GPA was previously known as Wegener’s granulomatosis (WG). She remains in remission today with persistent sensorineural hearing loss (SNHL) AU. She eventually underwent definitive successful tympanoplasty for the non-healing tympanic membrane perforation which was deferred for 6 months, after disease remission was definitive, and her conductive hearing loss resolved in both ears. Eventually both tympanostomy tubes extruded however, she developed a left ear chronic non-healing tympanic membrane perforation. Ultimately, her otologic disease responded well to the rheumatologic regimen, and a mastoidectomy was not necessary. Follow-up serologies revealed decreasing PR-3, C-ANCA, ESR, and CRP. The patient underwent rituximab biologic pharmacotherapy. Due to her active limited otologic GPA, the otologist deferred mastoidectomy to allow for disease quiescence with immunosuppressant pharmaco- and biologic therapy, in collaboration with rheumatology recommendations. The patient was ultimately prescribed a steroid taper, and rheumatologic consultation was recommended in addition, referral to an otologist at our local academic center. Multi-system assessment excluded renal and respiratory manifestations. Bilateral myringotomies were performed, evacuating serous effusions, and tympanostomy tubes were placed bilaterally. The ESR, PR-3, and C-ANCA were all elevated.
The following serologic markers were obtained: ESR, CRP, and C-ANCA profile, which included antiproteinase 3 (PR-3) antibodies. A high resolution computed tomography (HRCT) scan of the temporal bones revealed non-coalescent chronic mastoid effusion in the right ear (AD) and a mastoid effusion with erosion of septations in the mastoid in the left ear (AS) ( Figure 2). Audiometric testing revealed mild–moderate conductive hearing loss bilaterally in lower frequencies with a mixed hearing loss with both sensorineural and conductive components in the higher frequencies bilaterally ( Figure 1). Tuning fork testing revealed negative Rinne testing consistent with bilateral conductive hearing loss (CHL) (Weber 512 Hz fork was midline). Otologic examination revealed bilateral middle ear effusions. After thorough history, the patient also complained of bilateral ear pain with chronic aural fullness bilaterally and “muffled hearing” which had progressively worsened over the preceding three months. These otologic and sinus symptoms had reportedly worsened over the preceding three months leading up to the consultation with our office. She reported feeling bilateral (AU) aural fullness, sinonasal congestion, nonpulsatile intermittent tinnitus bilaterally worse in her left ear, and facial pressure. She ultimately sought out a third opinion from our clinic for persistent symptoms of three months. The 2 general otolaryngologists recommended saline nasal irrigations and prescribed antibiotics without further diagnostic testing. Previously, after multiple visits to her primary care physician, as well as numerous urgent care centers, she was ultimately referred to 2 different otolaryngologists for progressively worsening otolaryngologic symptoms. All subjects Allied Health Cardiology & Cardiovascular Medicine Dentistry Emergency Medicine & Critical Care Endocrinology & Metabolism Environmental Science General Medicine Geriatrics Infectious Diseases Medico-legal Neurology Nursing Nutrition Obstetrics & Gynecology Oncology Orthopaedics & Sports Medicine Otolaryngology Palliative Medicine & Chronic Care Pediatrics Pharmacology & Toxicology Psychiatry & Psychology Public Health Pulmonary & Respiratory Medicine Radiology Research Methods & Evaluation Rheumatology Surgery Tropical Medicine Veterinary Medicine Cell Biology Clinical Biochemistry Environmental Science Life Sciences Neuroscience Pharmacology & Toxicology Biomedical Engineering Engineering & Computing Environmental Engineering Materials Science Anthropology & Archaeology Communication & Media Studies Criminology & Criminal Justice Cultural Studies Economics & Development Education Environmental Studies Ethnic Studies Family Studies Gender Studies Geography Gerontology & Aging Group Studies History Information Science Interpersonal Violence Language & Linguistics Law Management & Organization Studies Marketing & Hospitality Music Peace Studies & Conflict Resolution Philosophy Politics & International Relations Psychoanalysis Psychology & Counseling Public Administration Regional Studies Religion Research Methods & Evaluation Science & Society Studies Social Work & Social Policy Sociology Special Education Urban Studies & Planning BROWSE JOURNALSĪ 67-year-old female was first seen in the clinic with the chief complaint of nasal dyspnea/obstruction.
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