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Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients

King, Kelly A.*; Ansari, Ghedak; Panackal, Anil A.; Zalewski, Chris*; Anjum, Seher; Bennett, John E.; Beri, Andrea§; Kim, Hung Jeff*,||; Hammoud, Dima; Brewer, Carmen C.*; Williamson, Peter R.

doi: 10.1097/MAO.0000000000002242
MEDICAL NEUROTOLOGY
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Objective: To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM).

Study Design: Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM.

Setting: Tertiary referral center, National Institutes of Health Clinical Center.

Patients: Previously healthy adult patients with CM without immune suppressive therapy before disease onset.

Interventions: Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment.

Results: 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.

Conclusions: 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.

*National Institute on Deafness and Other Communication Disorders

Howard University College of Medicine

Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health

§Biomedical Translational Research Information System

||Department of Otolaryngology–Head and Neck Surgery, Georgetown University Hospital, Washington, DC

Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland

Address correspondence and reprint requests to Peter R. Williamson, 9000 Rockville Pike, Bldg. 10, Rm. 11C208, Bethesda, MD, 20892; E-mail: williamsonpr@mail.nih.gov.

Sources of Support: NIAID/NIH intramural program, AI001123 and AI001124, NIDCD/NIH intramural program ZIA-DC000064, and the Clinical Center at the National Institutes of Health.

The authors disclose no conflicts of interest.

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