A case of falciparum malaria: Acute hearing loss as the initial symptom.

A 49-year-old healthy woman, who returned from Burkina Faso, visited an ear, nose, and throat clinic with complaints of left hearing loss, tinnitus, and dizziness. Pure tone audiometry demonstrated bilateral mild sensorineural hearing loss. Three days later, she was transported in an ambulance to a general hospital due to high fever and disturbance of consciousness. Plasmodium falciparum was found in the peripheral blood smear. After diagnosing severe falciparum malaria with cerebral involvement, quinine hydrochloride, clindamycin, and artemether/lumefantrine were administered. After recovery of consciousness, she was followed up at our department with bilateral hearing loss. After taking prednisolone for 10 days, there was improvement to normal hearing level. Furthermore, no neurologic sequelae were observed. In this case, acute sensorineural hearing loss occurred before administration of the antimalarial drug. Therefore, hearing loss was not drug-induced, but was caused by the malaria itself. In patients with acute hearing loss and who have history of travel to tropical regions, physicians should include malaria and other causes of acute deafness in the differential diagnoses.

Effects of radiation on the temporal bone in patients with head and neck cancer.

Radiotherapy is a key component in the treatment of many head and neck cancers, and its potential to cause long-term adverse effects has become increasingly recognized. In this review, we describe the short-term and long-term sequelae of radiation-associated changes in and injury to the temporal bone and its related structures. The pathophysiology of radiation-induced injury and its clinical entities, including sensorineural hearing loss, chronic otitis media, osteoradionecrosis, and radiation-associated malignancies, are described. We also discuss radiation dose to the head and neck as it relates to these conditions. An improved understanding of radiation's effects on the temporal bone will enable physicians and researchers to continue efforts to reduce radiotherapy-related sequelae and guide clinicians in diagnosing and treating the various otologic conditions that can arise in patients with head and neck cancer who have received radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1428-1435, 2016.

Audiovestibular findings in patients with Vogt-Koyanagi-Harada disease.

CONCLUSION: The long-term follow-up study revealed a good audiovestibular prognosis in our patients with Vogt-Koyanagi-Harada disease (VKH) after adequate treatment. OBJECTIVES: To evaluate the audiovestibular findings and long-term prognosis of patients with VKH. METHODS: A total of 82 ears in 41 patients (9 males and 32 females, aged 18-78 years) with VKH were examined in the audiovestibular study. Of the 41 patients, 16 patients with follow-up periods of more than 12 months (13-158 months) were included in the long-term follow-up study. Audiovestibular examinations included pure-tone audiometry; positional, positioning, and spontaneous nystagmus tests; and a caloric test. RESULTS: Among the 41 patients, 28 (68%) complained of auditory symptoms at the initial visit and 28 (68%) showed sensorineural hearing loss (SNHL). Of the 24 patients who underwent nystagmus tests, only 3 (13%) presented with vestibular symptoms whereas 11 (46%) had nystagmus. Among 32 ears in 16 patients enrolled in the long-term follow-up study, 19 ears showed SNHL at the initial visit. The SNHL returned to normal in 14 ears (74%) and remained minimal in severity in the other 5 ears (26%) at the last visit. None of the patients showed persistent or repetitive vestibular symptoms.

Sudden sensorineural hearing loss: subclinical viral and toxoplasmosis infections as aetiology and how they alter the clinical course.

AIM: To explore in a prospective study the evidence of certain viral and toxoplasmosis infections in sudden sensorineural hearing loss (SSHL). METHODS: 84 consecutive patients with SSHL meeting certain criteria. All patients were assessed for specific IgM antibodies against cytomegalovirus, herpes simplex virus, toxoplasma and Epstein-Barr virus. All were treated with intravenous steroids and assigned to two groups: 76 IgM negative (NV group) and 8 IgM positive (no history of acute infection - V group). RESULTS: The mean hearing level at presentation was 86.5 dB HL (median, 100) in the V group and 60.7 dB HL (median, 61) in the NV group. The difference was statistically significant (p = 0.003). The mean hearing level following treatment was 81.8 dB HL (median, 88) in the V group and 48.7 dB HL (median, 39) in the NV group. The difference was statistically significant (p = 0.004). There was a considerable improvement in hearing after treatment only in the NV group (p < 0.000001). CONCLUSIONS: Recent subclinical viral or toxoplasmosis infections may be involved in the pathogenesis of SSHL (in approx. 10% of cases), suggesting that SSHL is not a single disease. When certain viruses or toxoplasmoses are involved, the hearing is much worse in comparison to patients with no such indication of infection. An alteration in treatment dosage or method of steroid administration may be needed in such cases.

Infection in childhood sensory hearing loss.

OBJECTIVE: To evaluate the possible role of infectious agents on the occurrence of idiopathic sensorineural hearing loss (SNHL) in children. METHODS: This case control study was carried out at Rasul Hospital in Tehran, Iran from 2002-2003. We compared specific serum antibodies (IgG, IgM) measured by enzyme linked immunosorbent assay in 95 sensory hearing loss cases and 63 controls. RESULTS: Acute infections (IgM) detected in cases included: cytomegalovirus (CMV) 34.6%, toxoplasma 11.5%, mumps 8.7%, rubella 5.3%, and herpes simplex 5.3%. Previous infections (IgG) detected in cases included CMV 72%, herpes 6.6%, toxoplasma 26%, mumps 23.3%, and rubella 17.2%. Acute CMV and toxoplasma infections were more frequent in cases. Previous CMV, toxoplasma, rubella, and herpes infections were higher in controls. There was no significant difference for acute mumps, rubella, and herpes infections between cases and controls. CONCLUSION: These data are compatible with infectious agents having a significant role in the studied idiopathic SNHL cases, but association does not prove causation. We recommend specific drugs for confirmed active infections (CMV, toxoplasma, herpes) in idiopathic SNHL infants diagnosed before their first birthday. Mumps and rubella induced SNHL are preventable with routine vaccination.

Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis.

Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a higher level and obstructive hydrocephalus. Finally, she died from status epilepticus and septic shock.

Angiostrongylus eosinophilic meningitis associated with sensorineural hearing loss.

A 59-year-old woman who presented with chronic headache, neck stiffness and left-sided hearing loss is reported. The diagnosis of angiostrongylus eosinophilic menigitis was made. The patient improved after treatment with prednisolone, including hearing. Angiostrongylus eosinophilic meningitis associated with sensorineural hearing loss has not previously been reported.

Prevalence of sensorineural hearing loss due to toxoplasmosis in Saudi children: a hospital based study.

A survey to identify the aetiology of hearing impairment among Saudi children was carried out. Children were divided into 2 groups according to presence or absence of laboratory evidence of toxoplasmosis "at risk' and "not at risk.' Serological tests for toxoplasmosis were done to 1054 children. We found positive IgM antibody against Toxoplasma gondii in the blood of 70 of the 1054 children (6.6%) (age ranged between 12 months and 14 years). Forty nine of the seventy infected children (70%) were found to have bilateral sensorineural hearing loss (11 of 19 children of the at risk group and 38 of 51 from the "not at risk' group). Hearing impairment was bilateral in all cases profound in 9, moderate to severe in 29 and mild in 11. Known causes of hearing impairment were excluded. The high prevalence of hearing impairment among children due to toxoplasmosis is presented.