Otorhinolaryngological findings in a group of patients with
               rheumatic diseases

Gusmão, Reinaldo Jordão; Fernandes, Fernando Laffitte; Guimarães, Alexandre Caixeta; Scaramussa, Lutiane; Sachetto, Zoraida; Pauna, Henrique Furlan; Carvalho, Guilherme Machado de

doi:10.1016/j.rbr.2013.10.003

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Revista Brasileira de Reumatologia

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Sumário

Original articles • Rev. Bras. Reumatol. 54 (3) • May-Jun 2014 • https://doi.org/10.1016/j.rbr.2013.10.003 copy

Otorhinolaryngological findings in a group of patients with rheumatic diseases

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction:

Otorhinolaryngological manifestations of rheumatologic diseases represent a great challenge not only to the generalistphysician but also to the ENT doctor andrheumatologist. They often represent early manifestations of an autoimmune disorder which requires prompt and aggressive immunosuppressive treatment. Auditory, nasal, laryngeal and eye symptoms can be the first manifestation of rheumatic diseases and their proper assessment helps the doctor to identify signs of disease activity. The objective of this study is to identify the ENT manifestations in patients with rheumatic diseases in a high complexity hospital, regarding facilitating an early diagnosis and treatment.

Methods:

We performed clinical and complete otorhinolaryngological evaluations in patients selected from the outpatient rheumatology in a standardized manner by the use of a standardized form filling during the secondhalf of 2010.

Results:

In the study group, systemic lupus erythematosus (SLE) patients had predominantly laryngeal manifestations, while patients with Sjögren's syndrome showed a higher prevalence of otologic manifestations. Changes in audiometric tests were found in 53% of Wegener's granulomatosis (WG) patients, 80% of relapsing polychondritis (RP), 33% of systemic lupus erythematosus (SLE) and 50% of Churg-Strauss syndrome (SCS). Regarding nasal alterations, these were found so prevalent in all conditions, especially Churg-Strauss syndrome.

Discussion and conclusion:

This study demonstrated that most patients treated in our hospital has the ENT signs and symptoms commonly associated in previous studies on rheumatic diseases, but further studies with a larger number of patients must be made to establish such relations.

Autoimmune diseases; Otorhinolaringology; Rheumatology

	Wegener's granulomatosis n = 17	Relapsing Polychondritis n = 5	Syndrome of Sjögren n = 5	Systemic Lupus Erythematosus n = 3	Syndrome of Churg-Strauss n = 2
Otalgia	8 (47%)	1 (20%)	0	0	0
Otorrhea	4 (23%)	0	1 (20%)	0	0
Tinnitus	7 (41%)	2 (40%)	3 (60%)	1 (33%)	1 (50%)
Ear fullness	3 (18%)	2 (40%)	4 (80%)	0	1 (50%)
Hearing loss	9 (53%)	2 (40%)	2 (40%)	1 (33%)	1 (50%)
Hyperacusis	0	0	0	0	0
Ear pruritus	3 (18%)	3 (60%)	5 (100%)	0	0
Dizziness	1 (6%)	0	1(20%)	0	0

	Wegener's granulomatosis n = 17	Relapsing Polychondritis n = 5	Syndrome of Sjögren n = 5	Systemic Lupus Erythematosus n = 3	Syndrome of Churg-Strauss n = 2
Relapsing polychondritis	11 (65%)	2 (40%)	5 (100%)	1 (33%)	1 (50%)
Nasal obstruction	10 (59%)	2 (40%)	2 (40%)	1 (33%)	1 (50%)
Rhinorrhea	6 (35%)	0	4 (80%)	0	1 (50%)
Nasal itching	6 (35%)	0	2 (40%)	0	1 (50%)
Hyposmia	2 (12%)	0	0	0	0
Anosmia	1 (6%)	0	0	0	0
Cacosmia	5 (29%)	0	1 (20%)	0	1 (50%)
Postnasal drip	7 (41%)	2 (40%)	1 (20%)	0	2 (100%)

	Wegener's granulomatosis n = 17	Relapsing Polychondritis n = 5	Syndrome of Sjögren n = 5	Systemic Lupus Erythematosus n = 3	Syndrome of Churg-Strauss n = 2
Dysphonia	3 (14%)	1 (20%)	2 (40%)	2 (67%)	1 (50%)
Cough	4 (23%)	2 (40%)	0	0	1 (50%)
Snoring	0	0	0	0	0
Foreign body sensation	1 (6%)	2 (40%)	0	0	0
Dysphagia	0	0	0	0	0
Odynophagia	0	0	0	0	0
Dyspnea	6 (35%)	1 (20%)	0	1 (33%)	1 (50%)
Hemoptysis	1 (6%)	0	0	0	1 (50%)
Hawk	7 (41%)	2 (40%)	3 (60%)	0	1 (50%)
Heartburn	1 (6%)	1 (20%)	2 (40%)	0	0
Gagging	1 (6%)	2 (40%)	0	0	0

	Wegener's granulomatosis n = 17	Relapsing Polychondritis n = 5	Syndrome of Sjögren n = 5	Syndrome of Churg-Strauss n = 2
Conjunctivitis	0	1 (20%)	2 (40%)	1 (50%)
Headache	3 (18%)	1 (20%)	0	1 (50%)
Facial paralysis	0	0	0	0

	Wegener's granulomatosis n = 17	Relapsing Polychondritis n = 5	Syndrome of Sjögren n = 5	Systemic Lupus Erythematosus n = 3	Syndrome of Churg-Strauss n = 2
Rhinoscopy, change in	12 (70%)	3 (60%)	5 (100%)	1 (33%)	2 (100%)
Otoscopy, change in	7 (41%)	0	0	0	0
Nasofibroscopy, change in	7 (41%)	3 (60%)	4 (80%)	2 (67%)	2 (100%)
Otoscopy, change in	7 (41%)	2 (40%)	5 (100%)	1 (33%)	0

	Otologic symptoms	Nasal symptoms	Laryngeal symptoms	Audiometric change
Wegener's Granulomatosis	9 (53%)	11 (65%)	7 (41%)	9 (53%)
Relapsing Polychondritis	3 (60%)	2 (40%)	2 (40%)	4 (80%)
Sjögren's Syndrome	5 (100%)	5 (100%)	3 (60%)	5 (100%)
Systemic Lupus Erythematosus	1 (33%)	1 (33%)	2 (67%)	1 (33%)
Churg-Strauss Syndrome	1 (50%)	2 (100%)	1 (50%)	1 (50%)

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[1] Corresponding author. E-mail: h_pauna@hotmail.com (H.F. Pauna).