue/fluid filling of the middle ear cavities and mastoid cells (Saka et al 2009). …”