Labyrinthine lesions in presumed inner ear hemorrhage-related sudden deafness

PURPOSE

Inner ear hemorrhage (IEH) is a rare cause of sudden sensorineural hearing loss (SSNHL). This study aimed to evaluate the lesional patterns in patients with presumed IEH from morphological and functional aspects.

METHODS

Seventeen patients with SSNHL and presumed IEH who completed audio-vestibular tests were included. The main outcome measures included clinical characteristics, radiology, and functional test results.

RESULTS

The morphological findings and functional tests revealed differences in locations and lesional spectrums. The magnetic resonance imaging (MRI) hyperintensity was likely to involve the vestibule (88.2%), the cochlea (76.5%), and the posterior and lateral semicircular canals (76.5% and 70.6%, respectively). Furthermore, 70.6% of cases showed abnormality in the entire labyrinth, and abnormalities in the vestibule/semicircular canals were observed in 17.6% of cases. Meanwhile, dysfunction was sequentially detected in the cochlea (100%), semicircular canals (94.1%), and vestibule (70.6%); 64.7% of cases showed combined deficit in the entire labyrinth, and 29.4% of cases showed combined deficit in the cochlea/semicircular canals. Although lesions in the labyrinth were frequently detected, the results of the radiological and functional tests did not always match and significantly differed in either cochlear or superior semicircular canal damage detection (p < 0.05 each).

CONCLUSIONS

In this cohort, IEH preferentially caused sudden audio-vestibular impairment, which was well demonstrated by a combination of MRI and functional tests. The specific lesional configurations revealed in this study may suggest a possible pathomechanism that could be further explored as a therapeutic target.

Association of sudden sensorineural hearing loss with asthma: a longitudinal follow-up study using a national sample cohort

OBJECTIVE

To investigate the risk of sudden sensorineural hearing loss (SSNHL) in asthma patients.

DESIGN

A longitudinal follow-up study using a retrospective cohort SETTING: The 2002-2013 Korean National Health Insurance Service-Health Screening Cohort PARTICIPANTS AND INTERVENTIONS: The ≥40 years old Korean population were enrolled. The asthma patients were 1:1 matched with the control group for age, sex, income and region of residence.

MAIN OUTCOME MEASURE

The occurrence of SSNHL was followed in both asthma and control groups. The stratified Cox proportional hazard model was used. Age, sex, income and region of residence were stratified, and Charlson Comorbidity Index scores, obesity, smoking, alcohol consumption and atopic dermatitis histories were adjusted. Subgroup analysis was performed according to age, sex, obesity, smoking and alcohol consumption.

RESULTS

The results showed that 1.0% (877/90 564) of the asthma group and 0.8% (706/90,564) of the control group exhibited SSNHL (p<0.001). The asthma group demonstrated a higher HR for SSNHL than the control group (adjusted HR 1.23, 95% CI 1.11 to 1.36, p<0.001). According to age and sex, the female subgroup showed elevated HRs for SSNHL in asthma patients. Both the non-smoker and current smoker groups demonstrated higher HRs for SSNHL in asthma patients than in controls. According to alcohol consumption or obesity, the <1 time a week alcohol consumption group and normal weight and severe obesity groups showed higher HRs for SSNHL in asthma patients than in the controls.

CONCLUSIONS

Adult asthma patients had a higher risk of SSNHL than the control participants matched for demographic and socioeconomic factors.

[Triggers and predictors of development and formation of sensorineural hearing loss]

The purpose of the study is to review the results of scientific researches in recent years in an expanded interdisciplinary view of the problem of etiopathogenesis of sensorineural hearing loss, as well as the role of comorbidities and triggers in the formation of persistent changes in the audio-receiving part of the auditory analyzer.

Round window membrane rupture following blunt force trauma

Round window rupture following barotrauma such as diving and air travel is well documented. However, we describe a case of round window rupture following a slap to the ear, which has not been described previously. A 12-year-old boy was slapped by his teacher in rural Nepal over his left ear and immediately noted hearing loss. There was no dizziness or tinnitus. He presented to our unit 21 days after the trauma and examination showed a perforation of the tympanic membrane in the anterior inferior quadrant with an otherwise normal ear examination and no nystagmus seen. Audiogram showed a left profound hearing loss, which was supported by auditory brainstem response test. Exploratory tympanotomy showed active perilymph leakage from the round window niche as demonstrated in the video attached. The round window was packed with cartilage and fascia to address the perilymph leakage. The patient was discharged the following day without any complications. This is an unusual cause for round window membrane rupture where the patient presented with hearing loss as his only symptom. Tympanotomy is recommended for patients with hearing loss following trauma with normal computed tomography imaging to exclude perilymph leak secondary to inner ear barotrauma.

