Sudden Sensorineural Hearing Loss in an Immunocompetent Patient With West Nile Encephalitis

Objective

Sudden sensorineural hearing loss (SSNHL) is a frequently encountered condition that is often idiopathic but may be precipitated by infection. Neuroinvasive disease resulting from West Nile virus (WNV) is a rare cause of SSNHL, typically affecting immunocompromised patients and generally associated with minimal hearing recovery. We present a case of an immunocompetent woman who was diagnosed with SSNHL in the setting of a WNV infection and showed significant hearing improvement.

Methods

Case report and literature review.

Results

A 55-year-old immunocompetent female presented to our Otolaryngology office after several visits to the emergency department for worsening disequilibrium and new onset bilateral hearing loss. An audiogram demonstrated bilateral SNHL. After a thorough inpatient evaluation for hematologic, oncologic, immunologic, and infectious etiologies, CSF and serum IgG and IgM antibodies to WNV were elevated. The patient was managed conservatively and, at follow-up, endorsed significant hearing improvement that was reflected on her repeat audiogram.

Conclusion

SSNHL in patients with neuroinvasive WNV is extremely rare, with only a small number of previously reported cases. WNV should be considered as a cause of SSNHL in the US, especially during the late summer and fall months. Patients should be counseled on the variable prognosis of the hearing loss, and early discussions regarding cochlear implantation should be pursued for patients without significant recovery of profound hearing loss.

Level of Evidence: IV