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Audiologic Manifestations of Patients with Post-Treatment Lyme Disease Syndrome

2003; Lippincott Williams & Wilkins; Volume: 24; Issue: 6 Linguagem: Inglês

10.1097/01.aud.0000100205.25774.5f

1538-4667

Lawrence I. Shotland, Mary Ann Mastrioanni, Daniel L. Choo, Yvonne M. Szymko-Bennett, Leonard G. Dally, Anita Pikus, Kathryn Sledjeski, Adriana Marques,

Dermatological diseases and infestations

In Brief Objective The purpose of this study was to characterize auditory function in patients diagnosed with post-treatment Lyme disease syndrome (PTLDS). Design Eighteen patients with PTLDS were evaluated and compared to a normal population. Evaluations consisted of pure tone and speech thresholds, word recognition (WRS), acoustic immittance battery, auditory brain stem response (ABR), and loudness discomfort level (LDL). Both seropositive and seronegative patients were evaluated. Audiologists were blinded to patient status. Results Forty four percent of the patients had one or more abnormal pure tone thresholds compared to gender- and age-adjusted norms. Thirty-one percent showed abnormally reduced LDLs, and 17% had abnormal acoustic reflexes at one or more frequencies. Conclusions This paper catalogs previously unstudied long-term auditory system sequelae resulting from PTLDS. Our most significant finding was the dramatically reduced loudness tolerance in the presence of either normal or minimally impaired hearing. The clinician is encouraged to consider PTLDS when confronted with these or similar findings in patients having history of Borrelia burgdorferi infection and continued complaints. As part of a comprehensive effort to study post-treatment Lyme disease syndrome (PTLDS), this article describes the auditory responses on a cohort of PTLDS patients. Eighteen patients underwent comprehensive audiologic evaluations, brain magnetic resonance imaging (MRI) with gadolinium, and cerebrospinal fluid analysis. They were compared with 33 age- and sex-matched healthy controls and with a published database. Of the 18 patients, 41% showed non-specific white matter lesions on MRI; 44% had subtle pure-tone abnormalities exceeding the 95% percentile; and 31% had reduced loudness tolerance levels. The reduced loudness tolerance in the presence of either normal or minimally impaired hearing appears to be part of PTLDS. Whereas other articles have reported hearing loss in Lyme disease patients, definitions of hearing loss are inconsistent among studies. In contrast to the more traditional approach of identification according to clinical hearing loss, the approach used in the present study appears to be more sensitive for the purpose of identifying disease-related abnormalities.