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LYME DISEASE PATIENT WITH PERMANENT TINNITUS AND HEARING LOSS

lyme-disease-tinnitus

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this episode, I’ll be discussing a case involving a 46-year-old man with Lyme disease who developed permanent tinnitus and hearing loss.

Jozefowicz-Korczynska and colleagues first described this case in the journal Frontiers in Neurology in 2019.

A 46-year-old male farmer was hospitalized with a “sudden onset of tinnitus and hearing loss in the left ear, dizziness, severe balance instability, and gait ataxia,” the authors write.  (Gait ataxia consists of lack of voluntary coordination of muscle movements.)

Doctors initially suspected vestibular schwannoma, which is a benign tumor of the 8th nerve (also referred to as an acoustic nerve) that affects hearing and balance. But diagnostic testing was normal.

However, a Western blot test and spinal tap revealed the patient was positive for Lyme disease. He was treated with a 3-week course of oral doxycycline, but his dizziness and gait problems persisted.

The patient did not receive any additional oral or intravenous antibiotics. Instead, he was referred to a Balance Disorders Unit for vestibular evaluation.

“Upon his examination, the patient presented with severe gait disturbance and imbalance,” the authors write.

Audiology tests indicated the man had mild to moderate sensory-neural hearing loss in both ears.

He underwent vestibular rehabilitation therapy for 10 consecutive days which significantly improved his balance. But his hearing loss and tinnitus remained.

“Unfortunately, the antibiotic therapy was not successful in decreasing hearing loss or tinnitus, suggesting permanent damage to the hearing nerve and cochlea,” write the authors.

Another study by Logigian et al. from Tufts University of Medicine found that 4 out of 27 patients with chronic neurologic Lyme disease presented with hearing loss and tinnitus.2

Meanwhile, a study in Poland revealed that 162 out of 216 patients with tick-borne diseases had otolaryngological (ear, nose, throat) symptoms.

“The most common complaint was tinnitus (76.5%) accompanied by vertigo and dizziness (53.7%), headache (39%), and unilateral sensorineural hearing loss (16.7%).”3

The following questions are discussed in this episode:

  1. Initially, doctors suspected vestibular schwannoma. Can you explain this condition and why it was considered as a possible diagnosis?
  2. The patient was tested for Lyme disease. His symptoms were not typical for Lyme, so why was testing ordered?
  3. Would more than a three-week course of doxycycline have helped resolve the man’s tinnitus and hearing loss?
  4. How common is hearing loss, vertigo, tinnitus, and gait impairment in Lyme disease?
  5. What are other causes of tinnitus and hearing loss?
  6. Why was the patient referred to a balance disorder unit and was his treatment successful?
  7. There have been several cases of hearing loss reported in the literature. Can you discuss the Tufts University and Poland studies featured in one of your blogs?
    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Jozefowicz-Korczynska M, Zamyslowska-Szmytke E, Piekarska A, Rosiak O. Vertigo and Severe Balance Instability as Symptoms of Lyme Disease-Literature Review and Case Report. Front Neurol. 2019 Nov 12;10:1172.
  2. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
  3. Sowula K, Skladzien J, Szaleniec J, Gawlik J. Otolaryngological symptoms in patients treated for tick-borne diseases. Otolaryngol Pol. 2018;72(1):30-34.

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