A novel autosomal recessive GJB2-associated disorder: Ichthyosis follicularis, bilateral severe sensorineural hearing loss, and punctate palmoplantar keratoderma

Ichthyosis follicularis, a distinct cutaneous entity reported in combination with atrichia, and photophobia has been associated with mutations in MBTPS2. We sought the genetic cause of a novel syndrome of ichthyosis follicularis, bilateral severe sensorineural hearing loss and punctate palmoplantar keratoderma in two families. We performed whole exome sequencing on three patients from two families. The pathogenicity and consequences of mutations were studied in the Xenopus oocyte expression system and by molecular modeling analysis. Compound heterozygous mutations in the GJB2 gene were discovered: a pathogenic c.526A>G; p.Asn176Asp, and a common frameshift mutation, c.35delG; p.Gly12Valfs*2. The p.Asn176Asp missense mutation was demonstrated to significantly reduce the cell-cell gap junction channel activity and increase the nonjunctional hemichannel activity in the Xenopus oocyte expression system. Molecular modeling analyses of the mutant Cx26 protein revealed significant changes in the structural characteristics and electrostatic potential of the Cx26, either in hemichannel or gap junction conformation. Thus, association of a new syndrome of an autosomal recessive disorder of ichthyosis follicularis, bilateral severe sensorineural hearing loss and punctate palmoplantar keratoderma with mutations in GJB2, expands the phenotypic spectrum of the GJB2-associated disorders. The findings attest to the complexity of the clinical consequences of different mutations in GJB2.

A novel CHST3 allele associated with spondyloepiphyseal dysplasia and hearing loss in Pakistani kindred

Skeletal dysplasias (SDs) are highly heterogeneous disorders composed of 40 clinical sub-types that are part of 456 well-delineated syndromes in humans. Here, we enrolled consanguineous kindred from a remote area of Sindh province of Pakistan, with 14 affected individuals suffering with short stature, kyphoscoliosis, joint dislocations, clubfoot, heart valve anomalies and progressive bilateral mixed hearing loss. To identify pathogenic variants in this family, whole exome sequencing (WES) was performed in one affected and one normal individual, which revealed a novel transversion mutation (c.802G>T; p.Glu268*) in CHST3 associated with the phenotype. CHST3 encodes a chondroitin 6-O-sulfotransferase-1 (C6ST-1) enzyme that is essential for the sulfation of proteoglycans found in cartilages. Previously, mutations in CHST3 have largely been reported in sporadic cases of SD, primarily with severe spinal abnormalities, joint dislocations, joint contractures, and clubfoot. Clinical and radiological examination of the affected individuals in this family provides new insights into phenotypic spectrum of CHST3 alleles and disease progression with age.

Positron Emission Tomography Imaging Reveals Auditory and Frontal Cortical Regions Involved with Speech Perception and Loudness Adaptation

Considerable progress has been made in the treatment of hearing loss with auditory implants. However, there are still many implanted patients that experience hearing deficiencies, such as limited speech understanding or vanishing perception with continuous stimulation (i.e., abnormal loudness adaptation). The present study aims to identify specific patterns of cerebral cortex activity involved with such deficiencies. We performed O-15-water positron emission tomography (PET) in patients implanted with electrodes within the cochlea, brainstem, or midbrain to investigate the pattern of cortical activation in response to speech or continuous multi-tone stimuli directly inputted into the implant processor that then delivered electrical patterns through those electrodes. Statistical parametric mapping was performed on a single subject basis. Better speech understanding was correlated with a larger extent of bilateral auditory cortex activation. In contrast to speech, the continuous multi-tone stimulus elicited mainly unilateral auditory cortical activity in which greater loudness adaptation corresponded to weaker activation and even deactivation. Interestingly, greater loudness adaptation was correlated with stronger activity within the ventral prefrontal cortex, which could be up-regulated to suppress the irrelevant or aberrant signals into the auditory cortex. The ability to detect these specific cortical patterns and differences across patients and stimuli demonstrates the potential for using PET to diagnose auditory function or dysfunction in implant patients, which in turn could guide the development of appropriate stimulation strategies for improving hearing rehabilitation. Beyond hearing restoration, our study also reveals a potential role of the frontal cortex in suppressing irrelevant or aberrant activity within the auditory cortex, and thus may be relevant for understanding and treating tinnitus.

Cochlear ossification in patients with profound hearing loss following bacterial meningitis

CONCLUSION

Cochlear ossification following bacterial meningitis is related to causative pathogen, but not age at disease or time point of evaluation. However, progression may occur over time, especially in case of primary signs of ossification.

OBJECTIVE

To investigate the occurrence and degree of cochlear ossification on CT and MRI in patients with bilateral profound hearing loss following bacterial meningitis, in relation to causative pathogen, age at disease, and time point of evaluation. Progression of ossification in cases that underwent more than one scan was evaluated.

METHODS

In the period 1982-2008, 47 cochlear implantations were performed in 34 consecutive candidates suffering from bilateral profound hearing loss following bacterial meningitis. A retrospective review of patient files and preoperative CT and MR images was performed.

