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Xie W, Karpeta N, Tong B, Liu Y, Zhang Z, Duan M. Comorbidities and laboratory changes of sudden sensorineural hearing loss: a review. Front Neurol 2023; 14:1142459. [PMID: 37144001 PMCID: PMC10151530 DOI: 10.3389/fneur.2023.1142459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is defined as an abrupt hearing loss of more than 30 dB in three contiguous frequencies within 72 h. It is an emergency disease requiring immediate diagnosis and treatment. The incidence of SSNHL in Western countries' population is estimated between 5 and 20 per 1,00,000 inhabitants. The etiology of SSNHL remains unknown. Due to the uncertainty of the cause of SSNHL, at present, no specific treatment targets the cause of SSNHL, resulting in poor efficacy. Previous studies have reported that some comorbidities are risk factors for SSNHL, and some laboratory results may provide some clues for the etiology of SSNHL. Atherosclerosis, microthrombosis, inflammation, and the immune system may be the main etiological factors for SSNHL. This study confirms that SSNHL is a multifactorial disease. Some comorbidities, such as virus infections, are suggested to be the causes of SSNHL. In summary, by analyzing the etiology of SSNHL, more targeting treatments should be used to achieve a better effect.
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Affiliation(s)
- Wen Xie
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Niki Karpeta
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology-Head and Neck Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Busheng Tong
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China
| | - Yuehui Liu
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhilin Zhang
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Maoli Duan
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology-Head and Neck Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maoli Duan
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Dumberger LD, Hwa TP, Panara K, Husain S, Yver C, Bigelow DC. Profound Sudden Sensorineural Hearing Loss in Hematologic Malignancy: A Case for Urgent Cochlear Implantation With Discussion and Systematic Review of the Literature. Otol Neurotol 2021; 42:e815-e824. [PMID: 33782258 DOI: 10.1097/mao.0000000000003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To perform a systematic review of sensorineural hearing loss (SNHL) in hematologic malignancy; to describe an illustrative case of urgent cochlear implantation for bilateral profound SNHL and vestibular hypofunction in hyperviscosity syndrome; to suggest an approach to management of hyperviscosity syndrome-associated deafness with cochlear implantation. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic search of PubMed and Embase databases was undertaken for articles detailing clinical information about SNHL caused directly by hematologic malignancies. RESULTS A total of 37 studies from 1989 to 2020 were qualitatively reviewed, the majority of which were case studies or case series. Causes of hearing loss in hematologic malignancy were found to include hyperviscosity syndrome, labyrinthine hemorrhage, infiltration, and infection. Patients with profound SNHL in hematologic malignancies from hyperviscosity syndrome may be candidates for cochlear implantation, and are also at increased risk for cochlear ossification. We review previous cases for their diagnostic approach, treatment paradigm, and outcomes data, and propose an approach to management. CONCLUSION Bilateral sudden profound SNHL and vestibular hypofunction is a presenting symptom of hyperviscosity syndrome in hematologic malignancy. Although this entity is rare and previous reports have suggested improvement in hearing with oncologic treatment, cases with profound hearing loss are unlikely to recover serviceable hearing. We advocate for early magnetic resonance imaging with attention to fluid signal in the inner ear and serial audiometric follow-up to guide clinical decisions. We advise early consideration for cochlear implantation.
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Affiliation(s)
- Lukas D Dumberger
- Division of Neurotology & Lateral Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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What Is Your Diagnosis? J Avian Med Surg 2020; 34:403-408. [PMID: 33355419 DOI: 10.1647/1082-6742-34.4.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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4
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Shallis RM, Stahl M, Bewersdorf JP, Hendrickson JE, Zeidan AM. Leukocytapheresis for patients with acute myeloid leukemia presenting with hyperleukocytosis and leukostasis: a contemporary appraisal of outcomes and benefits. Expert Rev Hematol 2020; 13:489-499. [PMID: 32248712 DOI: 10.1080/17474086.2020.1751609] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Hyperleukocytosis, defined as a total white blood cell count (WBC) >50 or more commonly >100 × 109 cells/L, is a presenting feature of acute myeloid leukemia (AML) in about 6-20% of cases and is associated with a higher risk of tumor lysis syndrome (TLS), disseminated intravascular coagulation (DIC), clinical leukostasis with end organ damage, and mortality.Areas covered: In this review, authors discuss the implications of hyperleukocytosis in AML and the current understanding of cytoreductive strategies with a focus on the use of leukocytapheresis.Expert commentary: Efforts to rapidly reduce peripheral myeloblasts have included the use of leukocytapheresis. Early studies demonstrated feasibility in reducing peripheral WBC and blast counts as well as clinically relevant patient outcomes which prompted its common use for many years. However, more recent data have directly challenged the previously touted reports of reduced TLS and DIC incidence as well as survival benefit, even in patients with clinical leukostasis. The use of leukocytapheresis remains highly controversial with wide practice variations among physicians, institutions, and countries given the lack of high-quality data, risks associated with leukocytapheresis itself, associated high costs, resource utilization, and lack of evidence-based clinical guidelines.
