Eustachian Tube Enhancement Directly Reflects Disease Activity in ANCA-Associated Otitis Media

Objective: Otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is associated with Eustachian tube (ET) involvement. To date, the clinical feasibility of using contrast-enhanced magnetic resonance imaging (CE-MRI) to assess ET enhancement in OMAAV management remains unclear. Therefore, we investigated whether ET enhancement on CE-MRI reflects disease activity in patients with ANCA-associated vasculitis (AAV)/OMAAV. Study design: Prospective cohort with within-patient comparisons. Setting: Tertiary referral center. Patients: Eight patients with AAV (12 OMAAVs) and 8 with otitis media with effusion (OME) as controls. Intervention: All patients underwent 3.0-Tesla fat-suppressed CE-MRI with <1 mm slice thickness at disease onset and also in remission for patients with OMAAV. Myeloperoxidase-deoxyribonucleic acid (MPO-DNA) complex levels in middle ear fluid samples were measured to confirm OMAAV diagnosis. Main outcome measure: MRI signal intensities in each anatomic ET segment, audiometric results, and biomarker levels, compared with disease activity. Results: In active OMAAV, ETs showed significant contrast enhancement on the affected side in all patients, even those with prior oral steroid use. ET enhancement was distributed in at least 2 continuous segments centered on the isthmus (12 OMAAVs, 100%), and enhancement was remarkably diminished during remission. ET enhancement positivity was closely associated with higher levels of ANCA and MPO-DNA complex ( P <0.001). The diagnostic performance of ET enhancement was 100%/87.5% (sensitivity/specificity) for evaluating OMAAV disease activity and 100%/91.7% (sensitivity/specificity) for differentiating active OMAAV from non-OMAAV conditions. Conclusion: ET enhancement on high-resolution CE-MRI provides radiologic evidence of localized vasculitic inflammation in patients with active OMAAV.