A 23-year-old Pakistani man presented with a 3-day history of severe bilateral hearing loss, fever and disorientation. He had a history of fever, headache, neck pain and flu-like symptoms a week prior to presentation, as well as diarrhea and abdominal pain during his recent travel to Pakistan. Due to high suspicion of meningoencephalitis, ceftriaxone, vancomycin and acyclovir were started with oral prednisolone. Blood culture was positive for Salmonella Typhi, to cover possible drug resistant strains (common in Pakistan), antibiotics were changed to meropenem and azithromycin. Antibiotics were later deescalated to ceftriaxone due to culture sensitivity. Fluoroscopic-guided LP showed high protein level without leukocytosis. CSF culture, TB work-up, and viral screen were negative. Initial pure tone audiometry (PTA) showed moderate bilateral SNHL almost to all frequencies. PTA after 15 days improved to mild SNHL to high frequencies only. The patient gradually improved clinically, and his SNHL completely resolved after 1 month.
Discussion:
The best treatment of typhoid fever induced SNHL is to treat the infection itself with effective antibiotics, especially in patients with recent travel to endemic areas like Pakistan. In this patient’s clinical course, hearing loss appeared during the second week, with gradual improvement 5 days after antibiotics until complete recovery was achieved after one month. Prompt initiation of adjunctive corticosteroids possibly contributed to his SNHL improvement.