Audiovestibular Manifestations in Giant Cell Arteritis

Abstract

Giant cell arteritis (GCA) is a multisystemic vasculitis of elderly people that involves large and medium-sized blood vessels with predisposition to the cranial arteries. Some cranial ischemic manifestations, in particular permanent visual loss, have been widely described. Audiovestibular manifestations have been less commonly reported. In the present study we assessed the frequency and outcome of audiovestibular manifestations in a series of GCA and isolated polymyalgia rheumatica (PMR) patients examined prospectively between June 1999 and May 2001 at the single hospital for a defined population. Patients were included in the study if a temporal artery biopsy had been performed and they were examined within a week after beginning corticosteroid treatment. Patients with abnormal otoscopy or tympanogram, history of cerebrovascular complications, syphilis, Ménière and other vestibular syndromes, infections involving the inner ear, barotrauma, or being treated with ototoxic drugs were excluded. During the study period 44 patients with GCA and 10 patients with biopsy-negative isolated PMR were examined. Patients with isolated PMR were younger. Audiovestibular dysfunction was significantly more frequent in GCA patients than in those with isolated PMR and matched controls. Almost 90% of the GCA patients had vestibular dysfunction, which was generally reversible after several days of steroid treatment; after 3 months of treatment, vestibular dysfunction was observed in only 13 (29.6%) of the 44 GCA patients. These patients with persistent vestibular dysfunction were more likely to have persistent head-shaking nystagmus. Twelve (27.3%) of the 44 GCA patients had hearing improvement after 3 months of therapy. After 6 months of therapy, only 1 of the 44 GCA patients had abnormal vestibular tests. However, no additional improvement in hearing function was observed. The present study confirms a high frequency of audiovestibular manifestations in GCA. It also suggests that audiovestibular damage may be reversible in some patients with GCA.

Audiovestibular Manifestations in Systemic Vasculitis: An Update

“…Moreover, no additional improvement in hearing function was observed after another 3 months of treatment. These data suggest that the possible improvement in hearing function may be achieved generally early during the first months after the onset of therapy [16]. In summary, our results support the presence of both auditory and vestibular dysfunction closely related to the vasculitic process in GCA patients.…”

“…This fact is even more important in GCA whose presenting manifestation is PMR only, as in these cases low dose prednisone does not prevent the development of blindness. The presence of abnormal vestibular tests in patients presenting with PMR without cranial manifestations of GCA may be considered as a red flag to raise the suspicion of an underlying GCA [16]. Takayasu's arteritis is a chronic vasculitis of unknown etiology that affects the aorta, its major branches, the pulmonary artery and the coronary arteries; it causes headache, absence of arterial pulses, heart failure, renovascular hypertension and ocular and cerebral ischemia.…”

Cochleovestibular Dysfunction in Ankylosing Spondylitis

“…These authors also concluded that vertiginous complaints were mainly orthostatic and due to general microvascular involvement. Amor-Dorado et al [2003], in a study of patients with giant cell arteritis, reported that the cochlea and the vestibular system were both affected by the disease. The interesting finding in their study is the reversibility of auditory and vestibular pathologies.…”

Epidemiology of giant cell arteritis and polymyalgia rheumatica

“…More rarely, visual loss is caused by central retinal artery occlusion, ischemic retrobulbar neuritis, or occipital infarction in the setting of a stroke involving the vertebrobasilar territory (4). Less common neurologic complications include transient ischemic attacks and cerebral infarctions, in particular in the vertebrobasilar territory (4), and audiovestibular dysfunction (5).…”