Contemporary Clinical Management of Otosyphilis for Practicing Otolaryngologists—A Scoping Review

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OBJECTIVE: The COVID-19 pandemic marked the resurgence of an old disease, syphilis. The CDC reported increased syphilis cases in the United States from 2016 to 2022, necessitating early recognition of syphilis to properly diagnose complications. We revisit otosyphilis management with the intent of developing an updated diagnostic testing algorithm and treatment plan for otolaryngologists to prevent worsening hearing loss. DATA SOURCES: MEDLINE, PubMed, Embase, Web of Science, and Cochrane databases. METHODS: A scoping review of diagnostic and treatment methods for otosyphilis was completed and reported in compliance with the guidelines outlined in the PRISMA-ScR extension for scoping reviews statement. A retrospective case series was also conducted by reviewing patient charts from a tertiary care hospital network. Patients with otosyphilis or neurosyphilis with otic symptoms, as diagnosed by an otolaryngology or infectious disease specialist, were included. RESULTS: In 57 studies (222 patients), the mean reported symptom duration was 6.6 ± 5.0 weeks (n = 30) with nine outliers presenting after 6 months (65%) had hearing loss, 95 (43%) tinnitus, and 53 (24%) vertigo. Most (97%) received penicillin. Of 84 with outcomes, 48 (57%) improved. In 18 additional patients from the tertiary hospital system cohort (17 males, 1 female; 25-87 years, 9 HIV-positive), penicillin or doxycycline was used. Six patients fully recovered, four required further therapy, two partially recovered, and one did not improve. CONCLUSION: Otosyphilis has an insidious presentation and can mimic other audiovestibular demanding early testing. Complex serologic interpretation may require referral to infectious disease specialists. Clear diagnostic protocols ensure timely treatment and improved outcomes.

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