A 51-year-old woman presented with mixed hearing loss, high fever and general fatigue. Treatment with systemic antibiotics was ineffective. Laboratory findings showed positive C-reactive protein, high erythrocyte sedimentation rate, negative PR3-ANCA and negative MPO-ANCA. CT and exploratory mastoidectomy findings showed a granulomatous lesion in the mastoid cavity. Histological examination revealed nonspecific granulomatous inflammation. The hearing level of the patient fluctuated according to a dose of steroid medication. Administration of oral methotrexate was effective in reduction of the steroid dose. Methotrexate may be a well tolerated and durable option for the treatment of steroid responsive hearing loss and granuloma. As the patient might have the associated systemic immune-mediated disease in the future, the careful followup will be neccesary in this case.
