The otologic manifestations of AIDS are protean. The pinna and external auditory canal may be affected by Kaposi sarcoma and by persistent and potentially invasive fungal infections (particularly Aspergillus fumigatus). Serous otitis media due to eustachian tube dysfunction may arise from adenoidal hypertrophy (HIV lymphadenopathy), recurrent mucosal viral infections, or an obstructing nasopharyngeal tumor (eg, lymphoma). Unfortunately, ventilating tubes are seldom helpful and may trigger profuse watery otorrhea. Acute otitis media is usually caused by typical bacterial organisms, including Proteus, Staphylococcus, and Pseudomonas, and rarely, by Pneumocystis jirovecii. Sensorineural hearing loss is common and, in some cases, results from viral CNS infection. In cases of progressive hearing loss, cryptococcal meningitis and syphilis must be excluded. Acute facial paralysis due to herpes zoster infection (Ramsay Hunt syndrome) occurs commonly and follows a clinical course similar to that in nonimmunocompromised patients. Treatment is with high-dose acyclovir (see Chapter 32). Corticosteroids may also be effective as an adjunct.