Diabetes mellitus and hearing loss: A review

Diabetes (type 2) and sensorineural hearing loss are common health problems manifested with ageing. While both type 1 and type 2 diabetes have been associated with hearing loss, a causal link has been difficult to establish. Individuals with diabetes have twice the incidence of hearing loss compared to those without diabetes and those with prediabetes have a 30% higher rate of hearing loss. Whether hearing loss is associated with diabetes independent of glycemic control remains to be determined. Hearing loss has its own set of risk factors and shares others with diabetes. This review will summarize the complex relationship between diabetes and sensorineural hearing loss.

[Alström syndrome, a rare cause of renal failure: case report and review of the literature]

We describe the case of a 26-year-old male patient with a previous diagnosis of Alström Syndrome who presented drowsiness, dyspnea, tremors, and a dull abdominal pain, without signs of peritoneal irritation. The patient also presented sensorineural hearing loss, decreased vision, due to chorioretinal dystrophy, difficulty walking with back-lumbar double curve scoliosis, impaired glycemic homeostasis, and a significant deterioration of renal function. Alström syndrome is a multisystem disease characterized by rod-cone dystrophy, hearing loss, obesity, insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dilated cardiomyopathy, and progressive renal and hepatic dysfunction. Around 450 cases have been identified worldwide. Clinical signs, age of onset and severity can vary significantly between different families and within the same family. Careful nephrological follow-up is necessary in patients with syndromic ciliopathies, since long-term kidney problems can have an impact on other diseases, eg. cardiovascular disease.

Congenital Unilateral Hearing Loss: Characteristics and Etiological Analysis in 121 Patients

OBJECTIVE

To describe the characteristics and etiological analysis in patients with congenital unilateral hearing loss.

STUDY DESIGN

Retrospective cohort analysis.

SETTING

Tertiary referral center.

PATIENTS

Children with permanent congenital unilateral hearing loss born between 2007 and 2018. Patients were referred after universal newborn hearing screening or by a colleague to confirm the diagnosis and perform etiological examinations.

MAIN OUTCOME MEASURES

Hearing loss type, severity, and evolution linked with the results of etiological testing.

RESULTS

In the 121 included children, aural atresia is the leading cause of congenital unilateral hearing loss (32%), followed by structural anomalies (19%) and cCMV (13%), whereas 24% remained idiopathic after etiological work-up. Severity is mainly moderately severe (33% with 56-70 dB hearing loss, majority aural atresia) or profound (31% with > 90 dB hearing loss, predominantly cochlear nerve deficiency). Syndromic features were present in 26%. Although discussed with all parents, only 26% of the children regularly used hearing amplification.

CONCLUSIONS

Congenital conductive unilateral hearing loss is mainly caused by aural atresia, which proportion in congenital unilateral hearing loss proved higher than previously reported. Cochlear nerve deficiency and cCMV are the predominant etiologies of congenital unilateral sensorineural hearing loss. Etiological work-up in affected patients is mandatory as it might impact the approach, and syndromic features should be actively searched for.

