Epidemiological study of ANCA-positive patients with refractory otitis media-like symptoms and implications for diagnosis of on MPO-ANCA-associated refractory otitis media

DOI
  • Takeda Noriaki
    Department of Otolaryngology, Unoversity of Tokushima School of Medicine
  • Kamimura Seiichiro
    Department of Otolaryngology, Unoversity of Tokushima School of Medicine
  • Takemura Teiji
    Department of Otolaryngology, Minoh City Hosputal
  • Ota Yumi
    Department of Otolaryngology, Osaka University Medical School
  • Morihana Tetuo
    Department of Otolaryngology, Osaka University Medical School
  • Inohara Hidenori
    Department of Otolaryngology, Osaka University Medical School
  • Kitamura Yoshiaki
    Department of Otolaryngology, Unoversity of Tokushima School of Medicine
  • Abe Koji
    Department of Otolaryngology, Unoversity of Tokushima School of Medicine

Bibliographic Information

Other Title
  • 難治性中耳炎症状を呈するANCA陽性症例の疫学調査と診断基準の問題点に関する検討

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Abstract

It was reported that among the patients who complained of refractory otitis media-like symptoms, some had anti-neutrophil cytoplasmic autoantibodies (ANCA) in the serum, but did not meet the criteria of ANCA-associated vasculites such as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Most of them showed a positive MPO-ANCA, but not PR3-ANCA in the serum with no pulmonary and renal lesions. Subsequently, these patients often suffered from sensorineural hearing loss and facial palsy. In 2011, we proposed the diagnostic term and criteria of MPO-ANCA-associated middle ear disease with sensorineural hearing loss and facial palsy (MPO-ANCA-associated middle ear disease). In the present epidemiological study, we examined 17 ANCA-positive patients with refractory otitis media-like symptoms from 25 affiliated hospitals. The diagnosis of GPA was given to 11 patients, while 6 patients were diagnosed as MPO-ANCA-associated middle ear disease. In the latter group of 6 patients, however, the diagnosis GPA was warranted on the basis of a positive MPO-ANCA in the serum. Indeed, it was reported that some patients with GPA that was diagnosed histopathologically, showed a positive MPO-ANCA in the serum. Therefore, the present study suggests that MPO-ANCA-associated middle ear disease should be classified as a subtype of GPA despite the lack of histopathological evidence of vasculitis.

Journal

  • Otology Japan

    Otology Japan 24 (5), 760-765, 2014

    Japan Otological Society

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