Sarcoidosis and Fluctuating Hearing Loss

Abstract

Neurological manifestations of sarcoidosis occur in 5% of affected patients. Of the cranial nerves, the eighth nerve is the fourth most frequently involved. The central nervous system lesion is presumed to be a granulomatous meningitis that directly infiltrates the cranial nerves or causes them to be compressed from involvement of adjacent intracranial structures. Sensorineural hearing loss and vertigo usually occur in concert with other neurological findings, but may be the only presenting complaint. Sarcoidosis is not generally recognized as a cause of fluctuating sensorineural hearing loss. The fluctuating quality of the hearing loss has been noted by other investigators, but no patient has been previously reported with hearing fluctuation as the initial complaint. A chest radiograph and eye examination are mandatory. The diagnosis may be suspected from hilar adenopathy and uveitis, and confirmed by node biopsy. The hearing will usually improve on steroid therapy. Sarcoidosis represents yet another disease entity the otolaryngologist must consider in the differential diagnosis of fluctuating hearing loss.