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 ai...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Allergy, Asthma & Clinical Immunology |
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| Online Access: | https://doi.org/10.1186/s13223-022-00706-x |
| _version_ | 1811315401576939520 |
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| author | Noeul Kang Joongbo Shin Yang-Sun Cho Jin-Young Lee Byung-Jae Lee Dong-Chull Choi |
| author_facet | Noeul Kang Joongbo Shin Yang-Sun Cho Jin-Young Lee Byung-Jae Lee Dong-Chull Choi |
| author_sort | Noeul Kang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T11:29:30Z |
| format | Article |
| id | doaj.art-5d885cde443a4bad90ac69d1656039bf |
| institution | Directory Open Access Journal |
| issn | 1710-1492 |
| language | English |
| last_indexed | 2024-04-13T11:29:30Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
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| series | Allergy, Asthma & Clinical Immunology |
| spelling | doaj.art-5d885cde443a4bad90ac69d1656039bf2022-12-22T02:48:36ZengBMCAllergy, Asthma & Clinical Immunology1710-14922022-08-0118111010.1186/s13223-022-00706-xIntractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control studyNoeul Kang0Joongbo Shin1Yang-Sun Cho2Jin-Young Lee3Byung-Jae Lee4Dong-Chull Choi5Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of MedicineHealth Promotion Center, Samsung Medical CenterDivision of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDivision of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineAbstract 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.https://doi.org/10.1186/s13223-022-00706-xEosinophilic granulomatosis with polyangiitisEosinophilic otitis mediaMiddle ear effusionOtologicEGPAEOM |
| spellingShingle | Noeul Kang Joongbo Shin Yang-Sun Cho Jin-Young Lee Byung-Jae Lee Dong-Chull Choi Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study Allergy, Asthma & Clinical Immunology Eosinophilic granulomatosis with polyangiitis Eosinophilic otitis media Middle ear effusion Otologic EGPA EOM |
| title | Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study |
| title_full | Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study |
| title_fullStr | Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study |
| title_full_unstemmed | Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study |
| title_short | Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case–control study |
| title_sort | intractable middle ear effusion in egpa patients might cause permanent hearing loss a case control study |
| topic | Eosinophilic granulomatosis with polyangiitis Eosinophilic otitis media Middle ear effusion Otologic EGPA EOM |
| url | https://doi.org/10.1186/s13223-022-00706-x |
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