Otosyphilis: Resurgence of an Old Disease

Abstract

Objectives: To describe the clinical characteristics of patients presenting with a new diagnosis of otosyphilis over the past 10 years in a large, urban, safety-net hospital affiliated with a large county sexually transmitted disease clinic.Methods: Retrospective case series. A chart review was performed of all patients who presented to an adult otolaryngology clinic with a new diagnosis of syphilis and hearing loss from January 2008 to December 2017.Results: Twelve patients met the criteria for "suspected" or "likely" otosyphilis based on Centers for Disease Control and Prevention definitions. The average age was 48 years (range 19-59). All were male. Nine (75%) were men who have sex with men. Eight (67%) were positive for human immunodeficiency virus. One (8%) presented with primary, nine (75%) with secondary, and two (17%) with early latent syphilis. Seven (58%) presented with bilateral audiogram-confirmed hearing loss, two (17%) with unilateral hearing loss, and three (25%) with suspected hearing loss based on fluctuating symptoms. Nine (75%) presented with tinnitus and two (17%) with vertigo. The median duration of otologic symptoms prior to presentation was 2 weeks (range: 0-16 weeks). All presented within the last 2 years surveyed.Conclusion: We have seen an increase in the number of otosyphilis cases in our clinic. We suspect otosyphilis may be underdiagnosed and emphasize the importance of screening for syphilis in patients with new audiologic symptoms of vertigo, tinnitus, or hearing loss.

Aetiology of Ludwig van Beethoven’s hearing impairment: hypotheses over the past 100 years – A systematic review

“…Overall, syphilis is still one of the aetiologies which has most often been accused of being the cause of Beethoven’s hearing loss by medical publishers over the past 100 years. However, in the literature published by otolaryngologists, this differential diagnosis has not been favoured any more during the last 50 years even if nowadays the diagnosis of otosyphilis still needs to be considered in the differential diagnostic mind of the clinical otologists as recently mentioned by Theeuwen [ 31 ].…”

Hearing loss in individuals at risk for neurosyphilis

“…This proportion is similar to what was seen in a smaller series of 12 patients with otosyphilis who underwent formal audiometry. 18…”

“…12,14–17 A recent series of 12 patients with syphilis and hearing loss who underwent formal audiometry found that the most common presentation was bilateral, asymmetric, mild or moderate high frequency sensorineural hearing loss. 18 Residual hearing loss after otosyphilis treatment is often reported. 10–13 Here we report results of portable audiometry in 329 individuals enrolled in a study of CSF abnormalities in active syphilis, 33 of whom had hearing loss and were reexamined after otosyphilis treatment.…”

Revisiting the ‘great masquerader’

“…In a recent case series of 12 patients with otosyphilis, 8 (67%) were positive for HIV. 5 Otosyphilis is often a presumptive diagnosis based on positive serology in patients with cochleovestibular symptoms with no other likely causes. It may present differently depending on the stage of syphilis.…”