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Sudden sensorineural hearing loss associated with herpes simplex virus type 1 infection

  • Eltan Pollak, Chief Information Officer, Assaf Harofeh Medical Center Nes Ziona Israeleitan.pollak@telrad.co.il
Submitted July 06, 2001

I read with interest the case report by Rabinstein et al about sudden bilateral hearing loss (SHL) in a patient with HSV-1 stomatitis and meningitis, proved by culture and PCR [1].

This is an unusual case from several aspects: Viral infections leading to SHL usually cause viral cochleitis or neuronitis, without evidence of meningeal involvement [2]. On the other hand, SHL as a sole manifestation of meningeal disease has been reported in rare cases of neurosarcoidosis and bacterial meningitis [3,4]. In the setting of viral meningitis, SHL occurs usually as a part of the clinical picture of viral meningoencephalitis, whereas the herpes meningitis in the reported case was “clinically asymptomatic “. Would this mean the routine work up of patients with SHL, especially bilateral SHL, should include also a lumbar puncture? It would be also interesting to know about the kind of treatment that the patient has received for her pyelonephritis, since ototoxic agents may have contributed to her hearing loss.

Recently, attention has been drawn to the possibility of HSV as a causatus agent of vestibular neuronitis without cochlear involvement [5]. Moreover, half of the patients with SHL have also balance problems and vertigo. The reported patient has shown imbalance and a positive Romberg test, which could be due to a bilateral vestibular damage additionally to her cochlear damage. I wonder if any vestibular clinical or laboratory tests, such as head thrust test, dynamic visual acuity test or electronystagmography with caloric testing, were performed to asses the vestibular functions of the patient?

References:

1. Rabinstein A, Jerry M, Saraf-Lavi E, Sklar E, Bradley WG. Sudden sensorineural hearing loss associated with herpes simplex virus type 1 infection. Neurology 2001; 56: 571-572.

2. Schuknecht HF, Donovan ED. The pathology of idiopathic sudden sensorineural hearing loss. Arch Otorhinolaryngol 1986; 243: 1-15.

3. Souliere CR Jr, Kava CR, Barrs DM, Bell AF. Sudden hearing loss as the sole manifestation of neurosarcoidosis. Otolaryngol-Head-Neck-Surg 1991; 105: 376-381.

4. Kwartler JA, Linthicum FH, Jahn AF, Hawke M. Sudden hearing loss due to AIDS- related cryptococcal meningitis – a temporal bone study. Otolaryngol-Head-Neck Surg 1991; 104: 265-269.

5. Arbusow V, Schulz P, Strupp M, Dietrich M, Reihardstoettner A, Rauch E, Brandt T. Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuronitis. Ann Neurol 1999; 46: 416-419.

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Neurology | Print ISSN:0028-3878
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