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Published on: June 15, 2018
Cochlear Implantation in a Patient with Granulomatosis with Polyangiitis
Noam Bartov1, Tzofit Dahan2, Doron Halperin1
1Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Insights
Cochlear implants (CI) can restore hearing in patients with Granulomatosis with polyangiitis (GPA)-related hearing loss (HL). Medical management of GPA inflammation before CI surgery is crucial for successful outcomes.
Area of Science:
- Otolaryngology
- Rheumatology
- Audiology
Background:
- Granulomatosis with polyangiitis (GPA) can cause hearing loss (HL) through otologic manifestations.
- Cochlear implants (CI) offer a solution for profound HL unresponsive to hearing aids.
- Current guidelines for CI in GPA patients are lacking.
Observation:
- A case report details a 71-year-old female with GPA and bilateral profound HL undergoing CI.
- Pre-operative management included audiological assessments and medical treatment (prednisone, methotrexate) for inflammation.
- CI surgery proceeded without complications.
Findings:
- The patient achieved a speech reception threshold of 25 dBHL.
- Post-operative monosyllabic word discrimination score was 75%.
- Medical control of GPA inflammation is effective, negating the need for subtotal petrosectomy.
Implications:
- GPA-related hearing loss is treatable with cochlear implantation.
- Successful CI outcomes are achievable with appropriate medical management of GPA.
- This approach provides a viable option for deaf patients with GPA.
Background:
Granulomatosis with polyangiitis (GPA) otologic manifestations include conductive and sensorineural hearing loss (HL). Vasculitis is assumed to be the primary cause of otologic manifestations. Deaf patients and patients with HL who do not benefit from hearing aids can benefit from cochlear implants (CI). There are currently no specific guidelines for treatment of patients with GPA suited for CI.
Objectives:
To assess whether patients who are deaf due to GPA are good candidates for CI and if prior surgical or medical treatment of the inflammation are needed.
Methods:
A case report is presented.
Results:
A 71-year-old female patient with GPA and bilateral profound HL underwent CI. Prior to CI, preparation consisted of audiological evaluations by an otolaryngologist and a rheumatologist, followed by a course of prednisone and methotrexate for middle ear and nasal inflammations. CI was performed with no complications. The speech reception threshold and the monosyllabic word discrimination score after surgery were 25 dBHL and 75%, respectively.
Conclusions:
Inflammation due to GPA can be controlled medically with immunosuppressive medications without subtotal petrosectomy, as in chronic suppurative otitis media. Satisfactory audiological results can be expected.
