Otoneurological findings in inner ear syphilis

Area of Science:

• Otolaryngology
• Neurology
• Infectious Diseases

Background:

• Syphilis can affect the auditory and vestibular systems.
• Neurosyphilis, particularly late-stage, poses diagnostic challenges.
• Ototoxicity from syphilis can lead to significant balance and hearing dysfunction.

Purpose of the Study:

• To investigate the otoneurological findings in patients with a history of ear syphilis.
• To identify characteristic signs of inner ear dysfunction in syphilis patients.
• To explore the relationship between syphilis and endolymphatic hydrops.

Main Methods:

• Retrospective review of 81 ears from 48 patients with a 10-year history of ear syphilis.
• Comprehensive otoneurological examinations, including primary equilibrium tests (Mann's, stepping).
• Electronystagmography (ENG), bithermal caloric testing, pendular rotation (VOR) testing, furosemide VOR tests, transtympanic electrocochleography, and glycerol testing.

Main Results:

• 25 patients reported vertigo, 13 experienced giddiness/unsteadiness.
• Abnormal findings were noted in approximately 50% of patients on initial equilibrium tests.
• Frequent spontaneous and positional nystagmus observed on ENG; abnormal caloric and VOR test responses.
• Positive furosemide VOR tests in 5/8 patients; abnormal electrocochleography (-SP response) in 13/22 ears.
• Positive glycerol test findings in 11/26 ears, suggesting endolymphatic hydrops.

Conclusions:

• Inner ear syphilis can present with symptoms of vertigo and imbalance.
• Otoneurological examinations reveal frequent abnormalities in vestibular function.
• Findings suggest that some cases of inner ear syphilis exhibit characteristic signs of endolymphatic hydrops.