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Response to “Routine Testing of Borrelia Serology in Sudden Sensorineural Hearing Loss” from James E. Saunders

and the authors of this article both state that routine screening of patients with SSNHL is not warranted. Borrelia is a relatively rare cause of SSNHL, but these tests may have value in determining an etiology of SSNHL in selected patients. Clinicians must employ their diagnostic acumen to determine which patients are at risk for this particular etiology (among others). When faced with positive serum antibodies, the clinician must then decide whether to proceed with CSF sampling or to treat the patient without confirmatory CSF titers. In their article, Bakker et al appropriately question the diagnostic value of Borrelia serology in SSNHL and thus provide important information to help make these difficult decisions. We should be careful, however, not to infer from their review that Borrelia serology is of no value in the evaluation of patients with SSNHL.