Otosyphilis: report on six cases

Abstract

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.

Otosyphilis in HIV-Coinfected Individuals: A Case Series from Toronto, Canada

“…10,12,14,[16][17][18][19][20]22,41 Among previous reports of HIV-positive patients with otosyphilis, subjective improvement occurred in 10 of 13 patients (76.9%) for whom outcomes were reported. [25][26][27][28][29][30][31][32] In a previous study of 48 patients with otosyphilis, those patients with profound hearing loss at initiation of treatment were the least likely to experience improvement.…”

“…12,20,40 As such, steroids have been used as adjunctive therapy in both congenital and acquired syphilitic hearing loss with varying degrees of success. 17,21,40,41 Previous reports of steroid therapy in HIV-negative patients with otosyphilis have administered 40-80 mg/d of prednisone for durations of 2-4 weeks followed by a tapering course. In the previously reported cases of otosyphilis in patients with HIV, 25-32 none of the patients were prescribed adjunctive steroid therapy while four of the patients in this series were prescribed prednisone.…”

Unilateral Sudden Hearing Loss Due to Otosyphilis

“…The hope of eradication, however, was unrealistic and over the last ten years the incidence of syphilis has increased again, particularly in Eastern Europe and Russia, but also in the homo- and bisexual communities of large cities in Western Europe. 1,2 …”

Otoneurologic Manifestations of Otologic and Systemic Disease

“…38 The symptoms are typically preceded by otalgia. 42,43 Otoneurologic manifestations may occur in secondary, tertiary, or congenital syphilis. Investigators have postulated that the reactivation of varicella-zoster virus may occur in the vestibular and spiral ganglia as well.…”