Sensorineural Hearing Loss as the Prominent Symptom in Meningeal Carcinomatosis

Sensorineural hearing loss (SNHL) has been reported rarely in patients with meningeal carcinomatosis (MC). We summarized the clinical data of eight MC patients with SNHL and 35 patients reported from publications. In the eight patients with SNHL, the medium onset age was 48 (range from 37 to 66) years and six (75%) were male. Seven (87.5%) suffered from headaches as the initial symptom, and they experienced SNHL during the first two months after the occurrence of headaches (0.5 to 2 months, average 1.5 months). The audiogram configuration was flat in three patients (37.5%) and showed total deafness in five patients (62.5%). The damage of cranial nerves VI (abducens) was observed in six patients (75%), and four patients (50%) had cranial nerves VII (facial) injury during the disease course. The percentage of damage of cranial nerves was higher than the patients without SNHL (VIth, 75.0% vs. 13.3%, p = 0.002 and VIIth 50.0% vs. 6.7%, p = 0.012). Four (50%) patients suffered from lung adenocarcinoma as primary tumor, two (25%) experienced stomach adenocarcinoma, one had colon cancer, and one patient was unknown. The symptom of SNHL improved after individualized therapy in four patients (focal radiotherapy and chemotherapy for three patients and whole brain radiotherapy for one patient), but all passed away from 2 to 11 months after diagnosis. Total deafness and flat hearing loss in audiogram were the common types of SNHL resulting from MC. MC patients with SNHL were more likely to suffer from the damage of other cranial nerves, especially to cranial nerves VI and VII. Treatment might improve SNHL, but not improve the case fatality rate.

Primary presentation of sarcoidosis with profound bilateral sensorineural hearing loss

We present a case of a 7-year-old Afro-Caribbean girl presenting with rapidly progressive bilateral sensorineural hearing loss. She was found to have an elevated Angiotensin converting enzyme (ACE) and mediastinal lymphadenopathy containing non-caseating granulomas with multinucleate giant cells, in keeping with sarcoidosis. Cranial imaging demonstrated labyrinthitis. She underwent urgent bilateral cochlear implantation with rehabilitation of hearing sufficient to restart education within 1 month.

Glial-Specific Deletion of Med12 Results in Rapid Hearing Loss via Degradation of the Stria Vascularis

Mediator protein complex subunit 12 (Med12) is a core component of the basal transcriptional apparatus and plays a critical role in the development of many tissues. Mutations in Med12 are associated with X-linked intellectual disability syndromes and hearing loss; however, its role in nervous system function remains undefined. Here, we show that temporal conditional deletion of Med12 in astrocytes in the adult CNS results in region-specific alterations in astrocyte morphology. Surprisingly, behavioral studies revealed rapid hearing loss after adult deletion of Med12 that was confirmed by a complete abrogation of auditory brainstem responses. Cellular analysis of the cochlea revealed degeneration of the stria vascularis, in conjunction with disorganization of basal cells adjacent to the spiral ligament and downregulation of key cell adhesion proteins. Physiologic analysis revealed early changes in endocochlear potential, consistent with strial-specific defects. Together, our studies reveal that Med12 regulates auditory function in the adult by preserving the structural integrity of the stria vascularis.SIGNIFICANCE STATEMENT Mutations in Mediator protein complex subunit 12 (Med12) are associated with X-linked intellectual disability syndromes and hearing loss. Using temporal-conditional genetic approaches in CNS glia, we found that loss of Med12 results in severe hearing loss in adult animals through rapid degeneration of the stria vascularis. Our study describes the first animal model that recapitulates hearing loss identified in Med12-related disorders and provides a new system in which to examine the underlying cellular and molecular mechanisms of Med12 function in the adult nervous system.

Relation between otitis media and sensorineural hearing loss: a systematic review

OBJECTIVES

This systematic review summarises the evidence on the correlation between recurrent acute otitis media (rAOM) or chronic suppurative otitis media (CSOM) and sensorineural hearing loss (SNHL).

RESEARCH METHODS

PubMed, Embase and Cochrane Library databases were searched from inception to 15 January 2021. Two authors independently identified articles, extracted data and performed quality assessment for included studies. Studies comparing the sensorineural hearing levels of patients with a history of rAOM/CSOM for >3 months to a control group were included.

RESULTS

Screening of 4168 articles lead to inclusion of two case-control studies (control-group: patients non-OM) and seven cohort-studies (control group: contralateral ear). Quality assessment indicated considerable risk of bias in all studies. Reported populations varied (sample size 13-607, mean age 22-41.5 years, mean duration of disease 6.1-12.4 years). The OR for SNHL in the OM-group was 3.30-7.86 (95% CI 1.16 to 9.40, p<0.05) in cohort studies (n=2), and 0.05 (95% CI 0 to 0.78, p<0.05) in a case-control study. Mean/median bone conduction thresholds were respectively 1.19-32.21/0-10 dB higher on all frequencies (0.5-4 kHz) for the OM-group in four cohort studies (p<0.05). Two other studies reported no statistical test outcomes.

