Prognostic Value of Initial Hearing Severity in Otitis Media With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: A Retrospective Cohort Study

Objective: To identify prognostic factors for hearing outcomes in patients with otitis media with ANCA-associated vasculitis (OMAAV). Study design: Retrospective cohort study. Setting: Tertiary referral center. Patients: A total of 45 ears from 24 patients with OMAAV were followed up for more than 1 year after treatment. Interventions: Corticosteroids with or without immunosuppressive agents. Main outcome measures: The final hearing outcome was defined as good (≤30 dB) or poor (>30 dB) based on the average air conduction at 5 frequencies. Potential prognostic factors were analyzed by constructing a receiver operating characteristic (ROC) curve, followed by multivariate logistic regression analysis. Results: The mean hearing level before treatment was 62.5 dB. Twelve ears (26.7%) achieved a final hearing of ≤30 dB. Multivariate logistic regression analysis revealed that the pretreatment air-conduction threshold was significantly associated with good hearing outcomes (OR = 33.6, P = 0.005). The area under the ROC curve for pretreatment hearing level was 0.946, demonstrating high accuracy. The cutoff value set at 50 dB had the best combination of sensitivity (91.7%) and specificity (84.8%) for predicting good hearing outcomes. Other variables, including C-reactive protein level, age, systemic involvement of ANCA-associated vasculitis, and treatment intensity, were not significant predictors. Conclusions: Pretreatment hearing level is a powerful predictor of the final auditory outcome in OMAAV. Early diagnosis and prompt initiation of treatment may improve long-term hearing prognosis. The hearing level, rather than the systemic involvement of the disease, should be prioritized when determining the therapeutic intensity.