Atypical otosyphilis presenting as chronic suppurative otitis media with isolated conductive hearing loss

Otosyphilis is an uncommon manifestation of Treponema pallidum infection that typically causes sensorineural hearing loss, tinnitus, and vertigo. Conductive hearing loss resulting from middle ear involvement is exceptionally rare. CASE PRESENTATION: A 32-year-old Ethiopian woman presented with a 6-month history of persistent left ear discharge and progressive hearing loss....

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Clinicians should consider otosyphilis even when hearing loss is purely conductive rather than sensorineural, as atypical presentations can masquerade as routine chronic suppurative otitis media and delay diagnosis.

Atypical otosyphilis presentations risk prolonged misdiagnosis, underscoring the need to include syphilis serology in the workup for treatment-resistant ear disease regardless of the audiometric pattern.

1. 01Otosyphilis classically causes sensorineural hearing loss, but this case shows isolated conductive hearing loss.
2. 02The presentation mimicked chronic suppurative otitis media (a long-term draining ear infection), delaying correct diagnosis.
3. 03Syphilis serology should be considered even in atypical otological presentations.
4. 04Early identification and antibiotic treatment of otosyphilis can prevent further hearing deterioration.
5. 05Rising rates of syphilis globally make awareness of its ear manifestations increasingly important.

PMID

42983479

DOI

10.1186/s13256-026-06472-3.

Journal

Journal of Medical Case Reports

Publication type

case_report

Evidence level

4

Sample size

1

Population

Individual patient presenting with atypical otosyphilis

Intervention

Diagnosis and characterisation of atypical otosyphilis presentation