From the Guidelines
Temporal arteritis, also known as giant cell arteritis, can potentially cause hearing loss, though it's not among the most common symptoms. If you're experiencing hearing loss along with symptoms like headache, scalp tenderness, jaw pain when chewing, vision changes, or unexplained fever and fatigue, seek immediate medical attention as temporal arteritis requires prompt treatment. The standard treatment is high-dose corticosteroids, typically starting with prednisone 40-60mg daily, which should be initiated quickly to prevent serious complications like permanent vision loss.
Key Points to Consider
- The hearing loss associated with temporal arteritis occurs because inflammation can affect blood vessels supplying the inner ear or auditory nerve.
- Diagnosis typically involves blood tests for inflammatory markers (ESR and CRP) and confirmation with a temporal artery biopsy, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis 1.
- Treatment usually continues for 1-2 years with a slow taper of steroids, and your doctor may add steroid-sparing agents like methotrexate.
- Regular monitoring of symptoms and inflammatory markers is essential during treatment, as suggested by the 2018 update of the EULAR recommendations for the management of large vessel vasculitis 1.
- While the steroid therapy may not reverse existing hearing loss, it can prevent further progression and other serious complications.
Recent Guidelines and Recommendations
- The 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis recommends early initiation of high-dose glucocorticoid therapy for induction of remission in large vessel vasculitis 1.
- The 2018 update of the EULAR recommendations for the management of large vessel vasculitis suggests that an immunosuppressive agent should be considered for use in large vessel vasculitis as adjunctive therapy 1.
- The 2024 EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update, highlights the importance of imaging modalities in the diagnosis and management of large vessel vasculitis 1.
From the Research
Temporal Artery and Hearing Loss
- The temporal artery is associated with giant cell arteritis (GCA), a condition that can lead to hearing loss 2, 3.
- Sensorineural hearing loss (SNHL) is a rare but important manifestation of GCA, and timely intervention may play a key role in overall prognosis 2.
- A study of 271 cases of temporal arteritis found four cases with concomitant sensorineural hearing loss, highlighting the rare occurrence of this association 3.
- In some cases, hearing loss can precede the diagnosis of GCA by several days to months, and recognition and treatment may lead to partial or full recovery 3.
Treatment and Management
- Corticosteroids remain the main treatment for GCA, and the choice of initial prednisone dosage takes into account the disease severity and comorbidities 4.
- Methotrexate has a moderate corticosteroid sparing effect and can reduce the rate of relapse in patients with GCA 5, 6.
- A case-control study found that the addition of methotrexate to glucocorticoid therapy decreased the rate of subsequent relapse by nearly 2-fold compared to patients taking glucocorticoids alone 6.
- High doses of intravenous methylprednisolone are often prescribed for severe ischemic complications, but there is no evidence that such doses are superior to classical doses 4.
Hearing Loss and GCA
- A case report of a 66-year-old male with GCA and persistent bilateral sensorineural hearing loss despite optimal doses and duration of glucocorticoids highlights the importance of timely intervention 2.
- The patient's hearing loss did not improve with treatment, suggesting that delayed institution of glucocorticoid therapy may have contributed to the persistent hearing loss 2.
- Another study found that all cases of sensorineural hearing loss associated with GCA had full or partial return of hearing after treatment with corticosteroids 3.