Gleich L L, Linstrom C J, Kimmelman C P
Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary-New York Medical College, NY 10003.
Laryngoscope. 1992 Nov;102(11):1255-9. doi: 10.1288/00005537-199211000-00010.
Traditional treatment of otosyphilis with penicillin and corticosteroids has achieved hearing improvement; however, selecting which patients with a positive fluorescent treponemal antibody absorption (FTA-ABS) test will benefit from treatment remains a problem. In order to study this problem, 18 patients with cochleovestibular dysfunction of unknown etiology and positive syphilis serology were treated with intravenous penicillin and corticosteroids. In addition, lumbar puncture and human immunodeficiency virus (HIV) testing were performed on all patients. Hearing improved in 5 (31%) of 16 patients, tinnitus decreased in 11 (85%) of 13, and vertigo improved in 6 (86%) of 7. Factors associated with hearing improvement were hearing loss present less than 5 years, fluctuating hearing, and age less than 60. Improvement was unrelated to the severity of the loss or previous therapy. All patients with cerebrospinal fluid abnormalities, including two patients with HIV disease, had subjective improvements. A diagnostic and treatment protocol is presented.
传统上使用青霉素和皮质类固醇治疗耳梅毒已实现听力改善；然而，选择哪些荧光密螺旋体抗体吸收（FTA-ABS）试验呈阳性的患者将从治疗中获益仍然是一个问题。为了研究这个问题，对18例病因不明的耳蜗前庭功能障碍且梅毒血清学呈阳性的患者进行了静脉注射青霉素和皮质类固醇治疗。此外，对所有患者进行了腰椎穿刺和人类免疫缺陷病毒（HIV）检测。16例患者中有5例（31%）听力改善，13例中有11例（85%）耳鸣减轻，7例中有6例（86%）眩晕改善。与听力改善相关的因素为听力损失出现少于5年、波动性听力以及年龄小于60岁。改善与听力损失的严重程度或先前治疗无关。所有脑脊液异常的患者，包括两名艾滋病患者，主观症状均有改善。本文提出了一种诊断和治疗方案。
