Cryptococcal Meningitis: Implications for the Otologist

Abstract

Cryptococcal meningitis can present to the otologist with hearing loss and vestibular dysfunction. A man with cryptococcal meningitis presenting with bilateral profound sensorineural hearing loss and vestibular dysfunction is described. The difficulty in arriving at the diagnosis and consequences of misdiagnosis are discussed. Histological and clinical studies suggest that the cochlear nerve is likely to be damaged in patients who have deafness associated with this disease. Retrocochlear damage may result in cochlear implantation having a poor outcome.

Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients

“…This suggests disease-specific dysfunction, although occupational noise exposure history, with and without the use of hearing protection, was common in this group (71%). This is consistent with a number of clinical reports, [27][28][29][30][31][32] as well as other reported case series documenting abnormal hearing in 14-33% of adults with CM 17,33,34 , notably more than hearing loss in children with CM, reported to be less than 10% 19 . However, the rate is less than that observed in bacterial meningitis, which was recently shown to affect 44% of children with a preponderance of SNHL 35 , but more than tuberculous meningitis which also causes a basilar meningitis similar to CM but has less than a 5% incidence of hearing loss 33 .…”

Cryptococcus Meningitis and reversible hearing loss

“…Hypoacousia is described in as many as 27% of patients and may fluctuate 1 , with losses ranging from moderate unilateral to severe bilateral 2 . The mechanism leading to lesions in the auditory system has been studied.…”

Reversible hearing loss following cryptococcal meningitis: case study

“…8,12 However, many histopathological studies have implicated the cochlear nerve, with varying involvement of the vestibular component. 8,12 However, many histopathological studies have implicated the cochlear nerve, with varying involvement of the vestibular component.…”

“…Temporal bone studies have shown varying patterns of vestibulocochlear nerve involvement and end organ damage 8 , 12 . However, many histopathological studies have implicated the cochlear nerve, with varying involvement of the vestibular component 12 – 14 .…”

“…However, many histopathological studies have implicated the cochlear nerve, with varying involvement of the vestibular component 12 – 14 . Consequently, most would agree that this retrocochlear damage may limit the efficacy of a cochlear implant 8 . This is in contrast to patients with bacterial meningitis in whom retrocochlear involvement is limited 6 …”