title: Sudden onset unilateral sensorineural hearing loss after rabies vaccination.
abstract: A 33-year-old man developed profound sudden onset right-sided hearing loss with tinnitus and vertigo, within 24 h of pretravel rabies vaccination. There was no history of upper respiratory tract infection, systemic illness, ototoxic medication or trauma, and normal otoscopic examination. Pure tone audiograms (PTA) demonstrated right-sided sensorineural hearing loss (thresholds 90-100 dB) and normal left-sided hearing. MRI internal acoustic meatus, viral serology (hepatitis B, C, HIV and cytomegalovirus) and syphilis screen were normal. Positive Epstein-Barr virus IgG, viral capsid IgG and anticochlear antibodies (anti-HSP-70) were noted. Initial treatment involved a course of high-dose oral prednisolone and acyclovir. Repeat PTAs after 12 days of treatment showed a small improvement in hearing thresholds. Salvage intratympanic steroid injections were attempted but failed to improve hearing further. Sudden onset sensorineural hearing loss (SSNHL) is an uncommon but frightening experience for patients. This is the first report of SSNHL following rabies immunisation in an adult.
authors.affiliation: Department of ENT, West Scotland Deanery, Glasgow, UK.
authors.forename: Saleh
authors.initials: S
authors.lastname: Okhovat
authors.affiliation: Department of ENT, Northwick Park Hospital, London, Harrow, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Fox
authors.affiliation: Department of ENT, St Mary's Hospital, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Magill
authors.affiliation: Department of ENT, St Mary's Hospital, London, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Narula
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001621:Betahistine / Q000627:therapeutic use; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003639:Hearing Loss, Sudden / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D017442:Histamine Agonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011818:Rabies / Q000188:drug therapy / Q000276:immunology; D011819:Rabies Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D017442:Histamine Agonists; D011819:Rabies Vaccines; D011239:Prednisolone; D001621:Betahistine; D000212:Acyclovir