Patricia Coyle
source: Rheumatic Diseases Clinics of North America
Volume 19 Number 4 November 1993
pgs. 993-1009
pg.995 "Cranial Nerve Palsy--70 % to 80% of Lyme-related cranial neuropathies involve the facial nerve(cranial nerve7) Bell's Palsy is the single most commonly diagnosed neurologic abnormality of Lyme disease ...........Up to one third of patients have bilateral involvement which is very suggestive for Lyme disease. Only Guillain-Barre syndrome and neurosarcoidosis are other major causes of acute bilateral facial nerve palsy."--( both of these conditions have unknown etiology)---" Facial weakness may occur in the setting of meningitis or may be an isolated lesion with normal CSF. The prognosis of Lyme-related Bell's palsy is the same as for idiopathic Bell's palsy, and 85% of patients have virtually complete recovery within a few months.....Lyme disease may affect the optic nerve to produce optic neuritis, ischemic optic neuropathy, or disc edema; cranial nerves 3,4 and 6 to produce diplopia; the trigeminal nerve (cranial nerve five ) to produce facial numbness or pain; cranial nerve 8 to produce hearing loss or tinnitus; and rarely cranial nerves 9 through 12......"
Title: Otolaryngologic aspects of Lyme disease.
Authors: Moscatello AL, Worden DL, Nadelman RB, Wormser G, Lucente F
Source: Laryngoscope 1991 Jun;101(6 Pt 1):592-5
Organization: Department of Otolaryngology, New York Medical College.
Abstract:
Lyme disease is a systemic illness caused by the spirochete Borrelia burgdorferi and transmitted by the bite of a tick in the Ixodes ricinus complex. While the illness is often associated with a characteristic rash, erythema migrans, patients may also present with a variety of complaints in the absence of the rash. The otolaryngologist may be called upon to see both groups of patients, with any number of signs and symptoms referable to the head and neck, including headache, neck pain, odynophagia, cranial nerve palsy, head and neck dysesthesia, otalgia, tinnitus, hearing loss, vertigo, temporomandibular pain, lymphadenopathy, and dysgeusia. We review our institutional experience with 266 patients with Lyme disease, 75% of whom experienced head and neck symptoms. We also summarize the diagnostic and treatment modalities for this illness.
Language: Eng
Unique ID: 91251692
from the archives:
Subject: Re: URGENT - Deafness as a lyme symptom?
From:
heirgm@umdnj.eu (heirgm)
Date: 1998/02/04
Sudden hearing loss has been reported in LD. It can go on to profound
hearing loss or resolve with tx. There is one case report where
hearing returned after a few months after treatment ended. Following
are some references for your review.
Unique Identifier
97374644
Authors
Quinn SJ. Boucher BJ. Booth JB.
Title
Reversible sensorineural hearing loss in Lyme disease.
Source
Journal of Laryngology & Otology. 111(6):562-4, 1997 Jun.
Abstract
We report a case of bilateral sensorineural hearing loss of two
years
duration which appears to have been due to late Borrelia burgdorferi
infection. The 39-year-old woman presented with bilateral deafness
and
multiple other neurological complaints some six months after
developing a
'target' lesion on the lower leg after walking in the New Forest.
'Serology' for Borrelia burgdorferi became positive and the patient
made a
complete recovery from both her deafness and her other neurological
problems after a five-week course of oral antibiotic therapy.
<871>
Unique Identifier
95129405
Authors
Goldfarb D. Sataloff RT.
Title
Lyme disease: a review for the otolaryngologist. [Review] [24 refs]
Source
Ear, Nose, & Throat Journal. 73(11):824-9, 1994 Nov.
