自身免疫性中性粒细胞胞浆抗体相关性血管炎合并中耳炎的听力预后。
The hearing prognosis of otitis media with ANCA-associated vasculitis.
作者信息
Iwata Shinji, Okada Masahiro, Suemori Koichiro, Teraoka Masato, Yamada Hiroyuki, Ishizaki Jun, Matsumoto Takuya, Hato Naohito
机构信息
Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
出版信息
Auris Nasus Larynx. 2021 Jun;48(3):377-382. doi: 10.1016/j.anl.2020.09.004. Epub 2020 Sep 18.
OBJECTIVE
The concept of otitis media with ANCA-associated vasculitis (OMAAV) was recently proposed by the study group of the Japan Otological Society. However, information remains limited regarding the hearing outcome of OMAAV. Thus, we investigated this issue in this study.
METHODS
We retrospectively examined 50 ears from 32 patients diagnosed with OMAAV at our hospital between 2010 and 2019. We collected the results of pure tone audiometry (PTA) at diagnosis and changes in PTA threshold after treatment, serological findings including ANCA type, titer, soluble interleukin-2 receptor (sIL2R), and C-reactive protein, organs involved at initial diagnosis, treatment, and disease relapse from medical records. According to the hearing outcome, patients were divided into two groups: good prognosis and poor prognosis groups. We investigated the clinical features, treatment, and changes in PTA between the groups.
RESULTS
Age, sex, ANCA negativity, and the use of intravenous cyclophosphamide (IVCY) were significantly related to hearing prognosis of OMAAV, while other organs involved at diagnosis, serological findings, and relapse rate were not significantly associated with hearing outcome. Hearing level at diagnosis was significantly better in good prognosis group, while air-bone gap (ABG) was not significantly different between the groups. The air conduction (AC), bone conduction (BC), and ABG were significantly improved in the good prognosis group. However, ABG was not improved in the poor prognosis group, while AC and BC were significantly improved. The AC hearing level at diagnosis (58.5 dB) and hearing gain at 2 weeks after treatment (12.5 dB) were suggested as good indicators for predicting the hearing outcome of OMAAV.
CONCLUSION
Younger age, male sex, shorter period from onset to diagnosis, the use of IVCY, and better hearing threshold at diagnosis were the good prognostic factors of the hearing outcome of OMAAV. These results suggest that earlier diagnosis of OMAAV might be needed for better hearing outcome, and the use of IVCY may be recommended for the treatment of OMAAV patients.
目的
日本耳科学会研究小组最近提出了自身免疫性血管炎相关性中耳炎（OMAAV）的概念。然而，关于 OMAAV 的听力预后信息仍然有限。因此，本研究对此进行了调查。
方法
我们回顾性检查了 2010 年至 2019 年期间我院确诊为 OMAAV 的 32 例患者的 50 只耳朵。我们从病历中收集了纯音听阈测试（PTA）在诊断时和治疗后 PTA 阈值变化的结果、包括抗中性粒细胞胞质抗体（ANCA）类型、滴度、可溶性白细胞介素-2 受体（sIL2R）和 C 反应蛋白在内的血清学发现、初诊时涉及的器官、治疗和疾病复发。根据听力结果，患者分为预后良好组和预后不良组。我们调查了两组之间的临床特征、治疗和 PTA 变化。
结果
年龄、性别、ANCA 阴性和使用静脉注射环磷酰胺（IVCY）与 OMAAV 的听力预后显著相关，而其他初诊时涉及的器官、血清学发现和复发率与听力结果无显著相关性。预后良好组的听力诊断水平明显较好，而两组之间的气骨导差（ABG）无明显差异。预后良好组的气导（AC）、骨导（BC）和 ABG 均显著改善。然而，预后不良组的 ABG 没有改善，而 AC 和 BC 显著改善。诊断时的 AC 听力水平（58.5dB）和治疗后 2 周的听力增益（12.5dB）被认为是预测 OMAAV 听力结果的良好指标。
结论
年龄较小、男性、从发病到诊断的时间较短、使用 IVCY 和更好的诊断时听力阈值是 OMAAV 听力结果的良好预后因素。这些结果表明，OMAAV 的早期诊断可能对更好的听力结果至关重要，并且可能建议对 OMAAV 患者使用 IVCY 进行治疗。
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