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Affiliation(s)
- Rory M Shallis
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Maximilian Stahl
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jan Philipp Bewersdorf
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeanne E Hendrickson
- Departments of Laboratory Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
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Cass ND, Gubbels SP, Portnuff CDF. Sudden Bilateral Hearing Loss, Tinnitus, and Vertigo as Presenting Symptoms of Chronic Myeloid Leukemia. Ann Otol Rhinol Laryngol 2018; 127:731-734. [DOI: 10.1177/0003489418787831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The objective was to describe a unique case of sudden bilateral hearing loss, tinnitus, and vertigo presenting as the first symptoms of chronic myeloid leukemia (CML). Methods: A patient case is discussed along with a review of associated literature. Results: A patient presented with sudden onset hearing loss, tinnitus, and vertigo, and was diagnosed with CML with an initial white blood cell (WBC) count of 555 000 per microliter. The proposed etiology of otologic symptoms is hyperleukocytosis. Serial audiograms showed minimal improvement in hearing despite reduction of WBC. Conclusion: In cases of bilateral, sudden onset sensorineural hearing loss, evaluation for systemic causes of otologic symptoms, including CML, should be considered.
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Affiliation(s)
- Nathan D. Cass
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Samuel P. Gubbels
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cory D. F. Portnuff
- UCHealth Hearing and Balance Clinic, University of Colorado Hospital, Aurora, Colorado, USA
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Tachiki L, Dong ZM, Burwick N. Atypical chronic lymphocytic leukemia presenting with massive IgM paraprotein. Ann Hematol 2018; 97:921-922. [PMID: 29411125 DOI: 10.1007/s00277-018-3261-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Tachiki
- University of Washington School of Medicine, 1959 NE Pacific Street, Box 356421, Seattle, WA, 98195, USA.
| | - Zhao Ming Dong
- University of Washington School of Medicine, 1959 NE Pacific Street, Box 356421, Seattle, WA, 98195, USA.,VA Puget Sound Healthcare System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Nicholas Burwick
- University of Washington School of Medicine, 1959 NE Pacific Street, Box 356421, Seattle, WA, 98195, USA.,VA Puget Sound Healthcare System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
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Linenberger ML, Price TH. Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications. J Intensive Care Med 2016; 20:88-103. [PMID: 15855221 DOI: 10.1177/0885066604273479] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Apheresis is the process of separating the blood and removing or manipulating a cellular or plasma component for therapeutic benefit. Such procedures may be indicated in the critical care setting as primary or adjunctive therapy for certain hematologic, neurologic, renal, and autoimmune/rheumatologic disorders. In part I of this series, the technical aspects of apheresis were described and the physiologic rationale and clinical considerations were discussed. This review highlights the pathophysiologic basis, specific clinical indications, and treatment parameters for disorders that more commonly require management in the intensive care unit. The choice of plasma or cellular apheresis in these cases is guided by wellaccepted, evidence-based clinical treatment guidelines. For some disorders, such as liver failure, severe sepsis, and multiple-organ dysfunction syndrome, apheresis treatment approaches remain experimental. Ongoing studies are investigating the potential utility of conventional plasma exchange, ex vivo plasma manipulation, and newer technologies for these and other disorders in severely ill patients.
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Affiliation(s)
- Michael L Linenberger
- Apheresis and Cellular Therapy, Seattle Cancer Care Alliance, Seattle, WA 98109, USA.
