Ear, Nose, Throat Manifestations of Wegener's Granulomatosis

Background and Aim: Wegener's granulomatosis (WG) is an uncommon condition characterized by necrotizing granulomatosis of the upper and lower respiratory tracts and glomerulonephritis. We retrospectively reviewed three cases of WG to provide an update on diagnostic methods and treatment options and to review common head and neck manifestations of the disease.

Case Reports: Case 1: A 77-year-old woman referred with bilateral deafness as a result of bilateral otitis media with effusion, which was treated with myringotomy on both sides. Case 2: A 65-year-old woman with a long-term history of high temperature and severe headaches of unknown etiology. Case 3: A 53-year-old man with history of long-term fever, nasal crusting, and sinus inflammation that did not respond to usual treatment. We evaluated the clinical course and method of therapy for all these cases. Diagnosis of WG was made when a patient had clinical findings and a positive titer of cANCA, or when there were clear histological findings. Two cases were confirmed positive for cANCA and one for pANCA and were treated with glucocorticoids and immunosuppressive drugs with marked improvement.

Conclusions: Diagnosis of WG is made by a combination of physical examination, laboratory studies, and tissue biopsy. Head and neck manifestations are abundant and varied. Early diagnosis is usually difficult due to atypical symptoms and signs. The otolaryngologist plays a role in the diagnosis and treatment of head and neck manifestations and complications of the disease. Wegener's granulomatosis must be concluded in the differential diagnosis of atypical inflammations of ear, nose, and sinuses.