National Institute on Deafness and Other Communication Disorders.
Howard University College of Medicine.
Otol Neurotol. 2019 Jul;40(6):e657-e664. doi: 10.1097/MAO.0000000000002242.
To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM).
Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM.
Tertiary referral center, National Institutes of Health Clinical Center.
Previously healthy adult patients with CM without immune suppressive therapy before disease onset.
Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment.
Twenty-nine patients (58 years) underwent audiologic evaluation between 6 months and 3.5 years after CM diagnosis; 21 patients were seen for longitudinal assessment with an average duration of follow up of 20.3 months. Nearly three-quarters (73%) of the cohort presented with hearing loss, most commonly (90%) sensorineural in origin. The most frequent degree of loss was mild and then moderate, although some patients had severe or profound impairment. Hearing loss improved (43%) or remained stable (38%) in most cases. Ears with internal auditory canal enhancement on magnetic resonance imaging (MRI) had significantly more hearing loss than those without enhancement, although a similar finding was not observed with gyral enhancement or the presence of ependymitis or ventricular volume expansion. Hearing loss was not associated with reduced cerebrospinal fluid (CSF) glucose, CSF total protein, cryptococcal antigen, or total cell count.
Hearing loss is a common manifestation of cryptococcal meningitis in previously healthy patients and may involve a cochlear or neural site of lesion, or both. Routine surveillance of hearing in patients is recommended, regardless of symptomatology, to ensure early and appropriate intervention and care.
确定先前健康的非 HIV cryptococcal 脑膜脑炎 (CM) 患者的听力和耳科学结果。
对前瞻性观察研究中招募的一组患者进行回顾性病例分析，这些患者是先前健康但患有 CM 的个体。
三级转诊中心，美国国立卫生研究院临床中心。
无免疫抑制治疗的先前健康成人 CM 患者。
诊断评估包括听力计、声导抗、耳声发射和听觉脑干反应研究，以及听力学评估。
29 例患者（58 岁）在 CM 诊断后 6 个月至 3.5 年内进行了听力评估；21 例患者接受了纵向评估，平均随访时间为 20.3 个月。近四分之三（73%）的患者出现听力损失，最常见的是（90%）感觉神经性起源。最常见的听力损失程度是轻度，然后是中度，尽管有些患者有严重或深度听力障碍。在大多数情况下，听力损失有所改善（43%）或保持稳定（38%）。内耳增强 MRI 患者的听力损失明显高于无增强患者，尽管在出现脑回增强或室管膜炎或脑室容积扩张时未观察到类似发现。听力损失与脑脊液 (CSF) 葡萄糖、CSF 总蛋白、 cryptococcal 抗原或总细胞计数无关。
听力损失是先前健康患者 cryptococcal 脑膜炎的常见表现，可能涉及耳蜗或神经病变部位，或两者兼而有之。建议对患者进行听力常规监测，无论症状如何，以确保早期和适当的干预和护理。
