Audiovestibular manifestations in giant cell arteritis: a prospective study

Area of Science:

• Rheumatology
• Otolaryngology
• Neurology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis affecting large and medium vessels, primarily in older adults.
• Cranial ischemic complications like visual loss are common in GCA, but audiovestibular manifestations are less frequently reported.
• Audiovestibular dysfunction can significantly impact quality of life in patients with GCA.

Purpose of the Study:

• To assess the frequency and clinical outcomes of audiovestibular manifestations in patients with GCA.
• To compare the incidence of audiovestibular dysfunction in GCA patients versus those with isolated polymyalgia rheumatica (PMR).
• To evaluate the reversibility of audiovestibular symptoms following corticosteroid treatment in GCA.

Main Methods:

• Prospective study of GCA and biopsy-negative PMR patients treated with corticosteroids.
• Exclusion of patients with pre-existing audiovestibular conditions or risk factors.
• Audiovestibular testing and clinical assessment performed at baseline and follow-up intervals (3 and 6 months).

Main Results:

• Audiovestibular dysfunction was significantly more common in GCA patients (nearly 90%) compared to PMR patients and controls.
• Vestibular dysfunction in GCA was largely reversible within days of steroid treatment, with only 29.6% remaining affected at 3 months.
• Hearing improvement was noted in 27.3% of GCA patients after 3 months, with no further hearing gains observed by 6 months.

Conclusions:

• Audiovestibular manifestations are a frequent, yet often underreported, complication of GCA.
• Early corticosteroid therapy appears to reverse a significant portion of GCA-associated audiovestibular dysfunction.
• While vestibular symptoms show good reversibility, hearing improvement may be less consistent in GCA patients.