Page 250 - AIDSBK23C

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infections. Use of nasal drugs is not a precipitating factor. Clinical symptoms can include fever,
headache, nasal obstruction and/or rhinorrhea, otorrhea, local pain, and swelling. The infections
can cause a mass, perforation, and invasion of surrounding tissues. The symptoms are often
present for a long time. Biopsy is usually needed for a specific diagnosis. Treatment outcomes
are often poor, but the patients usually die from other causes.[1014]
Examination of the ear in AIDS reveals that mild, or low grade, to severe otitis media can
be present in about half of patients. When low grade, the degree of inflammation is not great,
and serous to serosanguineous effusions can be seen. Purulent exudates with marked acute and
chronic inflammation can be seen with severe otitis. Causative organisms are the same as those
in the general population: Streptococcus pneumoniae, Haemophilus influenza, and Moraxella
catarrhalis. Pneumocystis carinii may rarely present as otitis media and mastoiditis.
Cholesteatoma may complicate these findings. Viral infections found in the middle ear include
cytomegalovirus, adenovirus, and herpes simplex virus. Other lesions reported to involve middle
and inner ear include cryptococcosis, cytomegalovirus, and Kaposi’s sarcoma. However, in
adults these ear infections appear to be asymptomatic and not associated with
deafness.[1015,1016,1017]
Otitis externa may be caused by Pseudomonas aeruginosa and by Aspergillus.[692] Otic
pneumocystosis is rarely reported, with granulation tissue forming a mass in the external
auditory canal. Microscopically, the amount of foamy exudate containing recognizable
organisms is variable.[1018]
Sensorineural hearing loss in HIV-positive persons may result from infections, central
nervous system lesions or ototoxicity from antiretroviral medications. The prevalence of HIV-
related sensorineural hearing loss has been estimated to be between 21% and 49%. Infectious
agents implicated in sensorineural hearing loss include Pneumocystis carinii, Candida albicans,
Staphylococcus aureus, Mycobacterium tuberculosis, Toxoplasma gondii, Cryptococcus
neoformans, Treponema pallidum, herpes viruses, and HIV directly.[1017]
Vestibular dysfunction with vertigo, dizziness, or balance problems may result from
either otologic or central neurologic disorders. In HIV-infected persons, there can be peripheral
or central vestibular dysfunction early in the course of infection and increasing over time.
Progression to AIDS may be accompanied by central nervous system complications that also
affect vestibular function.[1019]