Otosyphilis: a practical guide to diagnosis and treatment.

The diagnosis and management of patients with suspected treponemal infection of the temporal bone pose some challenges. The following points deserve emphasis: 1) the MHA-TP or FTA-Abs is recommended over the reagin serologic tests (VDRL, RPR); 2) one should regard this process as an attempt to define a subgroup of patients with sensorineural hearing loss who will benefit from a combination of antibiotics and steroid therapy rather than explicitly diagnosing infection of the temporal bone. The response rate to therapy is limited; but, otosyphilis, as one of the few treatable causes of sensorineural hearing loss, must be suspected in the differential diagnosis of a wide range of otologic patients.