Neuroborreliosis (NB) is a neurologic complication of Lyme disease that can cause sudden hearing loss, which can in some cases be bilateral.

A 61-year-old woman consulted for bilateral sudden hearing loss with headache and earache, following an episode of fever. Interview found a skin lesion suggestive of migratory erythema, which had developed 3 months previously after a walk in a German forest and had not initially been treated. Examination revealed severe sensorineural hearing loss and lymphocytic meningitis. Blood tests found long-standing IgM and IgG positive Borrelia burgdorferi infection with intrathecal synthesis of IgM and IgG antibodies. Corticosteroid treatment and ceftriaxone was initiated, and normalized hearing within 3 weeks.

Hearing impairment in NB may involve inflammatory, immunologic or cytotoxic mechanisms affecting hair cells. Early treatment with corticosteroids and targeted antibiotics should be prescribed when NB is suspected, to optimize the chances of recovery. In endemic geographic areas, signs of Lyme disease should be screened for in case of sudden hearing loss.