Hearing Loss| Unusual Infections

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  • Hearing Loss| Unusual Infections


  • Lyme disease
  • Syphilis
  • Herpes Zoster (Ramsay Hunt Syndrome)

Risk Factors

  • Lyme: Living in an endemic area, exposure to ticks
  • Syphilis: Sexual activity
  • Ramsay Hunt: age, lack of vaccination, immunocompromised


  • May be abrupt
  • Syphilis: Would be neurosyphilis, so could have gait problems, other neuro issues; hearing loss can be unilateral or bilateral; can be abrupt
  • Lyme: would be neuro lyme; May be unilateral or bilateral
  • Antecedent history erythema migrans
  • Zoster: Unilateral ar pain, peripheral facial nerve palsey with Ramsay-Hunt from CN7 involvement; due to proximity w/CN8, may also have hearing loss, hyperacusis, tinnitus, vertigo

Physical Exam Findings

  • Neurosyphilis: gait problems, cognitive impairment, hearing loss (bilateral or unilateral)
  • Lyme: Prior episode erythema migrans
  • Ramsay Hunt--> vessicles on ear drum/canal, face, CN7 palsy
  • Resolution of skin findings in 2-4w