[Wegener granulomatosis: a clinical case with parossistic positional vertigo due to involvement of the lateral semicircular canal].

The ear is involved in more than 20% of all cases of Wegener Granulomatosis (W.G.): such involvement takes place either through direct proliferation of the necrotic-granulomatosis tissue in the middle ear, or is a consequence of perieustachian tube infiltration from the rhinopharnyx. The inner ear is affected later and it is not clear as to exactly how. The present paper deals with the case of a 63-year-old woman who had a year been suffering from bilateral ear pain, and persistent otorrhea with typical signs of purulent chronic middle-ear otitis. During the course of the illness the patient complained of atypical paroxymal positional vertigo, compatible with cupulolithiasis of the semi-circular horizontal canal (as per E.N.G. recording). Transoral biopsy of the rhinopharynx and of the left nasal fossa revealed histopathological signs compatible with W.G.. In the light of post-mortem temporal bone studies performed by Friemann and Blatt on W.G. patients the present case could lead to further studies regarding the advancement of this pathological process within the middle and inner ears and the etiopathogenetic mechanisms involved. In particular, during the course of W.G., the appearance of benign paroxymal positional vertigo through cupulolithiasis of the semicircular horizontal canal may be justified: a) by the progressive involvement of the posterior labyrinth structures affecting the semicircular canals prior to the lateral canal and running on to the posterior canal; b) by the discovery of proteiform material in the labyrinthine fluids.