Hearing impairment and facial palsy as initial signs of Wegener's granulomatosis

In two patients with Wegener's granulomatosis, treatment-resistant serous otitis media was followed by unilateral facial nerve palsy. Later both patients developed uraemia due to extracapillary glomerulonephritis. In one of them, who was treated with prednisone and cyclophosphamide, renal function improved, while in the other patient it remained impaired. Both patients suffered lasting hearing impairment in spite of general improvement during the course of the disease. The facial nerve palsy improved slightly in one, while no improvement was seen in the other. The possibility of Wegener's granulomatosis of other autoimmune collagen diseases should be considered in cases of treatment-resistant serous otitis media. Early diagnosis and treatment can possibly save the patient from the life-threatening consequences of these diseases.