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Spiers AS. Management of the Chronic Leukemias: Special Considerations in the Elderly Patient. Part I. Chronic Lymphocytic Leukemias. Hematology 2016; 6:291-314. [DOI: 10.1080/10245332.2001.11746584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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Sinclair KM, Hawkins MG, Wright L, Chin RP, Owens SD, Guzman DSM, Kent MS, BVSc HLS. Chronic T-cell Lymphocytic Leukemia in a Black Swan ( Cygnus atratus ): Diagnosis, Treatment, and Pathology. J Avian Med Surg 2016; 29:326-35. [PMID: 26771322 DOI: 10.1647/2015-075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An asymptomatic 14-year old, male black swan ( Cygnus atratus ) housed at a zoological institution was presented for routine preshipment examination. Hematologic findings indicated that the bird had a severe lymphocytic leukocytosis, consistent with chronic lymphocytic leukemia. Radiographs showed the presence of multiple soft tissue masses within the caudal coelomic cavity; ultrasound showed one mass to be an enlarged spleen, a cystic mass near the gonads, and a mass suspected to be associated with the ventriculus. Results of further antemortem diagnostics, including bone marrow aspiration, fine-needle aspirate cytology of the coelomic masses, and immunohistochemical staining confirmed T-cell leukemia with infiltration of the bone marrow and the spleen. The bird showed partial response to treatment with chlorambucil, lomustine, prednisone, l-asparaginase, and whole-body radiation, with neither evidence of adverse effects nor clinical signs of disease. Although the leukemia showed response, there was no evidence of remission at any point. The swan died 433 days after initial evaluation and initiation of therapy. Necropsy, histopathologic findings, and immunohistochemistry results confirmed extensive infiltration of multiple organs, including the liver, spleen, heart, lungs, and kidneys with neoplastic T-cell lymphocytes.
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10
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Venous thromboembolism in patients with chronic lymphocytic leukemia. Thromb Res 2015; 136:1082-6. [DOI: 10.1016/j.thromres.2015.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/04/2015] [Accepted: 05/12/2015] [Indexed: 11/24/2022]
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11
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Sudden sensorineural hearing loss as the first manifestation of chronic myeloid leukaemia: case report. The Journal of Laryngology & Otology 2014; 128:1015-7. [DOI: 10.1017/s0022215114002102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Sudden sensorineural hearing loss rarely occurs in patients with chronic myeloid leukaemia.Case report:We present a case report of a patient who presented with sudden sensorineural hearing loss as the first manifestation of chronic myeloid leukaemia, and review the mechanisms responsible for sudden sensorineural hearing loss in leukaemic patients.Results:A 31-year-old female presented to our clinic with unilateral sudden sensorineural hearing loss and tinnitus. Pure tone audiometry revealed profound sensorineural hearing loss in the left ear at all frequencies. During an investigation into her hearing loss, the patient was found to have chronic myeloid leukaemia.Conclusion:Every case of sudden sensorineural hearing loss must be carefully evaluated, and haematological disorders must be considered in the differential diagnosis of sudden hearing loss.
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12
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Bruserud Ø, Liseth K, Stamnesfet S, Cacic DL, Melve G, Kristoffersen E, Hervig T, Reikvam H. Hyperleukocytosis and leukocytapheresis in acute leukaemias: experience from a single centre and review of the literature of leukocytapheresis in acute myeloid leukaemia. Transfus Med 2013; 23:397-406. [PMID: 23919332 DOI: 10.1111/tme.12067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 04/18/2013] [Accepted: 06/23/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hyperleukocytosis is usually defined as leukocyte count >100 × 10(9) L(-1) and can be seen in newly diagnosed leukaemias. Hyperleukocytic leukaemia is associated with a risk of organ failure and early death secondary to leukostasis. Mechanical removal of leukocytes by the apheresis technique, leukocytapheresis, is a therapeutic option in these patients. METHODS During a 16-year period, 16 patients were treated with leukocytapheresis (35 apheresis procedures) for hyperleukocytosis/leukostasis. We present our experience, and in addition we review previous studies of hyperleukocytosis/leukocytapheresis in patients with acute myeloid leukaemia (AML). RESULTS We used a highly standardised approach for leukocytapheresis in leukaemia patients with hyperleukocytosis. The average leukocytapheresis number for each patient was 2·2 (range 1-6). Median leukocyte count before apheresis was 309 × 10(9) L(-1) (range 104-935); the mean leukocyte count reduction was 71%, corresponding to a mean absolute reduction of 219 × 10(9) L(-1). No serious side effects were seen during or immediately after apheresis. CONCLUSIONS The data suggest that our standardised technique for leukocytapheresis effectively reduced the peripheral blood leukaemia cell counts. Previous studies in AML also support the conclusion that this is a safe and effective procedure for the treatment of a potentially life-threatening complication, but apheresis should always be combined with early chemotherapy.
