Otologic Sarcoidosis
Audiovestibular symptoms of sarcoidosis are uncommon but can include
sensorineural hearing loss, vertigo, gait disturbance and disequilibrium
from neurosarcoidosis affecting the vestibulocochlear nerves (16).
Middle ear sarcoidosis has also been reported as a sentinel
manifestation of the disease (23), presenting with tinnitus, hearing
loss, purulent otorrhoea and otalgia. In this scenario, audiometric
findings are mixed or conductive in nature, with CT demonstrating soft
tissue masses in the tympanic cavity extending into the mastoid antrum
and air cells. While skin is commonly involved in sarcoidosis, the
external ear is seldom involved (12, 24). Cases described include tender
and non-tender raised nodules, swelling or inflammation that can affect
the helix, lobules or external auditory canal (12, 24).
Otologic symptoms usually improve with oral or intralesional
corticosteroid therapy (12). Infliximab, a TNF-α blocking agent, has
also been reported as successful in treating ear lobe sarcoidosis
refractory to non-biologic immunosuppressants and intralesional injected
corticosteroids (24). Case reports have suggested that surgical excision
of granulation tissue alongside systemic steroid therapy can result in
improvement of symptoms (23).