Case Report - Otolaryngology Online Journal (2020) Volume 10, Issue 4

Lyme disease And Sudden Hearing Loss: Case Report

Otorhinolaryngology Service of Pedro Hispano Hospital, Matosinhos, Portugal

*Corresponding Author:

Andre Carcao
Department of Otorhinolaryngology
Pedro Hispano Hospital, Matosinhos, Portugal
Tel: +351912714910
Email: andre.carcao92@gmail.com

Received: June 15, 2020; Accepted: July 25, 2020; Published: July 31, 2020

Abstract

Lyme disease is a tck-borne multsystemic infecton caused by Borrelia burgdorferi. It can be associated with involvement of cranial nerves and otolaryngologic manifestatons. We report a case of women with sudden sensorineural hearing loss without other symptoms. Acute Lyme infecton was detected by laboratory tests. Afer systemic antbiotc treatment, hyperbaric and cortcoid treatment the patent showed a clear audiologic recovery. Although borreliosis has a low incidence, it should be considered as a possible aetological factor in sudden sensorineural hearing loss.

Keywords

Lyme disease, Sudden hearing loss, Corticotherapy, Antibiotic

Introduction

Lyme disease (LD) or Lyme borreliosis, one of the most prevalent vector-borne diseases in Europe, is caused by spirochetes of the Borrelia burgdorferi species complex, which are transmitted by several species of Ixodid ticks [1]. In Portugal, LD has been a mandatory reporting disease since 1999, but there seems to be a clear underreporting of cases, hindering its epidemiological analysis and understanding of its impact on public health in national territory [2]. LD can be associated with involvement of cranial nerves and otolaryngologic manifestations [3,4]. The most commonly affected cranial nerve is the facial nerve, causing facial palsy [3,4]. Nevertheless the VIIIth cranial nerve can also be affected, provoking sudden sensorineural hearing loss (SSNHL) [3,4].

This case report aims to describe a case of Lyme disease where the main manifestation was unilateral SSNHL.

Case Description

A 41-year-old woman presented with a 3 day history of left SSNHL and tinnitus with no other symptomatology. Pure tone audiometry revealed average hearing thresholds of 80 dB in the symptomatic ear, which was in accordance with criteria for SSNHL. The patient was medicated with prednisolone 1 mg/kg/day for 8 days, followed by a tapering dose. Additionally, she received 20 sessions of hyperbaric oxygenation. Taking into account that the patient has travelled recently to a foreign country it was requested the laboratory test for Borrelia burgdorferi. The magnetic resonance imaging revealed no abnormalities of the cranial nerves and cerebrum.

Borrelia burgdorferi antibodies blood tests showed positive findings for immunoglobulin M (IgM) and negative findings for immunoglobulin G (IgG). These findings were then confirmed by Western Blot. LD was then assumed and the patient started treatment with doxycycline 200 mg/day for 14 days.

Post treatment assessment showed marked audiologic recovery with no residual symptoms. The re-evaluation of serologic test showed IgM negative and IgG positive for Borrelia burgdorferi corresponding to a past infection.

Discussion/Conclusion

SSNHL is a frightening symptom that often prompts an urgent or emergent visit to a clinician [5]. The most frequently used audiometric criterion for SSNHL is a decrease in hearing of 30 decibels affecting at least 3 consecutive frequencies [6]. SSNHL affects 5 to 27 per 100000 people annually, with about 66 000 new cases per year in the United States [7]. Much of the literature indicates that 32% to 65% of cases of SSNHL may recover spontaneously [8]. Clinical experience, however, shows that these numbers may be an overestimation [5].

Borrelia burgdorferi infection can be asymptomatic. Symptomatic cases are potentially progressive and the clinical course has customarily been considered in terms of three stages: early, localised disease; early, disseminated disease; and late disease [1]. The initial phase usually sees erythema migrans at the site of the tick bite, characterised by an erythematous, annular and expansive rash. The patient typically experiences ‘flu-like’ symptoms of malaise, headache, myalgia and arthralgia. However, erythema migrans can be absent in 20 to 50 per cent of cases, with neuroborreliosis or arthritis being the first manifestation of LD. Borreliae can disseminate haematogenously or directly to other organs and tissues. It can cause general systemic symptoms and signs, affecting the nervous system causing facial palsy, skin, joints and heart [9]. In Portugal, neuroborreliosis is the most common clinical manifestation of Lyme disease [2].

The correlation between LD and SSNHL is not well known. However, SSNHL can be seen in neuroborreliosis. In a group of 165 patients with a diagnosis of sudden hearing loss, serology was positive for Borrelia burgdorferi in 12 per cent of cases and Borrelia burgdorferi was 6 times more prevalent in this patient group than in the general population residing in the same area [10].

In the presented case, blood tests revealed recent Lyme infection, a positive IgM result, which was confirmed by Western blotting. Consequently, doxycycline was prescribed as the SSNHL was considered a symptom of the initial stage of Lyme disease. Nevertheless, the patient started corticosteroid and hyperbaric oxygen treatment immediately, in order to prevent excessive delay until blood tests results were available and confirmed the infection. Our case report provides evidence for the relationship between SSNHL and Lyme disease and its recovery after properly treatment.

Recently published guidelines regarding SSNHL do not recommend obtaining routine laboratory tests [5]. However, LD should be considered in higher risk individuals and/or in areas where incidence is high. SSNHL is a rare symptom of LD and it can occur without neuropathy. In this study blood tests were positive for Borrelia burgdorferi.

References

1. Stanek G, Wormser GP, Gray J, et al. Lyme borreliosis. Lancet 2012; 379:461-73.
2. Lopes de Carvalho I, Núncio M. Laboratoty diagnosis of Lyme borreliosis at the Portuguese National Institute of Health (1990-2004). Euro Surveill 2006; 11:257-60.
3. Moscatello AL, Worden DL, Nadelman RB, et al. Otolaryngologic Aspects of Lyme Disease. Laryngoscope 1991; 101:592-5.
4. Goldfarb D, Sataloff R. Lyme disease: a review for the otolaryngologist. Ear Nose Throat J 1994; 73:824-9.
5. Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol - Head Neck Surg (United States) 2019; 161(1_suppl):S1–45.
6. Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss: A double-blind clinical study. Arch Otolaryngol 1980; 106:772-6.
7. Alexander TH, Harris JP. Incidence of sudden sensorineural hearing loss. Otol Neurotol 2013; 34:1586-9.
8. Byl FM. Seventy-six cases of presumed sudden hearing loss occurring in 1973: Prognosis and incidence. Laryngoscope 1977; 87: 817-25.
9. Association BI. The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: A position statement by the British Infection Association. J Infect 2011; 62:329-38.
10. Peeters N, Colnot DR. In response to letter to the editor: Lyme disease associated with sudden sensorineural hearing loss: Case report and literature review. Otol Neurotol 2013; 34:1544.