Otoscopic and Audiometric Clues for Suspecting OMAAV in Elderly Patients With Refractory Otitis Media With Effusion.

OBJECTIVE: To evaluate whether tympanic membrane findings and audiometric parameters can distinguish otitis media with ANCA-associated vasculitis (OMAAV) from refractory otitis media with effusion (OME). STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: Twenty-one patients with OME-type OMAAV limited to otologic symptoms and 9 with refractory OME requiring differentiation from OMAAV. MAIN OUTCOME MEASURES: Tympanic membrane findings were assessed using the scoring system of OMAAV tympanic membrane (SCOT). Pure-tone audiometry was performed using 3-frequency pure-tone averages and frequency-specific thresholds. Receiver operating characteristic (ROC) and logistic regression analyses evaluated diagnostic performance. RESULTS: The total SCOT score was significantly higher in the OME-type OMAAV group than in the OME group (median, 2 vs. 0; P<0.01), particularly for vascular dilatation and posterior wall swelling. Although the 3-frequency pure-tone averages did not differ significantly, frequency-specific analysis revealed significantly elevated air conduction thresholds at 2000 and 8000 Hz and bone conduction thresholds at 250 and 500 Hz in the OMAAV group. The combination of the SCOT total score and the bone conduction threshold at 500 Hz showed promising diagnostic performance (area under the curve, 0.952), with a sensitivity of 100% and a specificity of 88.9%. CONCLUSION: The combined assessment of tympanic membrane findings using the SCOT score and the bone conduction threshold at 500 Hz may provide useful otologic clues that prompt further evaluation for OMAAV, including ANCA testing, in elderly patients with refractory OME.