Audiovestibular manifestations of sarcoidosis: a review of the literature

OBJECTIVE/HYPOTHESIS: Sarcoidosis is a multisystem disease of unknown etiology. Audiovestibular involvement is rare but has been reported in a number of cases. The objective of this review is to provide an evidence-based summary of the audiovestibular manifestations of sarcoidosis by collating the findings of these case reports. STUDY DESIGN: Retrospective review of 48 published case reports and 2 cases recently encountered in audiovestibular medicine clinics. METHODS: Case reports were identified using a key word search of Medline database. Clinical details, audiovestibular test results, and radiological findings were recorded for each patient when available. RESULTS: When type of hearing loss (HL) was recorded, all losses were sensorineural, with only two patients found to have an additional conductive loss. The severity of HL ranged from mild to profound. Median thresholds were moderately raised. The HL was bilateral in 75% of patients and asymmetrical in 75% of these cases. Seventy percent of HLs demonstrated some recovery. Many of the patients with recovery were treated with corticosteroids, but no statistically significant association between treatment and HL outcome was observed. Symptoms of vestibular impairment were common. Vestibular testing was performed in 24 cases and was abnormal in 23. Eighty-one percent of patients had additional features of neurosarcoidosis. Six patients had radiological evidence of a retrocochlear lesion. CONCLUSION: In taking into account the evidence from the clinical features, audiovestibular testing, radiological investigations, and postmortem findings, it is concluded that the audiovestibular manifestations of sarcoidosis are likely to be primarily a result of vestibulocochlear nerve neuropathy.