Sensorineural hearing loss as an initial manifestation of eosinophilic granulomatosis with polyangiitis: A diagnostic challenge

Background: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg–Strauss syndrome, is a rare ANCA-associated vasculitis characterized by asthma, hypereosinophilia, and systemic involvement. Otorhinolaryngological manifestations are common, but sensorineural hearing loss as an initial presentation remains rare and poorly described.
Case presentation: We report the case of a 54-year-old woman with long-standing asthma who presented with progressive bilateral sensorineural hearing loss, leading to ENT evaluation. She also reported nasal obstruction, rhinorrhea, and peripheral facial paralysis. Clinical examination revealed bilateral nasal polyposis. Laboratory findings showed marked hypereosinophilia (1950/mm³), elevated inflammatory markers, and positive C-ANCA. Imaging demonstrated sinonasal polyposis and peripheral pulmonary infiltrates. The diagnosis of EGPA was established based on clinical, biological, and radiological criteria. The patient was treated with systemic corticosteroids and underwent endoscopic sinus surgery, with favorable clinical evolution and stabilization of hearing.
Conclusion: This case highlights that sensorineural hearing loss may represent an early and misleading manifestation of EGPA. Recognition of this atypical presentation is essential for early diagnosis and prompt treatment, in order to prevent irreversible organ damage.