ENT Manifestations of Celiac Disease: A Scholarly Review

Abstract

Objectives: Celiac disease is a common multisystemic autoimmune disorder. It is now increasingly recognized that it may present with extraintestinal manifestations which contribute to the difficulty in its diagnosis. The objective of this scholarly review was to examine the extraintestinal ENT manifestations of celiac disease and its pathophysiology and management, in order to highlight that some patients with celiac disease may present initially to the otolaryngologist. Improving awareness of celiac disease among otolaryngologists may aid in the correct diagnosis and correct management plan. Methods: A literature review was conducted using the PubMed database to identify original articles related to celiac disease and ENT manifestations between the years 2000 and 2020. The search was performed using the search string: (“coeliac disease” OR “celiac disease”) AND (“ENT manifestations” OR “hearing loss” OR “epistaxis” OR “nasal septal perforation” OR “obstructive sleep apnoea” OR “vertigo” OR “tonsillitis” OR “sinusitis”). Only articles written in English were reviewed. Results: A total of 17 papers met the inclusion criteria. Extraintestinal ENT manifestations of celiac disease include sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, epistaxis, and vertigo with nystagmus. Sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, vertigo, and nystagmus are thought to result from immunologically mediated mechanisms, with intestinal malabsorption resulting in epistaxis. Conclusions: Celiac disease can cause extraintestinal ENT manifestations and requires a high index of suspicion from the otolaryngologist to diagnose and suitably manage. A gluten-free diet may result in sufficient symptom resolution for most manifestations. Sensorineural hearing loss due to celiac disease appears to be progressive and permanent and may require frequent audiological monitoring.

An Unusual Presentation of Celiac Disease: Vertigo

“…[2] In a recent review, ear-nose-throat manifestations of CD were analyzed, and sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, epistaxis, and vertigo with nystagmus were reported to be associated with immunologically mediated mechanisms. [4] In conclusion, clinicians should be aware that CD may also present with vertigo, and especially in patients with recurrent and prolonged vertigo attacks, CD should also be ruled out.…”

Associations between Celiac Disease, Extra-Gastrointestinal Manifestations, and Gluten-Free Diet: A Narrative Overview

“…A literature review including 17 studies was conducted by Karunaratne and Karunaratne to identify the relationships between CeD and ear and nose manifestations [ 22 ]. Research targets included sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, and epistaxis.…”

Otorhinolaryngological Manifestations and Esophageal Disorders in Celiac Disease: A Narrative Review

“…SNHL accounts for approximately 90% of reported hearing loss in the general population, is usually permanent, and can be mild, moderate, severe, profound, or total. The pathological mechanism behind SNHL is not entirely clear and several mechanisms such as malabsorption and immune-mediated neurological damage, comprising autoantibodies, autoreactive T cells, and immune complex deposition, have been proposed [50,51]. Most used methods for the examination of hearing complaints were pure-tone audiometry (PTA), tympanometry, transiently evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), and contralateral suppression of the TEOAE.…”

“…Hemorrhagic events are common as part of the clinical spectrum of adult patients with CeD. In few cases, CeD has been linked to nasal septal perforation and epistaxis [50]. Case reports of 46 Romanian CeD patients with hemorrhagic manifestations, aged between 19 and 74 years, revealed that one patient suffered from bleeding nasal septal perforation and further three cases from life-threatened epistaxis, related to vitamin K and vitamin D malabsorption [59].…”