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Affiliation(s)
- Ø Bruserud
- Section of Haematology, Department of Clinical Science, University of Bergen; Department of Medicine, Haukeland University Hospital
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Vertigo as the first sign of chronic myeloid leukemia: a case report and literature review. Case Rep Otolaryngol 2013; 2013:505636. [PMID: 23476855 PMCID: PMC3583057 DOI: 10.1155/2013/505636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 01/09/2013] [Indexed: 11/17/2022] Open
Abstract
Acute vestibular deficit as the first sign of leukemia is extremely rare. The literature shows some cases of sudden hearing loss accompanied by instability and associated with hyperviscosity syndrome. We present the case of a patient who presents a harmonic vestibular deficit of the right ear. The complementary studies revealed an abnormally high level of leukocytes. A peripheral blood cytogenetic analysis is performed due to a high suspicion of leukemia, and the results show BCR/ABL fusion gene with a cut point in the M-BCR region, which confirms the diagnosis of chronic myeloid leukemia. In this case we detail the importance of taking hematological disorders into consideration in the differential diagnosis of patients with otoneurological symptoms, and we also review the etiopathogenic mechanisms, symptoms, diagnosis, and therapeutic options for chronic myeloid leukemia with sudden hearing loss and vertigo.
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Davies CEF, Whitelocke RAF, Agrawal S. Retinal complications associated with hyperviscosity in chronic lymphocytic leukaemia. Intern Med J 2008; 38:140. [DOI: 10.1111/j.1445-5994.2007.01602.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Acar GO, Acioğlu E, Enver O, Ar C, Sahin S. Unilateral sudden hearing loss as the first sign of chronic myeloid leukemia. Eur Arch Otorhinolaryngol 2007; 264:1513-6. [PMID: 17610073 DOI: 10.1007/s00405-007-0382-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 06/14/2007] [Indexed: 10/23/2022]
Abstract
Chronic myeloid leukemia (CML) is one of the etiologic causes of sudden hearing loss and vertigo. However, deafness in association with vestibular symptoms rarely occurs in CML as the first sign. In this article, a 50-year-old male with CML whose first signs and symptoms were unilateral sudden hearing loss and tinnitus in the right ear, vertigo and nausea was presented. Aetiopathogenetic mechanisms, clinical and radiological aspects and therapeutic options for CML with deafness and vertigo were discussed reviewing the literature.
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MESH Headings
- Hearing Loss, Sudden/diagnosis
- Hearing Loss, Sudden/etiology
- Hearing Loss, Sudden/therapy
- Hearing Loss, Unilateral/diagnosis
- Hearing Loss, Unilateral/etiology
- Hearing Loss, Unilateral/therapy
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
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Affiliation(s)
- Gül Ozbilen Acar
- Cerrahpaşa Medical School, Department of Otorhinolaryngology, Istanbul University, Istanbul, Turkey.
