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Facial Paralysis in Otitis Media Due to Granulomatosis with Polyangiitis
Madeleine C Chao1, Yalda Yazdani1, Hamid R Djalilian1,2,3
1Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.
Abstract:
Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis, commonly presents primarily with otitis media and hearing loss, as well as upper and lower respiratory symptoms. However, facial nerve paralysis is a rare manifestation of this uncommon necrotizing vasculitis. We report a patient with facial paralysis accompanied by otitis media. In further studies, our patient was diagnosed with GPA, which was neglected before. In such a presentation, acute suppurative otitis media is the most likely cause of the facial paralysis, but GPA must also be considered, especially in cases with new-onset, painful serous otitis, acute otitis media, or pale granulation tissue in the middle ear, in adults with no previous history of Eustachian tube dysfunction.
Insights
Facial paralysis can be a rare sign of Granulomatosis with polyangiitis (GPA), a condition often causing ear and respiratory issues. Early diagnosis of GPA is crucial, especially in adults with unexplained otitis media and facial nerve symptoms.
Area of Science:
- Rheumatology
- Otolaryngology
- Neurology
Background:
- Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is a rare necrotizing vasculitis.
- GPA typically affects the upper and lower respiratory tracts and can cause otitis media and hearing loss.
Observation:
- Facial nerve paralysis is an uncommon but significant manifestation of GPA.
- This report details a case of facial paralysis co-occurring with otitis media, leading to a delayed GPA diagnosis.
Findings:
- While acute suppurative otitis media is a common cause of facial paralysis, GPA should be considered in specific clinical scenarios.
- Key indicators for considering GPA include new-onset, painful serous otitis, acute otitis media, or the presence of pale granulation tissue in the middle ear of adults without prior Eustachian tube dysfunction.
Implications:
- Recognizing GPA in patients presenting with otitis media and facial paralysis is critical for timely diagnosis and treatment.
- This case highlights the importance of considering systemic vasculitis in the differential diagnosis of otological and neurological symptoms, even when seemingly unrelated causes are apparent.
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