Okhovat Saleh, Fox Richard, Magill Jennifer, Narula Antony
Department of ENT, West Scotland Deanery, Glasgow, UK.
Department of ENT, Northwick Park Hospital, London, Harrow, UK.
BMJ Case Rep. 2015 Dec 15;2015:bcr2015211977. doi: 10.1136/bcr-2015-211977.
A 33-year-old man developed profound sudden onset right-sided hearing loss with tinnitus and vertigo, within 24 h of pretravel rabies vaccination. There was no history of upper respiratory tract infection, systemic illness, ototoxic medication or trauma, and normal otoscopic examination. Pure tone audiograms (PTA) demonstrated right-sided sensorineural hearing loss (thresholds 90-100 dB) and normal left-sided hearing. MRI internal acoustic meatus, viral serology (hepatitis B, C, HIV and cytomegalovirus) and syphilis screen were normal. Positive Epstein-Barr virus IgG, viral capsid IgG and anticochlear antibodies (anti-HSP-70) were noted. Initial treatment involved a course of high-dose oral prednisolone and acyclovir. Repeat PTAs after 12 days of treatment showed a small improvement in hearing thresholds. Salvage intratympanic steroid injections were attempted but failed to improve hearing further. Sudden onset sensorineural hearing loss (SSNHL) is an uncommon but frightening experience for patients. This is the first report of SSNHL following rabies immunisation in an adult.
一名33岁男性在进行旅行前狂犬病疫苗接种后24小时内，突然出现严重的右侧听力丧失，并伴有耳鸣和眩晕。他没有上呼吸道感染、全身性疾病、耳毒性药物使用或外伤史，耳镜检查正常。纯音听力图（PTA）显示右侧感音神经性听力损失（阈值90 - 100分贝），左侧听力正常。内听道MRI、病毒血清学检查（乙肝、丙肝、HIV和巨细胞病毒）以及梅毒筛查均正常。检测到爱泼斯坦 - 巴尔病毒IgG、病毒衣壳IgG和抗耳蜗抗体（抗HSP - 70）呈阳性。初始治疗包括一个疗程的高剂量口服泼尼松龙和阿昔洛韦。治疗12天后复查PTA显示听力阈值有小幅改善。尝试进行挽救性鼓室内注射类固醇，但未能进一步改善听力。突发性感音神经性听力损失（SSNHL）对患者来说是一种不常见但令人恐惧的经历。这是成人狂犬病免疫接种后发生SSNHL的首例报告。