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16
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Gokcan MK, Batikhan H, Calguner M, Tataragasi AI. Unilateral Hearing Loss As a Presenting Manifestation of Granulocytic Sarcoma (Chloroma). Otol Neurotol 2006; 27:106-9. [PMID: 16371856 DOI: 10.1097/01.mao.0000194813.69556.3d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To present a case of acute granulocytic sarcoma of the cerebellopontine angle whose presenting symptom was sudden onset unilateral sensorineural hearing loss. STUDY DESIGN Case report and review of the literature (MEDLINE, 1962-2005). METHODS A 34-year-old female patient with acute myeloid leukemia on remission admitted because of sudden hearing loss in her right ear for 10 days. She had experienced occasional tinnitus, ear fullness, and dizziness for a couple of months. After confirmation of her audiometric findings with auditory brainstem responses, the patient was put on a treatment regimen for sudden hearing loss. RESULTS On the second day of treatment, she developed ipsilateral facial paralysis, hoarseness caused by ipsilateral vocal fold paralysis, and nystagmus. Magnetic resonance imaging of the cranium revealed findings consistent with granulocytic sarcoma at the cerebellopontine angle, infiltrating the internal acoustic canal. As increased intracranial pressure symptoms developed subsequently, subtotal tumor resection was performed. However, the patient was lost, with Cushing's triad at the second postoperative month during postoperative chemotherapy. CONCLUSION Although up to 40% of leukemic patients may have otologic symptoms, sudden onset of sensorineural hearing loss is very rare. The patient presented in this report is the first reported case with a granulocytic sarcoma of the cerebellopontine angle who presented with acute sensorineural hearing loss. Despite the rarity of such a case, we would like to emphasize that leukemia must be kept in mind as an etiologic factor in sensorineural hearing loss and suggest that complete blood count and temporal bone imaging be routinely obtained.
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MESH Headings
- Adult
- Auditory Threshold
- Cerebellar Neoplasms/complications
- Cerebellar Neoplasms/diagnosis
- Cerebellar Neoplasms/surgery
- Cerebellopontine Angle/pathology
- Cerebellopontine Angle/surgery
- Evoked Potentials, Auditory, Brain Stem/physiology
- Facial Paralysis/etiology
- Female
- Hearing Loss, Sudden/etiology
- Humans
- Leukemia, Promyelocytic, Acute/complications
- Leukemia, Promyelocytic, Acute/therapy
- Magnetic Resonance Imaging
- Sarcoma, Myeloid/complications
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/surgery
- Treatment Outcome
- Vocal Cord Paralysis/etiology
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Affiliation(s)
- M Kursat Gokcan
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ibn-I Sina Hospital, Ankara, Turkey.
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Hsu YC, Su CY, Hsu RF. Unilateral Sudden Hearing Loss as a Presenting Manifestation of Chronic Myeloid Leukemia: Case Report. Otolaryngol Head Neck Surg 2004; 130:271-3. [PMID: 14990928 DOI: 10.1016/s0194-59980301589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Yao-Chung Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital in Kaohsiung Hsien, Taiwan.
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Ahmed S, Siddiqui AK, Rossoff L, Sison CP, Rai KR. Pulmonary complications in chronic lymphocytic leukemia. Cancer 2003; 98:1912-7. [PMID: 14584074 DOI: 10.1002/cncr.11736] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although pulmonary complications account for significant morbidity and mortality in patients with chronic lymphocytic leukemia (CLL), to the authors' knowledge there are sparse data available in published literature. The authors evaluated pulmonary complications in patients with CLL and identified prognostic variables that predict hospital mortality in these patients. METHODS Clinical data were analyzed retrospectively from patients with CLL who required hospitalization for a respiratory illness at a tertiary care institution from January 1993 to December 2001. A logistic regression analysis with a backward elimination procedure was carried out to determine prognostic variables that predict hospital mortality. RESULTS There were 110 patients who were admitted on 142 occasions with a pulmonary complication. The median age was 75 years (range, 43-97 years), and the male:female ratio was 1.7:1.0. Among 142 admissions, 68% were high risk according to the Rai criteria, 68% of patients admitted had received prior therapy for CLL, and 35% had received treatment within 3 months of admission. The most common pulmonary complications were pneumonias (75%), malignant pleural effusion/and or lung infiltrate due to CLL (9%), pulmonary leukostasis (4%), Richter transformation or nonsmall cell lung carcinoma (3%), and upper airway obstruction (2%). Forty-four of 110 patients (40%) died. In multivariate analysis, admission absolute neutrophil counts </= 0.5 x 10(9)/L (odds ratio, 4.6; 95% confidence interval [95% CI], 1.3-16.6) and blood urea nitrogen (BUN) levels >/= 20 mg/dL (odds ratio, 3.0; 95% CI, 1.1-8.3) were correlated significantly with mortality. CONCLUSIONS Pneumonia was the major pulmonary complication in hospitalized patients with CLL. Severe neutropenia and high BUN levels were correlated significantly with increased mortality.
