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A healthy man in his mid 30s residing in the northeastern United States was seen by his primary care physician in mid-June with a 2-week history of flulike symptoms. He was empirically started on doxycycline because he reported frequenting wooded areas.
One week later, he developed a complete right facial nerve paralysis. He was started on a course of prednisone, with subsequent full recovery of facial nerve function. About 2 weeks later, he reported new-onset right-sided hearing loss, tinnitus, and intermittent otalgia. He was evaluated in the otology clinic approximately 3 weeks after the onset of these otologic symptoms. He had no prior otologic history and no history of noise exposure. His otologic and head and neck examination findings were unremarkable.
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C. Neuroborreliosis cranial polyneuritis
Lyme disease, or Lyme borreliosis, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States, seen particularly in the coastal Northeast, upper Midwest, and West.1,2 It is a multisystem disease transmitted to humans by infected ticks of the Ixodes species. Otolaryngologic manifestations, including neck pain and stiffness, sore throat, dizziness, lymphadenopathy, otalgia, tinnitus, cranial nerve neuritis, and hearing loss, affect up to 75% of patients.3 In this patient, the diagnosis of Lyme disease was confirmed in a standard fashion by a positive IgM immunoblot, which showed reactivity to 23-, 39-, and 41-kDa proteins. Lyme disease typically manifests in 3 clinical stages of early localized disease, early disseminated disease, and late disease.
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Corresponding Author: Alexander G. Bien, MD, Albany ENT & Allergy Services, PC, 400 Patroon Creek Blvd, Ste 205, Albany, NY 12206 (email@example.com).
Published Online: December 20, 2018. doi:10.1001/jamaoto.2018.3626
Conflict of Interest Disclosures: None reported.
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