*4.13. Ear–Nose–Throat (ENT) Manifestations*

ENT complaints are common (40–50%) in pSS patients but objective fibroscopic abnormalities are less frequent (20%) [239]. Exocrinopathy can generate rhinitis sicca—reported by about 40% of pSS patients—which is a source of discomfort, nasal crusting, sinusitis, epistaxis or smell and taste disorders [240]. pSS patients are more likely to develop laryngopharyngeal reflux (LPR) because oesophageal involvement impairs anti-reflux mechanisms. LPR—in addition to pharyngitis sicca—manifests itself through various ENT complaints such as dysphonia, throat pain, chronic throat clearing or Eustachian tube dysfunction [241].

As with other systemic vasculitides, pSS may be responsible for sensorineural hearing loss or chondritis [242], responding to corticosteroid treatments. In an appealing way, pSS is associated with a sensorineural hearing loss in a significant proportion of patients, mainly affecting high frequencies, but whose clinical impact is not obvious [243].
