Involvement of the Ear Following Rabies-Immunisation

BY

Dr. RAMESH CHANDRA M.s. (ENT), D.L.O.

II'illingdon Hospital, Xew Delhi.

Sample Vaccine (5% suspension of phenol killed sheepbrain virus) is used in \Villingdon Hospital, New Delhi, forAnti-Rabies immunisation. Mehrotra and Khosla (1), 1963,have noted that the neurological complications of rabies-Immuni-sation has been variously reported as I in 287 to 1 in 8,287.Expert committee on Rabies, W.H.O. (2), 1960, has reportedthat the incidence of neuroparalytic accidents following a courseof nervous tissue vaccine varies from one country to another Tilltoday exact etiology for these complications is not known.Various theories as reported by Mehrotra and Khosla (1), 1963,are :-

1. Virus as causative factor -

(a) Inoculation of live virus.

(b) Fixed virus of the inoculum.

2. Measles, small-pox and rabies are pre-disposingfactors to an independant enanthem termed as an"Acute perivascular myelenoclisis ".

3. Toxic effect of constituent of nerve tissue.

4. Recent views - anaphylactic or allergic.

Affection of the ear following immunisation by anti-rabiesserum seems to be rare. Various neurological complication likedorso-lumber myelitis, Landry's paralysis, polyikuritis, encep-halo-myelitis etc. have been described but affection of the earseems to be rare. Appelbaum et al (3), 1953, after studying 44

Involvement of the Ear following Rabies - Imniunisation 133

cases of neurologic complications from 1928 to 1951, observedthat dizziness and atoxia were occasional findings.

Shree S. T., aged 70 years, retired male railway-employeewas bitten by a stray dog in the first week of Angst 1963. Thedog was immediately killed by the people. He felt giddy andblockage of left ear after 10th injection of sample-vaccine. Hedid not bring this to the to the notice .of attending physician andin all he received 15 injections. He never noticed discharge norfelt pain in the ear. He attended the E. N. T. Department on21-8-63 for the above complaints. He was already deaf in hisleft ear for the past 16 years which occured after a drowningaccident.

ON EXAMINATION

There was no spontaneous nystagmus or pastpointing.Rombergism - negative. Gait - falling to left side on closure ofthe eyes. Right-ear drum showed kidney shaped perforation afterit was cleared of little mucoid discharge. Conjestion was notnoticed. The left tympanic membrane was lustreless without anyperforation. Regions of nose and throat were normal.

rit *11Ly

(a) Hearing tests - Rinne - Positive in right ear and false-positive in left ear for alltuning forks.

A.B.C. - Markedly reduced on rightear.

C.V. - 6" (for numbed - right ear.Nil - left ear.

(b) Fistula test - Negative.

(c) Caloric test - Modified Kobrak test using coldalcohol.

Latent Period. Duration.Right ear ... 20 Sec. 90 Sec.Left ear ... 40 Sec. 90 Sec.

Ramesh Chandra

AUDIOGRAM

1+ I ^^ 1 1 1 1 1 1 ^ I^1'1 : (1 1

M----MU

-!-- U

-----mn

_____ __U -Ummmma-mnNO HEARING IN LEFT-EAR

TREATMENT

Patient was treated by antihistaminics, Vit. A in high dosesand antibiotics.

PROGNOSIS

Patient was observed for two months without any change inhearing. Discharge became scmty and patient felt giddy only onsudden movements.

DISCUSSION

The patient was alright before anti-rabies immunisationexcept for the anacusis in the left ear. After fifth injection ofSample Vaccine he felt giddy and deafness in the right ear. Thiscan be attributed to involvement of the right inner ear. Tuningfork tests and audiogram show neurosensory type of hearing loss.Sensation of giddyness and falling to the left side on walkingsuggest involvement of the vestibular labyrinth. Caloric testshows hypoactivity of both vestibular labyrinths. Patient wasalready deaf on his left ear for the past 16 years and it can be

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Involvement of the Ear following Rabies - Immunisation 135

deduced that both cochlear and vestibular function were affect-ed on this side since than. Therefore, the affection of the rightvestibular labyrinth must be of recent occurance due to anti-rabies vaccine. Patient, also, had no past history of ear dischargefrom the right ear. Otoscopy revealed discharge in the right earand central type of perforation of right tympanic membrane.The affection was painless Anti-rabies vaccine might have causedlocal allergy in the middle ear and subsequent perforation of theear drum.

SUMMARY

A case has been described in which the middle and innerear were involved duriug anti-rabies immunisation. Both cochlearand vestibular portions of the labyrinth have been involved.Allergy due to injection of the Sample Vaccine seems to be theresponsible cause.

ACKNOWLEDGEMENTS

I am indebted to Dr. H. L Khosla, M.D., CH. B. 'MedicalSuperintendent and Senior Staff Surgeon, AVillingdon Hospital,New Delhi fot his kind permission to record this case.

REFERENCES

1. Mchrotra A. N. and Khosla S. N.: The J. Asso. Phy. Ind., Vol. dit : September687, 690: 1963.

2. Expert Committee on: Fourth report of W.H.O Technical report series No.201:13: 1960.

3. Appelbaum E. et al: J. A. M. A.: 189; 1933.