Amor-Dorado Juan C, Llorca Javier, Garcia-Porrua Carlos, Costa Carmen, Perez-Fernandez Nicolas, Gonzalez-Gay Miguel A
Division of Otolaryngology, Hospital Xeral-Calde, Lugo, Spain.
Medicine (Baltimore). 2003 Jan;82(1):13-26. doi: 10.1097/00005792-200301000-00002.
Giant cell arteritis (GCA) is a multisystemic vasculitis of elderly people that involves large and medium-sized blood vessels with predisposition to the cranial arteries. Some cranial ischemic manifestations, in particular permanent visual loss, have been widely described. Audiovestibular manifestations have been less commonly reported. In the present study we assessed the frequency and outcome of audiovestibular manifestations in a series of GCA and isolated polymyalgia rheumatica (PMR) patients examined prospectively between June 1999 and May 2001 at the single hospital for a defined population. Patients were included in the study if a temporal artery biopsy had been performed and they were examined within a week after beginning corticosteroid treatment. Patients with abnormal otoscopy or tympanogram, history of cerebrovascular complications, syphilis, Ménière and other vestibular syndromes, infections involving the inner ear, barotrauma, or being treated with ototoxic drugs were excluded. During the study period 44 patients with GCA and 10 patients with biopsy-negative isolated PMR were examined. Patients with isolated PMR were younger. Audiovestibular dysfunction was significantly more frequent in GCA patients than in those with isolated PMR and matched controls. Almost 90% of the GCA patients had vestibular dysfunction, which was generally reversible after several days of steroid treatment; after 3 months of treatment, vestibular dysfunction was observed in only 13 (29.6%) of the 44 GCA patients. These patients with persistent vestibular dysfunction were more likely to have persistent head-shaking nystagmus. Twelve (27.3%) of the 44 GCA patients had hearing improvement after 3 months of therapy. After 6 months of therapy, only 1 of the 44 GCA patients had abnormal vestibular tests. However, no additional improvement in hearing function was observed. The present study confirms a high frequency of audiovestibular manifestations in GCA. It also suggests that audiovestibular damage may be reversible in some patients with GCA.
巨细胞动脉炎（GCA）是一种发生于老年人的多系统血管炎，累及大中型血管，易侵犯颅动脉。一些颅缺血表现，尤其是永久性视力丧失，已有广泛描述。而关于听觉前庭表现的报道则较少。在本研究中，我们评估了1999年6月至2001年5月期间在一家医院对特定人群进行前瞻性检查的一系列GCA患者和孤立性风湿性多肌痛（PMR）患者的听觉前庭表现的频率及转归。如果进行了颞动脉活检且在开始使用皮质类固醇治疗后一周内接受检查，则将患者纳入研究。排除耳镜检查或鼓室图异常、有脑血管并发症病史、梅毒、梅尼埃病及其他前庭综合征、内耳感染、气压伤或正在接受耳毒性药物治疗的患者。在研究期间，对44例GCA患者和10例活检阴性的孤立性PMR患者进行了检查。孤立性PMR患者较为年轻。GCA患者的听觉前庭功能障碍明显比孤立性PMR患者及匹配的对照组更为常见。几乎90%的GCA患者存在前庭功能障碍，在接受类固醇治疗数天后通常可逆转；治疗3个月后，44例GCA患者中仅有13例（29.6%）仍存在前庭功能障碍。这些持续存在前庭功能障碍的患者更可能有持续性摇头性眼球震颤。44例GCA患者中有12例（27.3%）在治疗3个月后听力有所改善。治疗6个月后，44例GCA患者中仅有1例前庭检查异常。然而，未观察到听力功能有进一步改善。本研究证实GCA患者中听觉前庭表现很常见。这也表明，部分GCA患者的听觉前庭损害可能是可逆的。
