Abstract
Wegener’s granulomatosis is often characterized by nasal and sinus disorders but rarely by isolated otitis. We report a case of localized Wegener’s granulomatosis involving hearing difficulty but otherwise asymptomatic. A 76-year-old woman suffering from otitis media with effusion of the left ear was treated with antibiotics combined with myringotomy and drainage tube insertion. Despite temporary hearing recovery, otitis media relapsed in both ears, necessitating methylpredonisolone, which cured the middle-ear granulation, effective by improving hearing. Systemic examination shared slightly elevated serum P-ANCA but negative C-ANCA. Computed tomography showed a nodule in the chest and transbronchial lung biopsy (TBLB) detected chronic pneumonia. Following otitis media and mastoiditis, she suffered facial palsy, necessitating masotoidectomy, during which granulation was found in the mastoid cavity with pathologically confirmed inflammatory change but no sign of specific vasculitis. Despite the absence of pathological proof, her clinical course and steroid sensitivity strongly suggested Wegener’s granulomatosis by exclusion. Methylpredonisolone at 30 mg/day/body weight was again administered and hearing and facial palsy improved. Four months later, unilateral laryngeal paralysis developed with IX and XII paralysis, against which a greater methylpredonisolone dose was used combined with cyclophosphate, to good effectiveness. Persistent otitis media is one potential risk of Wegener’s granulomatosis, but specific findings may be difficult to obtain from the middle ear, making medical history taking and immunological study essential to diagnosis. These patients must be followed up long enough to prevent recurring symptoms and cranial nerve paralysis.
Published Version
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