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Affiliation(s)
- Shahid Ahmed
- Divisions of Hematology and Oncology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Kim MS, Hyo Kim J, Kry D, Ae Choi M, Ok Choi D, Gon Cho B, Jin YZ, Ho Lee S, Park BR. Effects of acute hypotension on expression of cFos-like protein in the vestibular nuclei of rats. Brain Res 2003; 962:111-21. [PMID: 12543461 DOI: 10.1016/s0006-8993(02)03977-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The expression and regional distribution of cFos protein, which is an oncogene product and metabolic marker of neural excitation, were investigated in the vestibular nuclear complex following acute hypotension in adult Sprague-Dawley rats. Intravenous administration of nitroprusside elicited a 10-50% reduction in mean blood pressure for 10 min. Unilateral or bilateral chemical labyrinthectomies were performed 14 days before the start of the experiment to eliminate afferent signals from the peripheral vestibular receptors in the inner ear. All of the animals were sacrificed and the tissues were fixed 2 h after the onset of acute hypotension using the cardiac perfusion method for c-Fos immunohistochemical staining. The cFos-like immunoreactive (cFLI) neurons were expressed selectively in the central area of the medial vestibular nucleus following a 10% reduction in blood pressure. Once the blood pressure had fallen by 30%, bilateral expression of cFLI neurons was observed in the superior, medial, and spinal vestibular nuclei, but not in the lateral vestibular nucleus, of control rats with intact labyrinths. The expression of cFLI neurons increased proportionately with reductions in blood pressure. In unilaterally labyrinthectomized rats, acute hypotension induced the expression of cFLI neurons in vestibular nuclei contra lateral to the injured labyrinth, but not in the ipsilateral vestibular nuclei. However, cFLI neurons were not expressed in bilateral vestibular nuclei following acute hypotension in bilateral labyrinthectomized rats. These results suggest that afferent signals from the peripheral vestibular receptors are essential for cFos protein expression in the vestibular nuclei following acute hypotension.
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Affiliation(s)
- Min Sun Kim
- Department of Physiology, Wonkwang University School of Medicine, Iksan 570-749, South Korea
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Cukierman T, Gatt ME, Libster D, Goldschmidt N, Matzner Y. Chronic lymphocytic leukemia presenting with extreme hyperleukocytosis and thrombosis of the common femoral vein. Leuk Lymphoma 2002; 43:1865-8. [PMID: 12685846 DOI: 10.1080/1042819021000006367] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Very few case reports dealing with chronic lymphocytic leukemia (CLL) and hyperleukocytosis have been reported in the medical literature and none with venous thrombosis as a complication. Here, we describe a 73-year-old woman who presented with newly diagnosed CLL, leukostasis, and hyperleukocytosis (2000 x 10(9)/l), affecting the respiratory and nervous system. In addition, she also had deep vein thrombosis (DVT). Although hypercoagulability and thrombosis are well-described phenomena in solid tumors and in myeloproliferative neoplasms, CLL is generally not associated with an acquired coagulopathy. We hypothesize that in our patient the extreme number of circulating lymphocytes resulted in an abnormal accumulation of lymphocytes possibly causing stasis and occlusion of a larger vessel, which resolved after leukopheresis. The patient has since been successfully maintained with chemotherapy. We conclude that leukopheresis should be considered as the therapy of choice in CLL patients presenting with major complications of leukostasis.
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Affiliation(s)
- Tali Cukierman
- Department of Internal Medicine, Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Silverman JA, Franssen E, Buckstein R, Imrie KR. The development of marked elevation in white blood cell count does not predict inferior outcome in chronic lymphocytic leukemia. Leuk Lymphoma 2002; 43:1245-51. [PMID: 12152992 DOI: 10.1080/10428190290026295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although elevation of the white blood cell (WBC) count at diagnosis of chronic lymphocytic leukemia (CLL) appears to predict shortened survival, its significance later in the course of the disease remains unclear. We reviewed all cases of CLL seen in our center between 1980 and 1999 to evaluate the frequency and clinical significance of WBC elevation > 100 x 10(9)/L. CLL was confirmed according to standard diagnostic criteria and data was collected from diagnosis, occurrence of WBC > 100 x 10(9)/L, and last follow-up. 235 consecutive patients with CLL were identified; 94 were excluded. 141 included patients had a median age of 61 years and median WBC 19.7 x 10(9)/L at diagnosis. Median follow-up for all patients was 56 months, and median survival was 104 months. 41 patients (29%) had > or = 1 episode of WBC > 100 x 10(9)1/L, occurring at a median of 38 months from diagnosis. Compared to controls matched for modified Rai stage, development of a WBC > 100 x 10(9)/L did not predict inferior survival (median 107 vs. 101 months, p = 0.72). We conclude that the occurrence of a WBC count > 100 x 10(9)/L in patients with CLL does not shorten the survival, and patients require therapy only if other indications for treatment are present.