Abstract
Lyme disease is an important consideration in the differential
diagnosis
of patients seen by the otolaryngologist. Facial paralysis is the
most
common sign. The otolaryngologist may also see patients with
temporal
mandibular joint pain, cervical lymphadenopathy, facial pain,
headache,
tinnitis, vertigo, decreased hearing, otalgia and sore throat. The
incidence is increasing and known to be endemic to certain areas of
the
United States and abroad. This paper reviews the various ways Lyme
disease
appears to the otolaryngologist. Three cases along with a discussion
including epidemiology, vector, animal host relationship, clinical
manifestations and pathophysiology are included. The literature is
reviewed and the treatment discussed. [References: 24]
93227865
Authors
Ishizaki H. Pyykko I. Nozue M.
Title
Neuroborreliosis in the etiology of vestibular neuronitis.
Source
Acta Oto-Laryngologica - Supplement. 503:67-9, 1993.
Abstract
Symptoms and incidence of neuroborreliosis (NB) were studied in
ambulatory
patients visiting the ENT clinic in Helsinki. Especially we tried to
search for possible markers indicating the connection between
vestibular
neuronitis and NB. A total of 350 patients were screened with the
enzyme-linked immunosorbent assay (ELISA) technique for possible
antibodies against Borrelia burgdorferi (BB). Twelve patients had
positive
serological reactions for BB with sera titer levels ranging from
640-14700
(normal < 500). In 2 additional cases, NB was clinically confirmed.
In 7
cases a history of tick bite and in 4 cases erythema chronicum
migrans was
confirmed. In 9 cases, vertigo was the predominant symptom, and in 3
cases
the symptoms were linked to facial nerve paresis. Six patients
suffered
from hearing loss. In 7 cases, the diagnosis was initially settled
as
vestibular neuronitis. NB seems to be present in about 4% of cases
with
apparent otologic diseases in Finland. In the majority of the cases,
the
disease resembles vestibular neuronitis in the acute stage. Since NB
is
tractable, all patients visiting the ENT clinic, especially those
with
vertigo, should be screened.
Unique Identifier
90211474
Authors
Riechelmann H. Hauser R. Vogt A. Mann W.
Title
[The Borrelia titer in ENT diseases]. [German]
Source
Laryngo- Rhino- Otologie. 69(2):65-9, 1990 Feb.
Abstract
In 139 patients with facial paralysis, sudden hearing loss, vertigo,
and
lymphadenitis of the head and neck, the prevalence of borrelia
burgdorferi
serum antibodies was examined with the help of immunofluorescence
assays
for IgG- and IgM-antibodies, immunofluorescence assays after
absorption of
cross-reacting antibodies with treponema phagedenis, ELISA, and
Western
Blot. Six out of 22 patients with facial paralysis, 11 out of 72
with
hearing loss, eight out of 45 with vertigo, and five out of 25 with
lymphadenitis of the head and neck were seropositive. These patients
were
compared with a control group of 52 patients without any clinical
signs of
Lyme disease. The control group consisted of patients admitted for
surgery
of septal deformities (n = 19), squamous cell carcinomas (n = 27),
and
pleomorphic adenomas of the salivary glands (n = 6). In nine out of
52
patients in the control group, antibodies against Borrelia
burgdorferi
were detectable. According to Fisher's exact test, there was no
statistical difference between the two groups as regards the
prevalence of
seropositive patients. Lyme disease is a doubtful major etiologic
factor
in facial paralysis, sudden hearing loss, or vertigo.
Unique Identifier
89096089
Authors
Hanner P. Rosenhall U. Edstrom S. Kaijser B.
Title
Hearing impairment in patients with antibody production against
Borrelia
burgdorferi antigen.
Source
Lancet. 1(8628):13-5, 1989 Jan 7.
Abstract
This study aimed to evaluate the extent to which hearing disorders
may be
a result of tick-borne Borrelia burgdorferi infection. 98 patients
with
different patterns of hearing dysfunction were studied. The patients
had a
history of sudden hearing loss, disorders similar to Meniere's
disease, or
hearing loss in combination with acute facial palsy or with vertigo.
