Otoneurological findings in inner ear syphilis

Bilateral Vestibular Weakness

Bilateral vestibular weakness (BVW) is a rare cause of imbalance. Patients with BVW complain of oscillopsia. In approximately half of the patients with BVW, the cause remains undetermined; in the remainder, the most common etiology by far is gentamicin ototoxicity, followed by much rarer entities such as autoimmune inner ear disease, meningitis, bilateral Ménière’s disease, bilateral vestibular neuritis, and bilateral vestibular schwannomas. While a number of bedside tests may raise the suspicion of BVW, the diagnosis should be confirmed by rotatory chair testing. Treatment of BVW is largely supportive. Medications with the unintended effect of vestibular suppression should be avoided.

Bilateral otosyphilis in a patient with HIV infection

Otosyphilis is a rare but important cause of sensorineural hearing loss and dizziness, because this hearing loss can be reversed by early diagnosis and aggressive treatment. Moreover, HIV may alter the course of otosyphilis and hasten the development of otosyphilis by reducing host cellular immunity. We report the case of a 35-year-old HIV-infected patient with bilateral fluctuating sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis. We include a discussion of the relationship between otosyphilis and HIV infection.

Otosyphilis: report on six cases

Syphilis is a multisystemic disease that may also affect the inner ear. The objective of this study was to investigate the frequency, clinical presentation and outcome of otosyphilis. A retrospective analysis of inpatients seen by a team of ENT specialists and dermatologists at a teaching hospital in Dresden, Germany, during 1986-2000. Six cases of otosyphilis had been diagnosed. None was related to risk factors such as HIV infection or drug abuse. We identified four female and two male patients, age range 25-58 years. Four patients suffered from syphilis stage II, one from syphilis stage and another from congenitial syphilis. ENT complaints included loss or impairment of hearing, tinnitus and nystagmus. All were treated with penicillin G. Adjuvant therapy included systemic corticosteroids oral pentoxifillin in two patients each. Improvement of ENT symptoms was achieved in all but one patient, who suffered from congenitial syphilis. This study confirms that otosyphilis is still a complication of syphilis in developed countries. The first line therapy is systemic penicillin G. There is a lack of controlled trials for adjuvant treatments such as corticosteroids and pentoxifillin. Clinical cooperation between dermatologists/venereologists and ENT specialists supports the best outcome.

Delayed endolymphatic hydrops following acoustic tumor removal with intraoperative and postoperative auditory brainstem response improvements

A 36-year-old female with delayed endolymphatic hydrops (ELH) after acoustic tumor removal of the same ear is reported. She presented at our clinic with pressure, fullness, and tinnitus involving her right ear. She had an abnormal auditory brainstem response (ABR), and a computed tomography showed a right acoustic tumor. She underwent a complete tumor removal from a suboccipital incision with significant intraoperative and postoperative ABR improvements. Preoperatively, there was no fluctuation in her hearing and her electrocochleography (ECoG) was normal. She did well postoperatively, but 18 months after the tumor surgery she complained of noticeable fluctuating hearing loss with increased tinnitus and aural fullness of her right operated ear and nausea but no vertigo. Neurotological examinations showed a positive right urea dehydration and positive right ECoG for enhanced summating potential to clicks. She was diagnosed as cochlear Meniere's disease with delayed ELH, failed medical management and then underwent a valved shunt surgery for ELH to stabilize her hearing. Eight years after her acoustic tumor surgery and 6 and a half years after her ELH surgery she has stabilized hearing with normal ABR and ECoG. Her clinical course is presented and a pathogenesis of ELH is discussed.