Otologic Sarcoidosis
Audiovestibular symptoms of sarcoidosis are uncommon but can include sensorineural hearing loss, vertigo, gait disturbance and disequilibrium from neurosarcoidosis affecting the vestibulocochlear nerves (16). Middle ear sarcoidosis has also been reported as a sentinel manifestation of the disease (23), presenting with tinnitus, hearing loss, purulent otorrhoea and otalgia. In this scenario, audiometric findings are mixed or conductive in nature, with CT demonstrating soft tissue masses in the tympanic cavity extending into the mastoid antrum and air cells. While skin is commonly involved in sarcoidosis, the external ear is seldom involved (12, 24). Cases described include tender and non-tender raised nodules, swelling or inflammation that can affect the helix, lobules or external auditory canal (12, 24).
Otologic symptoms usually improve with oral or intralesional corticosteroid therapy (12). Infliximab, a TNF-α blocking agent, has also been reported as successful in treating ear lobe sarcoidosis refractory to non-biologic immunosuppressants and intralesional injected corticosteroids (24). Case reports have suggested that surgical excision of granulation tissue alongside systemic steroid therapy can result in improvement of symptoms (23).