Serum
antibodies against the B burgdorferi antigen were determined during
the
acute and convalescent periods. 17 patients (17%) showed serological
evidence of borreliosis (reciprocal titre of 320 or above). All but
3 of
these patients also had vertigo and 3 subjects had peripheral facial
palsy. All the 17 patients were treated with high doses of
intravenous
benzylpenicillin. The hearing of 5 patients improved on treatment.
Although the specificity of antibody production against borrelia
antigen
has not been completely clarified, it is concluded that repeated
serological examinations are worthwhile in patients with unexplained
hearing disorders.
91042860
Authors
Logigian EL. Kaplan RF. Steere AC.
Title
Chronic neurologic manifestations of Lyme disease [see comments].
Source
New England Journal of Medicine. 323(21):1438-44, 1990 Nov 22.
Abstract
BACKGROUND AND METHODS. Lyme disease, caused by the tick-borne
spirochete
Borrelia burgdorferi, is associated with a wide variety of
neurologic
manifestations. To define further the chronic neurologic
abnormalities of
Lyme disease, we studied 27 patients (age range, 25 to 72 years)
with
previous signs of Lyme disease, current evidence of immunity to B.
burgdorferi, and chronic neurologic symptoms with no other
identifiable
cause. Eight of the patients had been followed prospectively for 8
to 12
years after the onset of infection. RESULTS. Of the 27 patients, 24
(89
percent) had a mild encephalopathy that began 1 month to 14 years
after
the onset of the disease and was characterized by memory loss, mood
changes, or sleep disturbance. Of the 24 patients, 14 had memory
impairment on neuropsychological tests, and 18 had increased
cerebrospinal
fluid protein levels, evidence of intrathecal production of antibody
to B.
burgdorferi, or both. Nineteen of the 27 patients (70 percent) had
polyneuropathy with radicular pain or distal paresthesias; all but
two of
these patients also had encephalopathy. In 16 patients
electrophysiologic
testing showed an axonal polyneuropathy. One patient had
leukoencephalitis
with asymmetric spastic diplegia, periventricular white-matter
lesions,
and intrathecal production of antibody to B. burgdorferi. Among the
27
patients, associated symptoms included fatigue (74 percent),
headache (48
percent), arthritis (37 percent), and hearing loss (15 percent). At
the
time of examination, chronic neurologic abnormalities had been
present
from 3 months to 14 years, usually with little progression. Six
months
after a two-week course of intravenous ceftriaxone (2 g daily), 17
patients (63 percent) had improvement, 6 (22 percent) had
improvement but
then relapsed, and 4 (15 percent) had no change in their condition.
CONCLUSIONS. Months to years after the initial infection with B.
burgdorferi, patients with Lyme disease may have chronic
encephalopathy,
polyneuropathy, or less commonly, leukoencephalitis. These chronic
neurologic abnormalities usually improve with antibiotic therapy.
89096089
Authors
Hanner P. Rosenhall U. Edstrom S. Kaijser B.
Title
Hearing impairment in patients with antibody production against
Borrelia
burgdorferi antigen.
Source
Lancet. 1(8628):13-5, 1989 Jan 7.
Abstract
This study aimed to evaluate the extent to which hearing disorders
may be
a result of tick-borne Borrelia burgdorferi infection. 98 patients
with
different patterns of hearing dysfunction were studied. The patients
had a
history of sudden hearing loss, disorders similar to Meniere's
disease, or
hearing loss in combination with acute facial palsy or with vertigo.
Serum
antibodies against the B burgdorferi antigen were determined during
the
acute and convalescent periods. 17 patients (17%) showed serological
evidence of borreliosis (reciprocal titre of 320 or above). All but
3 of
these patients also had vertigo and 3 subjects had peripheral facial
palsy. All the 17 patients were treated with high doses of
intravenous
benzylpenicillin. The hearing of 5 patients improved on treatment.
Although the specificity of antibody production against borrelia
antigen
has not been completely clarified, it is concluded that repeated
serological examinations are worthwhile in patients with unexplained
hearing disorders.
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