CONCLUSION

Due to the high risk of bias of included studies, effect estimates heterogeneity and suboptimal research designs, no conclusion on the correlation between OM and SNHL can be made. It emphasises the need for future prognostic studies.

Profound Sudden Sensorineural Hearing Loss in Hematologic Malignancy: A Case for Urgent Cochlear Implantation With Discussion and Systematic Review of the Literature

OBJECTIVE

To perform a systematic review of sensorineural hearing loss (SNHL) in hematologic malignancy; to describe an illustrative case of urgent cochlear implantation for bilateral profound SNHL and vestibular hypofunction in hyperviscosity syndrome; to suggest an approach to management of hyperviscosity syndrome-associated deafness with cochlear implantation.

DATA SOURCES

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic search of PubMed and Embase databases was undertaken for articles detailing clinical information about SNHL caused directly by hematologic malignancies.

RESULTS

A total of 37 studies from 1989 to 2020 were qualitatively reviewed, the majority of which were case studies or case series. Causes of hearing loss in hematologic malignancy were found to include hyperviscosity syndrome, labyrinthine hemorrhage, infiltration, and infection. Patients with profound SNHL in hematologic malignancies from hyperviscosity syndrome may be candidates for cochlear implantation, and are also at increased risk for cochlear ossification. We review previous cases for their diagnostic approach, treatment paradigm, and outcomes data, and propose an approach to management.

CONCLUSION

Bilateral sudden profound SNHL and vestibular hypofunction is a presenting symptom of hyperviscosity syndrome in hematologic malignancy. Although this entity is rare and previous reports have suggested improvement in hearing with oncologic treatment, cases with profound hearing loss are unlikely to recover serviceable hearing. We advocate for early magnetic resonance imaging with attention to fluid signal in the inner ear and serial audiometric follow-up to guide clinical decisions. We advise early consideration for cochlear implantation.

Prevalence of Otological Disease in Turner Syndrome: A Systematic Review

INTRODUCTION

Girls and women with Turner syndrome (TS) present with multiple ear and hearing problems, ranging from external morphologic abnormalities to sensorineural or conductive hearing loss. The exact pathophysiology behind these otological diseases is not yet completely understood. The aim of this study is to provide a systematic review on the prevalence of otological disease in TS.

METHODS

We conducted a systematic review according to the PRISMA guidelines. A database search was performed in PubMed, Embase, Web of Science, and Cochrane library.

RESULTS

The prevalence of otological disease as external ear deformities (20-62%), recurrent otitis media (24-48%), and hearing loss (36-84%) is high in TS. The auditory phenotype in TS is complex and seems to be dynamic with CHL due to middle ear disease at young age and sensorineural hearing loss later in life.

CONCLUSION

This systematic review of the literature confirms that otological disease is definitely part of the widely variable phenotype in Turner patients. Strong evidence is lacking on the exact prevalence numbers, emphasizing the need for more prospective data gathering. Growing insights in its pathophysiology will help in the understanding and management of hearing problems in TS across lifespan.

Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom

Sudden sensory neural hearing Loss (SSNHL) needs to be identified and managed correctly in a secondary or tertiary centre. Whilst 45% of presentations are said to be idiopathic in nature, several viruses have been linked to its aetiology. It was noted, anecdotally, that more patients were presenting with SSNHL during the COVID-19 pandemic to our ENT service at Wrightington Wigan and Leigh teaching hospitals, UK (WWL). We identified 4 COVID-19 positive patients who presented to our ENT service with SSNHL. Despite normal findings on external ear examination, three of the patients showed bilateral hearing loss, whilst one had a predominantly unilateral loss. Given our findings we would like to present these four cases, as well as providing hypotheses on possible aetiology of this association. This may aid in research, diagnosis and treatment of future COVID positive patients with SSNHL.

The Dizzy Child

Dizziness occurs in children with an estimated prevalence of 0.45% to 15.0%. Vestibular disorders in the pediatric population can impact gross motor function development, visual acuity, and contribute to psychological distress. Appropriate case history and focused direct examination can be helpful when determining the etiology of dizziness. Vestibular testing can be completed in children and guide management of suspected vestibular dysfunction. Vestibular dysfunction is commonly seen in patients with sensorineural hearing loss. Migraine disorders are the most common cause of dizziness in childhood. Etiologies of dizziness in children differ from those commonly seen in adults.