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Harada T, Namiki S, Kawabata I. Acute profound sensorineural hearing loss as the initial manifestation of acute leukemia--report of a case. Auris Nasus Larynx 2000; 27:359-62. [PMID: 10996497 DOI: 10.1016/s0385-8146(99)00074-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper reports an unusual case in which acute lymphocytic leukemia presented acute profound sensorineural hearing loss as the initial manifestation of the disease. The patient is a 55-year-old woman who complained of left hearing loss of sudden onset. Pure tone audiometry revealed profound sensorineural hearing loss of the left ear at mid and low frequencies. The patient was tentatively diagnosed as idiopathic sudden deafness and admitted for the treatment, but her laboratory data indicated that she was at an advanced stage of leukemia. The patient's hearing loss did not improve subjectively until she deceased 1 year after the admission. The mechanism producing acute hearing loss in leukemic patients is reviewed and discussed, and the importance of differentiating possible underlying diseases before we diagnose idiopathic sudden deafness is stressed.
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Affiliation(s)
- T Harada
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical School, 1981 Tsujido-cho, Kamoda, Kawagoe-shi, 350-8550, Saitama-ken, Japan
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Affiliation(s)
- I S Lossos
- Department of Internal Medicine, Hadassh University Hospital, Jerusalem, Israel
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Williamson TH, Rumley A, Lowe GD. Blood viscosity, coagulation, and activated protein C resistance in central retinal vein occlusion: a population controlled study. Br J Ophthalmol 1996; 80:203-8. [PMID: 8703856 PMCID: PMC505429 DOI: 10.1136/bjo.80.3.203] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The role of blood viscosity and haemostasis has been investigated in mixed groups of patients with branch and central retinal vein occlusion (CRVO) with conflicting results. This may have partly been due to the different aetiologies of these two types of vein occlusion. METHODS In this study viscosity and coagulation (including activated protein C resistance) were examined in 87 patients with CRVO and compared with the results from an age-matched, population based control group. RESULTS Viscosity variables were higher in CRVO than in controls which suggested that reduced red cell deformability was associated with the occurrence of CRVO. A higher percentage of the patients with CRVO (12%) had activated protein C resistance than controls (5%). Patients who developed the complication of iris neovascularisation had relatively low antithrombin III, factor VII, and tissue plasminogen activator indicating both a tendency to thrombus formation and a reduction in fibrinolytic activity. CONCLUSION Increased blood viscosity may contribute to the production of CRVO by inducing stasis of blood flow, with thrombus formation in at risk individuals who go on to develop iris neovascularisation.
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Affiliation(s)
- T H Williamson
- Tennent Institute of Ophthalmology and Western Infirmary, Glasgow
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Genden EM, Bahadori RS. Bilateral Sensorineural Hearing Loss as a First Symptom of Chronic Myelogenous Leukemia. Otolaryngol Head Neck Surg 1995; 113:499-501. [PMID: 7567031 DOI: 10.1016/s0194-59989570095-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- E M Genden
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Abstract
Hyperviscosity syndrome is clinically manifested by oronasal bleeding, retinal hemorrhages, and variable neurological symptoms. It occurs when resistance to flow of blood increases sharply, resulting in impaired transit through the microcirculatory system. The most common cause of hyperviscosity is increased concentrations of gamma globulins, either monoclonal in malignant disease or polyclonal, usually seen with rheumatic disorders. Increased numbers of red blood cells, as in polycythemia vera, can result in viscous blood. Extreme increases in concentrations of mature and immature white blood cells can also produce hyperviscosity. Treatment with plasma exchange is required when the clinical syndrome is symptomatic. Although plasma exchange is not a completely benign procedure, it represents the most effective method of controlling hyperviscosity.
