International Journal of Pediatric Otorhinolaryngology (2008) 72, 257259

www.elsevier.com/locate/ijporl

CASE REPORT

Chikungunya virus induced sudden sensorineural hearing

loss

*
Kranti Bhavana, Isha Tyagi , Rajeev Kumar KapilaX

Neuro Otology Unit, Department of Neurosurgery, SGPGIMS, Rai Bareilly Road, Lucknow 226014, India

Received 28 July 2007; accepted 28 September 2007

Available online 26 December 2007

KEYWORDS

Summary The aim of this study is to demonstrate the association of Chikungunya

Chikungunya virus;

virus and sudden sensorineural hearing loss. In the case report described we had a case
Sudden sensorineural

which developed sudden unilateral sensorineural hearing loss following chikungunya

hearing loss;

fever. A 15-year-old female presented to us with the complains of unilateral sudden

Chikungunya fever

onset of hearing loss following an episode of fever, arthralgia and rashes 1 month ago.

At the time of these symptoms there were many cases of chikungunya fever in the city,

three being in her locality. Clinically Chikungunya fever was suspected and a positive

serological test further confirmed our diagnosis. The hearing loss could thus be

attributed to Chikungunya virus. Viruses have always been implicated in causing

sudden sensorineural hearing loss but Chikungunya virus as a cause has not been

documented earlier making this case report a unique one.

# 2007 Elsevier Ireland Ltd. All rights reserved.

1. Introduction

rash. Hearing loss rarely occurs in this disease which

makes the case report described below significant.

Chikungunya is a relatively rare form of viral fever

caused by an alphavirus that is spread by the bite of

Aedes aegypti mosquito [1,2]. In modern times,X

2. Case report

Chikungunya fever was first described in 1952

[3,4], following an outbreak on the Makonde Pla-X

A 15-year-old female had presented to our outpa-

teau, along the border between Tanganyika and

tient department with the complains of sudden

Mozambique. The word Chikungunya translates

onset of hearing impairment in the left ear 1 month

to that which bends up in reference to the

ago. She gave history of arthralgia in finger joints

stooped posture developed due to the rheumatolo-

and later in the knee joint along with high fever and
gic manifestations of the disease [4,5]. The triad ofX
rashes 1 week before the onset of hearing loss. Many

symptoms consists of fever, severe joint pain, and

cases of chikungunya fever were reported from

various parts of the city in that month and three

of these patients were from her neighborhood. She

had noticed a low grade tinnitus in her left ear 2 days

* Corresponding author.
after the onset of fever and on 3rd day she devel-

E-mail address: ityagi@rediffmail.com (I. Tyagi).X

0165-5876/$ see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi: 10.1016/j.ijporl.2007.09.022X
258 K. Bhavana et al.

Symptoms related to hearing have not been described in

oped deafness. It was associated with aural fullness,
severe giddiness, nausea and vomiting. She had
consulted a local physician where symptomatic
treatment for fever, joint pain and vomiting was given.
Her hearing loss was almost profound and progression
was rapid. Audiometry done after the subsidence of her
acute symptoms revealed pro-found sensorineural
hearing loss on the left side and audiometry after 1
month did not show any improvement in the hearing.
Historically Chikungu-nya fever was suspected and it
was subsequently proved on serological test. The Ig M
ELISA kit with chikungunya antigen showed a positive
response as the test specimen value exceeded the
negative control value by a factor of more than 2.1.
3. Discussion
literature which makes this case report important.X
Many viruses have been incriminated in causing sudden
hearing loss namely influenza A and B, rubeola, rubella,
mumps, herpes simplex, and CMV. The most consistent
evidence supporting viral etiology is the histopathologic
findings of varying
degrees of atrophy of the organ of Corti, stria vascularis,
and tectorial membrane with variable loss of the
neuronal population as shown by Schu-knecht et al. [7].
Perhaps the strongest evidence for the involvement of
viruses in hearing loss comes from the use of
immunofluorescent antigen studies such as those
performed by Davis and Johnson, demonstrating the
ability of rubeola and mumps to infect the inner ears of
animal models [8]. The following four evidences can be
used to categorize deafness by a viral infection [9]:X

Chikungunya fever has not been implicated in sud-den

sensorineural hearing loss but the case pre-sented above
definitely correlates this virus with this type of hearing
loss. The triad of symptoms consists of fever, severe Coincident symptoms suggesting coincident viral
joint pain, and rash. The fever is self-limiting like other infection.
viral illnesses but the joint pains can be both
incapacitating in the acute phase, and also very
prolonged, with some people being unable to walk or Serological data showing coincident viral infec-tion.
work for weeks, months and, rarely, for years [16].
Chikungunya fever usually occurs in post-monsoon
season which affects all age groups and both sexes are
equally affected. The incubation period ranges from 3 to Histopathological studies showing similarities between
12 days (usually 37 days). In susceptible populations, known viral infections and cases of sudden hearing loss.
Chikungunya fever can have attack rates as high as 40
85%. The onset is usually abrupt and sudden with high-
grade fever (usually 102105 8F), severe arthralgias, Extrapolations from the degeneration of the inner ear
myalgias and skin rash [16]. Prodromal symptoms seen in viral disease such as the pre-natal rubella
are rarely reported. During the initial few days, syndrome.
headache, throat discomfort, abdominal pain and
constipation are also frequent. There is conjunctival
suffusion, persistent conjunctivitis, and cervical or
sometimes generalized lymphadenopathy, with The third and fourth factors can be seen only after death
maculopapular or petechial rash present usually on the of the individual hence we have only history and
extremities, neck trunk and ear lobes. Swol-len tender serological tests giving us the evidence of viral
joints and crippling arthritis is usually evident [16]. infection. Many times sero-logical data too may not be
The viral polyarthropathy frequently involves the small available especially if patient has reported a long time
joints of the hand, wrist and ankles and may also after viral infection
involve the larger joints such as knee and shoulder.

4. Conclusion
Chikungunya fever in India occurs during the post-
monsoon season when there is increased amount of
stagnant water which is the breeding ground for the
Aedes aegypti mosquito. Recently the incidence of this
fever has increased in certain parts of India and
primarily consists of fever, rashes and joint pains.
Hearing loss very rarely occurs, but if it does, it is
profound like in other viral diseases.
Sudden sensorineural hearing loss following chikungunya virus infection
259
World Health Organization. Regional Office for South-East Asia.
Chikungunya fever, a re-emerging disease in Asia. Avail-able at URL:
http://www.searo.who.int/en/Section10/Sec tion2246.htm. Accessed
on October 28, 2006. X
Benjamin M. The internet living Swahili learning center. Chikungunya
is not a Swahili word, it is from the Makonde language! Available at
URL: http://research.yale.edu/swa hili/learn/?
q=en/chikungunya_makonde. Accessed on Octo-ber 28, 2006. X
Available online at www.sciencedirect.com
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