以慢性化脓性中耳炎伴孤立性传导性听力损失为表现的非典型耳梅毒

文献信息

中文摘要

背景： 耳梅毒是苍白密螺旋体感染的一种少见表现，通常引起感音神经性听力损失、耳鸣和眩晕。由中耳受累导致的传导性听力损失极为罕见。
病例介绍： 一名32岁埃塞俄比亚女性因持续6个月的左耳流脓和进行性听力下降就诊。耳镜检查显示两处中央性鼓膜穿孔。纯音测听显示中度传导性听力损失，气骨导差为35 dB。血清VDRL和TPHA阳性；HIV和GeneXpert MTB/RIF阴性。脑脊液分析无异常。鼓膜穿孔边缘肉芽组织活检在Warthin-Starry染色下显示形态与螺旋体一致的微生物，在相应临床背景下支持梅毒性中耳受累的诊断。由于资源限制无法进行静脉治疗，患者接受苄星青霉素治疗3周，随后行鼓室成形术。6个月时，气骨导差从35 dB改善至12 dB，VDRL滴度从1:16下降四倍至1:2。
结论： 本病例表明，梅毒性中耳疾病罕见地可表现为慢性化脓性中耳炎伴孤立性传导性听力损失。对于持续性慢性中耳炎且常规治疗失败的患者，即使缺乏典型的全身性或耳蜗前庭表现，临床医生也应考虑梅毒。

英文摘要

BACKGROUND: Otosyphilis is an uncommon manifestation of Treponema pallidum infection that typically causes sensorineural hearing loss, tinnitus, and vertigo. Conductive hearing loss resulting from middle ear involvement is exceptionally rare.
CASE PRESENTATION: A 32-year-old Ethiopian woman presented with a 6-month history of persistent left ear discharge and progressive hearing loss. Otoscopy revealed two central tympanic membrane perforations. Pure tone audiometry demonstrated moderate conductive hearing loss with an air-bone gap of 35 dB. Serum VDRL and TPHA were positive; HIV and GeneXpert MTB/RIF were negative. Cerebrospinal fluid analysis was unremarkable. Biopsy of granulation tissue at the edge of the tympanic membrane perforation demonstrated organisms morphologically consistent with spirochetes on Warthin-Starry staining, supporting a diagnosis of syphilitic middle ear involvement in the appropriate clinical context. The patient received benzathine penicillin for 3 weeks due to resource limitations precluding IV therapy, followed by tympanoplasty. At 6 months, the air-bone gap improved from 35 to 12 dB, and VDRL titers declined fourfold from 1:16 to 1:2.
CONCLUSIONS: This case illustrates that syphilitic middle ear disease may rarely present as chronic suppurative otitis media with isolated conductive hearing loss. Clinicians should consider syphilis in patients with persistent chronic otitis media that fails conventional therapy, even in the absence of classical systemic or cochleovestibular manifestations.