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Introduction
Sensorineural deafness is a well recognised manifestation of early acquired syphilis and was frequently seen in the nineteenth century.1 With the recent dramatic rise in the incidence of syphilis in the UK, there has been a re-emergence of presenting manifestations that had previously become rare.2 The presented case serves as a reminder that, with the re-emergence of syphilis, clinicians are likely to come across manifestations of syphilis in day to day ENT practice.
Case report
A 24-year-old, Caucasian woman was seen in the ENT emergency clinic with a two-day history of sudden onset, bilateral, profound hearing loss. This was preceded by a one-week history of severe headache, dizziness and loss of balance, but no tinnitus.
The patient's past medical history included migraine, anxiety and depression. She gave a history of a failed hearing test at school at the age of 11 years, but was subsequently found to have normal otoscopy and audiometry results (Figure 1). She denied using recreational drugs, took no regular medication and had no known allergies.
Fig. 1
Pure tone audiogram taken at age 11 years, showing normal hearing. Air conduction: [white circle] = right; x= left. Bone conduction: [Delta] = unmasked (right or left).
On examination, the patient was found to have profound hearing loss in both ears. As a result, the Weber and Rinne tests could not be analysed. Otoscopic and neurological examinations were otherwise normal. The patient was treated for migraine with associated hearing loss, and arrangements made for pure tone audiometry (PTA).
Audiometry on day two showed profound left-sided and moderately severe right-sided sensorineural hearing loss (Figure 2a).
Fig. 2
Pure tone audiograms taken on (a) day two, (b) day nine and (c) after completion of treatment. V = Vibrotactile; NR = Not Recorded.
On day nine, the patient was reviewed in the ENT clinic and complained of persistent hearing loss and headaches. She had also developed aphthous ulcers in her mouth and blisters on her palms. Pure tone audiometry at this stage now showed a 'dead' left ear and slight improvement on the right (Figure 2b).
The patient was admitted, and rheumatology and dermatology opinions were sought. Her full blood count, urea and electrolytes, and liver function test...