Otosyphilis Presenting as Sudden Hearing Loss in a Young Patient: A Case Report

Syphilis is an infectious disease caused by Treponema pallidum. Despite its high prevalence, diagnosis remains challenging due to diverse clinical manifestations and complexity of serologic interpretation. Otosyphilis is a rare complication of chronic infection, often mimicking various audiovestibular conditions. While sensorineural hearing loss is most common, middle ear or ossicular involvement may cause associated conductive loss. Failure to diagnose promptly can result in profound, irreversible hearing loss. To emphasize the importance of suspecting otosyphilis in young patients with acute hearing loss. A 33-year-old woman, previously healthy, developed bilateral tinnitus and hypoacusis for about 14 days. Three days after symptom onset she presented odynophagia and papular trunk lesions and received clavulanate-amoxicillin, without improvement. Audiologic testing showed moderate, bilateral, symmetric sensorineural hearing loss, worse at low frequencies. Serologic tests showed a VDRL of 1:256 and a positive FTA-ABS. Other serologic tests were negative. During the evaluation, the patient underwent a lumbar puncture, which yielded a cerebrospinal fluid sample within normal limits and with a negative VDRL. Intravenous treatment with potassium penicillin G was initiated every 4 hours for 14 days.Six months post-therapy, the patient reported little improvement in hearing; VDRL decreased to 1:1. Follow-up audiometry showed slight curve improvement (∼10 dB gain). Otosyphilis may not be accompanied by abnormalities in the cerebrospinal fluid. After specialized medical evaluation, if the findings are consistent with neurosyphilis, these patients should be treated even if the CSF is normal. It is important to monitor clinical changes in order to determine disease control, therapeutic success, and the potential need for retreatment.