COVID-19 caused hearing loss

Purpose

The objective of this cross-sectional study was to determine if there is a potential link between COVID-19 infection and hearing loss.

Methods

The prospective study was conducted in the COVID Hospital Clinical Centre Niš, Serbia. We performed tonal audiometry and used a custom questionnaire and medical histories to determine the incidence of hearing loss in COVID-19 positive patients.

Results

There were 74 patients with COVID-19 that met the inclusion criteria of this study and they composed our experimental group. Fifty-four (73%) were men and 20 (27%) women. There were 30 (40.5%) patients with hearing loss. Seventeen patients had unilateral and 13 had bilateral hearing loss. Significant differences between hearing loss groups and control group were found across all age groups, but not at all frequencies. No important differences were found when unilateral hearing loss and bilateral hearing loss groups were compared. There were no significant differences in distributions of comorbidities between the patients with hearing loss and normal hearing patients.

Conclusions

We found that 30 (40.5%) of the COVID-19 positive patients had sensorineural type of hearing loss. Across all age groups, there were statistically significant differences in frequencies between the COVID-19 positive patients and the control group. There were no significant differences in distributions of comorbidities between the patients with hearing loss and normal hearing patients. Distribution of unilateral and bilateral hearing loss and audiogram types was also not significantly different between the age groups.

Cochlear implantation after radiosurgery for vestibular schwannoma

OBJECTIVE

The object of this study was to ascertain outcomes of cochlear implantation (CI) following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS).

METHODS

The authors conducted a retrospective chart review of adult patients with VS treated with SRS who underwent CI between 1990 and 2019 at a single tertiary care referral center. Patient demographics, tumor features, treatment parameters, and pre- and postimplantation audiometric and clinical outcomes are presented.

RESULTS

Seventeen patients (18 ears) underwent SRS and ipsilateral CI during the study period. Thirteen patients (76%) had neurofibromatosis type 2 (NF2). Median age at SRS and CI were 44 and 48 years, respectively. Median time from SRS to CI was 60 days, but notably, 4 patients underwent SRS and CI within 1 day and 5 patients underwent CI more than 7 years after SRS. Median marginal dose was 13 Gy. Median treatment volume at the time of SRS was 1400 mm3 (range 84-6080 mm3, n = 15 patients). Median post-CI PTA was 28 dB HL, improved from 101 dB HL preoperatively (p < 0.001). Overall, 11 patients (12 ears) exhibited open-set speech understanding. Sentence testing was performed at a median of 10 months (range 1-143 months) post-CI. The median AzBio sentence score for patients with open-set speech understanding was 76% (range 19%-95%, n = 10 ears). Two ears exhibited Hearing in Noise Test (HINT) sentence scores of 49% and 95%, respectively. Four patients achieved environmental sound awareness without open-set speech recognition. Two had no detectable auditory percepts.

CONCLUSIONS

Most patients who underwent CI following SRS for VS enjoyed access to sound at near-normal levels, with the majority achieving good open-set speech understanding. Implantation can be performed immediately following SRS or in a delayed fashion, depending on hearing status as well as other factors. This strategy may be applied to cases of sporadic or NF2-associated VS.

ABBREVIATIONS

AAO-HNS = American Academy of Otolaryngology-Head and Neck Surgery; ABI = auditory brainstem implant; CI = cochlear implantation; CN = cranial nerve; CNC = consonant-nucleus-consonant; CPA = cerebellopontine angle; EPS = electrical promontory stimulation; ESA = environmental sound awareness; HINT = Hearing in Noise Test; IAC = internal auditory canal; NF2 = neurofibromatosis type 2; OSP = open-set speech perception; PTA = pure tone average; SRS = stereotactic radiosurgery; VS = vestibular schwannoma; WRS = word recognition score.

Congenital and Neonatally Acquired Sensorineural Hearing Loss

Hearing loss is one of the most common congenital diagnoses, recognized in large part by a robust newborn hearing screening program. Ensuring appropriate follow-up of failed newborn hearing screening is crucial to avoid delay in initiation of treatment for hearing loss. The most common etiology for congenital hearing loss is genetic, but some cases can be acquired. Understanding of the etiology aids in counseling for the family and in direction of treatment. Early diagnosis and treatment results in dramatically improved speech and developmental outcomes for affected children. Treatment including amplification, speech therapy, adaptations in the classroom, and family support leads to gains in academic performance, parental satisfaction, and quality of life. Early cochlear implantation has been shown to be beneficial in obtaining speech and language skills in patients with severe to profound sensorineural hearing loss and should be considered in the appropriate patient population. [Pediatr Ann. 2021;50(7):e292-e296.].

