急激な両側前庭機能低下と難聴を呈した１例

Abstract

Although unilateral loss of hearing and vestibular function is relatively common, bilateral auditory and vestibular dysfunction rarely occurs. We report a patient with bilateral auditory and vestibular dysfunction with simultaneous onset and describe the otological manifestations of this case. A 54-year-old man was admitted to hospital complaining of headache and fever. After hospitalization, he experienced vertigo, which consisted of a sensation of moving vertically and noticed bilateral hearing loss, which increased gradually. The patient was referred to our University Hospital because vertigo and hearing loss persisted after therapy, although his headache and fever improved. On the first visit to our clinic, skin eruptions suggestive of herpes virus infection were noted on the right cheek and around the angles of the mouth. Pure-tone audiometry revealed moderate to severe bilateral sensorineural hearing loss. Right-beating nystagmus with horizontal and torsional components was observed on gaze, positional and positioning nystagmus tests. A caloric test showed severe hypofunction of the bilateral semicircular canals. Hematological examination revealed an elevated antibody titer against herpes simplex virus. Steroid tapering treatment and prostaglandin treatment were performed and the he hearing level improved to 63.8dB on the right and 32.5dB on the left, and nystagmus on gaze, positional and positioning conditions disappeared. A caloric test after therapy showed mild canal dysfunction on the right and severe canal palsy on the left. At present, the patient does not have any marked disabilities in daily life. We speculated that the sudden loss of bilateral auditory and vestibular function was caused by herpes simplex viral meningitis because of the skin eruptions on the face and elevated antibody titer against herpes simplex virus.