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Affiliation(s)
- M A Gertz
- Dysproteinemia Clinic, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Chronic lymphocytic leukemia (CLL) is the form of leukemia which occurs most frequently in Western countries. Its etiology is unknown, and no relationship with viruses or genes has been demonstrated. Epidemiological data suggest that genetic and ambiental factors might be of some significance. Clinical features of CLL are due to the accumulation of leukemic cells in bone marrow and lymphoid organs as well as the immune disturbances that accompany the disease. The prognosis of patients with CLL varies. Treatment is usually indicated by the risk of the individual patient, which is clearly reflected by the stage of the disease. In the early stage (Binet A, Rai O) it is reasonable to defer therapy until disease progression is observed. By contrast, because their median survival is less than five years, patients with more advanced stages require therapy. For almost 50 years, no major advances in the management of CLL, which has revolved around the use of alkylating agents, have been made. In recent years, the therapeutic approach in patients with CLL has changed as a result of the introduction of combination chemotherapy regimens and, in particular, purine analogues. The latter are already the treatment of choice for patients not responding to standard therapies, and their role as front-line therapy is being investigated. Bone marrow transplants are also being increasingly used. It is to be hoped that in years to come the outcome of patients with CLL will be improved by these advances.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Prognosis
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Affiliation(s)
- E Montserrat
- Postgraduate School of Hematology Farreras Valentí, Department of Medicine, University of Barcelona, Hospital Clinic, Spain
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Candiloros H, Jeandel C, Vespignani H, Cuny G. [Bilateral mental neuropathy revealing prolymphocytic transformation of chronic lymphocytic leukemia]. Rev Med Interne 1992; 13:256-60. [PMID: 1337621 DOI: 10.1016/s0248-8663(05)80297-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Authors report an original case of mental neuropathy which reveal prolymphocytoid transformation of Chronic lymphocytic leukaemia. They discuss various pathogenic hypotheses which can join these two events; these are evolutive markers of bad prognosis concerning this hemopathy. Clinical, etiopathological and prognostic features of mental neuropathy associated with hemopathies are studied through this case.
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Soares FA, Landell GA, Cardoso MC. Pulmonary leukostasis without hyperleukocytosis: a clinicopathologic study of 16 cases. Am J Hematol 1992; 40:28-32. [PMID: 1566743 DOI: 10.1002/ajh.2830400106] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pulmonary leukostasis is a serious, almost always fatal, complication usually reported to occur in patients with acute granulocytic leukemias when the peripheral white blood cells exceed 50,000/mm3. We report a clinicopathologic study of 16 leukemic patients with pulmonary leukostasis and with less than 50,000/mm3 circulating leukocytes. The results demonstrated that hyperleukocytosis per se cannot be the cause of pulmonary leukostasis, but that other factors, such as the presence of circulating blasts and the affinity of neoplastic cells for the pulmonary endothelium, may be related to the development of acute respiratory distress in patients with leukemia.
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Affiliation(s)
- F A Soares
- Department of Pathology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
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Abstract
Diseases that cause hyperviscosity of the blood can result in otologic symptoms--especially vertigo. These symptoms are predominantly produced by peripheral vestibular involvement. The pathophysiology probably involves vascular obstruction in the venules. Specific changes in the microvasculature are presumed to be comparable to those that occur with hyperviscosity disorders in the retina. Maintenance of a normal blood viscosity will prevent damage to the ear, as well as other organs. Additionally, reduction of the blood viscosity can greatly improve otologic symptoms. Case studies and a review of the pertinent literature are included.
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Affiliation(s)
- J C Andrews
- Division of Head and Neck Surgery, UCLA Medical Center 90024
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Nakagawa T, Nishida H, Arai T, Yamada T, Fukuda M, Sakamoto S. Hyperviscosity syndrome with transient abnormal myelopoiesis in Down syndrome. J Pediatr 1988; 112:58-61. [PMID: 2961860 DOI: 10.1016/s0022-3476(88)80122-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- T Nakagawa
- Maternal and Perinatal Center, Tokyo Women's Medical College, Japan
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Lichtman MA, Heal J, Rowe JM. Hyperleukocytic leukaemia: rheological and clinical features and management. BAILLIERE'S CLINICAL HAEMATOLOGY 1987; 1:725-46. [PMID: 3327563 DOI: 10.1016/s0950-3536(87)80022-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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