Syphilitic otitis media: spread, manifestations, diagnosis and treatment
THE CONTEXT
Syphilitic otitis media is rare and can involve both the middle ear and the sensory structures of the inner ear.
Routes of infection
•
Spirochaetes reach the middle ear through the eustachian tube when syphilitic lesions are present in the nose or nasopharynx.
•
Infection may also be blood-borne.
Manifestations and tissue damage
•
Spirochaetes soon invade the sensory end organs of the inner ear and their nerves, causing profound sensorineural hearing loss, tinnitus and vertigo.
•
Bone necrosis and sequestrum formation are common and cause foetid ear discharge.
•
Secondary pyogenic infection may produce a clinical picture resembling chronic suppurative otitis media.
Diagnostic tests
•
Definite diagnosis requires specific treponemal antigen tests, such as the treponemal pallidum immobilization (TPI) test and fluorescent treponemal antibody absorption test (FTA-ABS).
•
VDRL and RPR tests are nonspecific but useful for monitoring disease; false positive results may occur.
Treatment
•
Treatment consists of antisyphilitic therapy, aural toilet and control of secondary infection.