Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study

Abstract

Background Ear, nose, and throat involvement are common in eosinophilic granulomatosis with polyangiitis (EGPA). Among otologic manifestation, middle ear effusion (MEE) is less recognized but a problematic condition as it may progress to hearing impairment when left untreated. This study aimed to evaluate the characteristics, risk factors and clinical outcomes of MEE in EGPA patients. Methods This is a case–control study of patients who were diagnosed and treated for EGPA from January 1995 to November 2018. Patients with ear symptoms (ear fullness, ear discharge, tinnitus or hearing loss) were assessed by otologists and were included in the case group (n = 23) if clinically relevant. The other patients without MEE were included in the control group (n = 52). Risk of MEE was calculated using the Cox proportional-hazard model. Results During median follow-up of 9.9 years, 23 (30.7%) out of 75 patients had MEE. In MEE group, 12 (52.2%) patients had hearing loss; conductive type in 10 (10/12, 83.3%) and mixed type in two (2/12, 16.7%). In multivariable regression analysis, major organ involvement at diagnosis (adjusted hazard ratio [aHR] 65.4; 95% confidence interval [CI], 1.50—2838.39; P = 0.030] , early onset of ear symptom after systemic therapy (< 6 months) (aHR 40.0; 95% CI, 1.35—1183.43; P = 0.033) and continuing the maintenance steroid without cessation (aHR 8.59; 95% CI, 1.13—65.42; P = 0.038) were independently associated with a risk of MEE. To control MEE, 16 (69.6%) patients had to increase maintenance steroid dose and 9 (39.1%) patients experienced recurrent MEE whenever maintenance dose was tapered. Conclusions MEE is a common but frequently neglected condition in EGPA which is often intractable. The maintenance steroid dose should be adequately adjusted to control MEE and to prevent from progressive hearing loss. Novel biologic agents possibly have a role in controlling MEE in EGPA.

Early Ear, Nose and Throat Manifestations in Eosinophilic Granulomatosis with Poliangioitis: Results from Our Cohort Group and Literature Review

“…Nevertheless, our results seem not to differentiate this study from existing research. To our knowledge, previous studies on ENT manifestations in EGPA [10,[12][13][14][15]21,22,25,26] describe ENT signs and symptoms after diagnosis and/or treatment, showing that different ENT manifestations are commonly present in EGPA but are not pathognomonic. We suggest that these manifestations have been present since the first stages of the disease and before EGPA diagnosis.…”

“…Therefore, OME may cause mild-tomoderate conductive hearing loss. Steroid treatment adequately dosed may prevent ear symptoms and progressive hearing loss in EGPA patients [22]. In addition, neurological involvement most commonly manifests as mononeuritis multiplex or hearing loss in EGPA patients [23].…”

Early ENT Manifestations in Eosinophilic Granulomatosis with Poliangioitis: Results from Our Cohort Group and Literature Review

“…Therefore, OME can result in a mild-to-moderate conductive hearing loss. Interestingly, the maintenance of steroid dose for EGPA should be adequately adjusted to control ear symptoms and to prevent progressive hearing loss [19]. In addition, neurological involvement most commonly manifests as mononeuritis multiplex or hearing loss in EGPA patients [20].…”