Patient-reported involvement of the eighth cranial nerve in giant cell arteritis

Abstract

Introduction The frequency of eighth nerve lesions in patients with giant cell arteritis (GCA) has rarely been examined. However, sudden onset deafness has been recorded as a presenting feature of GCA on several occasions. This study sought to establish how common this and other symptoms of eighth nerve involvement are in a large retrospective survey. Methods We contacted 170 patients with GCA and 250 matched PMR patients, inviting them to participate in a questionnaire survey of symptoms of eighth nerve dysfunction. We compared the presence of deafness, tinnitus, loss of balance and vertigo in both groups and examined the relationship between the onset of these symptoms and other features of GCA. Results A total of 317 patients were recruited. The percentage of patients with symptoms of possible vestibulocochlear disease prior to commencement of steroid therapy was significantly greater among GCA patients than PMR patients for all domains. Hearing loss which was twice as common in GCA as in PMR (53% vs 26%) [p = 0.001]. Deafness was concurrent in 35% of GCA patients with other symptoms and 45% reported colocation with headache. Recovery with steroids occurred in 56% of these. Conclusion Symptoms of eighth nerve dysfunction are present in over half of patients with GCA. Recovery with steroids was predicted by concurrence with headache in terms of both timing and location. It appears that eighth nerve involvement, especially acute hearing loss, is a not infrequent feature of GCA and often responds well to steroid therapy. Clinicians should enquire about these symptoms when evaluating a patient for possible GCA. Key Points • Deafness is a frequent presenting feature of giant cell arteritis. • Vertigo, tinnitus and loss of balance are also often reported by GCA sufferers. • Steroid therapy is more likely to relieve these symptoms if they are ipsilateral and concurrent with headache.

A Giant Silence – An atypical association of sensorineural hearing loss with Giant Cell Arteritis

“…13 Recovery from vertiginous symptoms was not as pronounced as recovery of hearing loss. 11 The mechanism of deafness is not entirely understood but may involve arterial wall inflammation of the posterior circulation or terminal cochleovestibular vasculature. 14 Multiple theories have been suggested regarding the exact mechanism, including vascular occlusion, immunological mechanisms and viral infection.…”

“…Improvement of hearing post‐steroids occurs in 56% of patients, 11 with early administration of steroids important in the recovery of SNHL 13 . Recovery from vertiginous symptoms was not as pronounced as recovery of hearing loss 11 …”

“…Recent studies demonstrate that SNHL may not be as uncommon as previously thought. Saravanan 11 shows that 35% of GCA patients had concurrent hearing loss. Similarly, a retrospective study by Chu 12 of Chinese patients demonstrated hearing loss in 25% of patients, although again, neither study commented specifically on hearing loss in the absence of other classical features of GCA.…”

Case 4-2022: A 55-Year-Old Man with Bilateral Hearing Loss and Eye Redness

“…Although hearing loss and elevations in the erythrocyte sedimentation rate and C-reactive protein level are consistent with this condition, the patient is young for the development of temporal arteritis; the mean age at onset is 72 years. 1,2 In addition, there was no jaw claudication or vision loss, and the lack of a response to glucocorticoids and the normal retinal examination make this possibility unlikely. 3 The history of shingles suggests the possibility of a recurrence of herpes zoster oticus.…”

3-Tesla magnetic resonance imaging reveals vasculitis-caused otitis media in a patient with giant cell arteritis

“…Previous studies have demonstrated that otologic involvement is rather common in GCA patients, with an incidence ranging from 25% [4] to 53% [5]. Sensorineural hearing loss is predominant and usually concomitant with other ischemic symptoms on the ipsilateral side, including ocular involvement, eye pain, and tenderness of the temporal artery [4,6].…”