Eustachian Tube Enhancement Directly Reflects Disease Activity in ANCA-Associated Otitis Media

Otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is associated with Eustachian tube (ET) involvement. To date, the clinical feasibility of using contrast-enhanced magnetic resonance imaging (CE-MRI) to assess ET enhancement in OMAAV management remains unclear. Therefore, we investigated whether ET enhancement on CE-MRI reflects disease activity in patients with ANCA-associated vasculitis (AAV)/OMAAV.

Prospective cohort with within-patient comparisons.

Tertiary referral center.

Eight patients with AAV (12 OMAAVs) and 8 with otitis media with effusion (OME) as controls.

All patients underwent 3.0-Tesla fat-suppressed CE-MRI with <1 mm slice thickness at disease onset and also in remission for patients with OMAAV. Myeloperoxidase-deoxyribonucleic acid (MPO-DNA) complex levels in middle ear fluid samples were measured to confirm OMAAV diagnosis.

MRI signal intensities in each anatomic ET segment, audiometric results, and biomarker levels, compared with disease activity.

In active OMAAV, ETs showed significant contrast enhancement on the affected side in all patients, even those with prior oral steroid use. ET enhancement was distributed in at least 2 continuous segments centered on the isthmus (12 OMAAVs, 100%), and enhancement was remarkably diminished during remission. ET enhancement positivity was closely associated with higher levels of ANCA and MPO-DNA complex ( P <0.001). The diagnostic performance of ET enhancement was 100%/87.5% (sensitivity/specificity) for evaluating OMAAV disease activity and 100%/91.7% (sensitivity/specificity) for differentiating active OMAAV from non-OMAAV conditions.

ET enhancement on high-resolution CE-MRI provides radiologic evidence of localized vasculitic inflammation in patients with active OMAAV.