PURPOSE: Syphilis is often called the "great imitator" as it can mask itself as a variety of other medical issues. Neurosyphilis is a subtype of syphilis that may occur at any stage of syphilis presentation. However, there is a substantial lack of literature on the presentation of hearing loss in this disease. The purpose of this case report is to discuss the presentation and outcomes related to a case of neurosyphilis. METHOD: This case report describes sudden aural fullness, tinnitus, and perceived hearing loss in a 30-year-old patient who was diagnosed with late-stage neurosyphilis. An initial audiometric evaluation identified a bilateral mild to moderately severe hearing loss that was found to be secondary to neurosyphilis. Following treatment of 2.4 million units of benzathine penicillin administered in three weekly shots, his hearing improved to normal levels. RESULTS: This case details the audiometric assessment and subsequent follow-up of this patient's care. Behavioral hearing thresholds and distortion product otoacoustic emissions recovered substantially following treatment. CONCLUSIONS: Hearing assessment may be a beneficial tool when considering patients with neurosyphilis. Additionally, continuous audiologic monitoring in this population would prove beneficial when considering treatment.