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Cryptococcal meningitis: presentation as sudden deafness.

M J Maslan, M D Graham, L M Flood

The American Journal of Otology

|September 1, 1985

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Sudden profound hearing loss can indicate cryptococcal meningitis, a serious infection. Prompt diagnosis and exclusion of this cause are crucial before initiating steroid treatment for hearing loss.

Area of Science:

Neurology
Infectious Diseases
Otolaryngology

Background:

Sudden sensorineural hearing loss (SSNHL) requires prompt diagnosis and management.
Cryptococcal meningitis is a serious fungal infection that can affect the central nervous system.

Observation:

A patient experienced sudden bilateral profound hearing loss after a two-month neurologic illness.
Cerebrospinal fluid analysis confirmed Cryptococcus neoformans infection.

Findings:

Standard antifungal treatment (amphotericin B and 5-fluorocytosine) did not restore hearing.
Auditory brain stem response and electrical promontory stimulation indicated profound deafness with significant neuronal damage.
Histopathology findings suggest a retrocochlear lesion, consistent with cryptococcal meningitis.

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Implications:

Cryptococcal meningitis should be considered in cases of sudden sensorineural hearing loss, especially after neurologic illness.
Excluding this occult pathology is vital before administering steroid therapy for hearing loss.
Early diagnosis and appropriate treatment of cryptococcal meningitis may improve outcomes and prevent irreversible hearing damage.