Nox3-Derived Superoxide in Cochleae Induces Sensorineural Hearing Loss

Reactive oxygen species (ROS) produced by NADPH oxidases (Nox) contribute to the development of different types of sensorineural hearing loss (SNHL), a common impairment in humans with no established treatment. Although the essential role of Nox3 in otoconia biosynthesis and its possible involvement in hearing have been reported in rodents, immunohistological methods targeted at detecting Nox3 expression in inner ear cells reveal ambiguous results. Therefore, the mechanism underlying Nox3-dependent SNHL remains unclear and warrants further investigation. We generated Nox3-Cre knock-in mice, in which Nox3 was replaced with Cre recombinase (Cre). Using Nox3-Cre;tdTomato mice of either sex, in which tdTomato is expressed under the control of the Nox3 promoter, we determined Nox3-expressing regions and cell types in the inner ear. Nox3-expressing cells in the cochlea included various types of supporting cells, outer hair cells, inner hair cells, and spiral ganglion neurons. Nox3 expression increased with cisplatin, age, and noise insults. Moreover, increased Nox3 expression in supporting cells and outer hair cells, especially at the basal turn of the cochlea, played essential roles in ROS-related SNHL. The extent of Nox3 involvement in SNHL follows the following order: cisplatin-induced hearing loss > age-related hearing loss > noise-induced hearing loss. Here, on the basis of Nox3-Cre;tdTomato, which can be used as a reporter system (Nox3-Cre+/-;tdTomato+/+ and Nox3-Cre+/+;tdTomato+/+), and Nox3-KO (Nox3-Cre+/+;tdTomato+/+) mice, we demonstrate that Nox3 inhibition in the cochlea is a promising strategy for ROS-related SNHL, such as cisplatin-induced HL, age-related HL, and noise-induced HL.SIGNIFICANCE STATEMENT We found Nox3-expressing regions and cell types in the inner ear, especially in the cochlea, using Nox3-Cre;tdTomato mice, a reporter system generated in this study. Nox3 expression increased with cisplatin, age, and noise insults in specific cell types in the cochlea and resulted in the loss (apoptosis) of outer hair cells. Thus, Nox3 might serve as a molecular target for the development of therapeutics for sensorineural hearing loss, particularly cisplatin-induced, age-related, and noise-induced hearing loss.

Effectiveness of electroacupuncture for the treatment of sudden sensorineural hearing loss: A retrospective study

This retrospective study investigated the use of electroacupuncture (EA) for the treatment of patients with sudden sensorineural hearing loss (SSNHL).Between May 2016 and April 2020, 140 patients with SSNHL were retrospectively analyzed. They were allocated to a treatment group (n = 70, received EA) and a control group (n = 70, received acupuncture). They received EA or acupuncture for a total of 3 months. The outcomes included average hearing threshold (AHT), tinnitus (as assessed by tinnitus handicap inventory [THI]), dizziness (as measured by dizziness handicap inventory [DHI]), and adverse events (AEs).After treatment, patients in both groups exerted more reduction in HT (P < .01), THI (P < .01), and DHI (P < .01), than those before the treatment. Furthermore, patients in the treatment group showed more relief in HT (P < .01), THI (P < .01), and DHI (P < .01), than those of patients in the control group. When it comes to AEs, both modalities had similar safety profile.The findings of this retrospective study indicated that the effectiveness of EA is superior to acupuncture in treating SSNHL. Future high quality studies are needed to warrant the present findings.

Cryptococcal meningitis presenting with acute hearing loss

Reversible sensorineural hearing loss is a recognised complication of cryptococcal meningitis. Cryptococcal meningitis typically presents with usual symptoms of fever, headache and neck stiffness. This case highlights acute, profound, bilateral hearing loss as the initial symptom and presentation of cryptococcal meningitis in a young woman, who was later diagnosed with AIDS.