RESULTS

Cochlear ossification was observed in 35% of patients and 26% of ears on CT. The corresponding values for MRI were 44 and 30% (difference not significant). Streptococcus pneumoniae infection caused ossification more frequently than Neisseria meningitidis. No difference was found between pediatric and adult cases, and the occurrence of ossification was not related to the time point of evaluation. Signs of progressive ossification were found in cases with two CT scans, especially if ossification was present at the first scan.

A boy with severe craniodiaphyseal dysplasia and apparently normal mother

We describe a boy and his mother affected with craniodiaphyseal dysplasia (CDD). The boy had a very severe form of the disease with extensive osteosclerosis already at birth. Facial diplegia, bilateral hearing loss and optic nerve atrophy were early, severe complications of the disease. At age 7 years progressive genu valgum and unusual epimetaphyseal radiographic appearances suggested hyperparathyroidism. This was confirmed by biochemical tests. Because of some facial similarity between the asymptomatic mother and the propositus, a limited skeletal survey of the mother was performed. It demonstrated cranial osteosclerosis and hyperostosis. It is possible that the mother has somatic mosaicism for a mutation of the genes causing CDD.

Evaluation of Cochlear Nerve Imaging in Severe Congenital Sensorineural Hearing Loss

The route of the cochlear nerve can be imaged using computed tomography (CT) or magnetic resonance imaging (MRI). To gain information about the cochlear nerve, we conducted a trial measuring the width of the cochlear nerve canal (CNC) using CT. When we examined images of the route of the cochlear nerve on MRI, both in ears with congenital sensorineural hearing loss (SNHL) and normal ones, we found that in ears in which the CNC was narrower than 1.5 mm with CT, images of cochlear nerve deficiency could be seen in that ear with MRI.

Leptomeningeal carcinomatosis: An unusual cause of sudden onset bilateral sensorineural hearing loss

We report a 66-year-old woman who developed sudden-onset bilateral sensorineural deafness due to leptomeningeal carcinomatosis involving the vestibulocochlear nerves. The clinical and diagnostic features of leptomeningeal carcinomatosis are discussed.

Ototoxicity in Children Receiving Platinum Chemotherapy: Underestimating a Commonly Occurring Toxicity That May Influence Academic and Social Development

Purpose

To describe the frequency and severity of ototoxicity in a series of pediatric patients treated with platinum-based chemotherapy.

Patients and Methods

Serial audiologic evaluations were conducted for 67 patients aged 8 months to 23 years who received platinum-based chemotherapy. Audiologic data was analyzed to determine time to hearing-loss using American Speech-Language-Hearing Association (ASHA) criteria, and the effects of treatment and patient characteristics on the incidence and severity of ototoxicity.

Results

Bilateral decreases in hearing were seen in 61% of patients (median time to hearing loss, 135 days). Children treated for medulloblastoma, osteosarcoma, and neuroblastoma had greater incidence and severity of hearing loss. Agreement between the usually reported National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and ASHA criteria was inadequate.

Conclusion

Traditional reporting of toxicity data (CTCAE) has under-reported ototoxicity and minimized the significance of hearing loss in children. As pediatric patients experience improved survival, the effects and implications of high-frequency hearing loss with regard to academic achievement and speech and language development are important considerations, especially in patients younger than 5 years.

Case report: Y;6 translocation with deletion of 6p

Translocations between the Y chromosome and an autosome are rare. We report a phenotypic male with a translocation between the Y chromosome and chromosome 6p, leading to partial 6p monosomy and XX male syndrome. He is the second child to be reported with this karyotype. Phenotypic findings included growth retardation, severe developmental delay, a Dandy-Walker malformation, cardiac and urogenital abnormalities, bilateral hearing loss, cleft palate, severe kyphoscoliosis, minor digital anomalies, and a hypoplastic phallus. Craniofacial dysmorphism consisted of dolichocephaly, hypertelorism, down-slanting palpebral fissures, depressed nasal bridge and a tented upper lip. Cytogenetic analysis showed the karyotype 46,XX,der(6)t(Y;6)(p11.2;p23).ish der(6)(SRY+,6pTEL48-). The effects of partial monosomy 6p are discussed and compared to other patients with interstitial and terminal 6p deletions.

Meningeal carcinomatosis causing isolated bilateral symmetric progressive hearing loss

A 53-year-old man presented with isolated bilateral progressive hearing loss from about 5 months. Fourteen months after onset of this isolated symptom a diagnosis of meningeal carcinomatosis (MC) was made. Isolated bilateral deafness is a rare first manifestation of MC.

Autoimmune-Mediated Sympathetic Hearing Loss: A Case Report

BACKGROUND

Damage to one inner ear is occasionally followed by contralateral sensorineural hearing loss. This has been defined as sympathetic hearing loss.

HYPOTHESIS

It is hypothesized that autoimmunity can play a role in the pathogenesis of sympathetic hearing loss.

METHODS

A male patient who developed right-sided sympathetic hearing loss at 20 years of age, 11 years after deafness of the left ear caused by a temporal bone fracture, is described. The patient's serum was analyzed for the presence of autoantibodies against inner ear tissues by immunocytochemistry and Western blotting using rat inner ear tissues. The patient's serum was tested specifically for antibodies against heat shock protein 70 by immunodot blot. The presence of autoantibodies known to play a role in systemic autoimmune disease was also examined.

RESULTS

Immunocytochemistry on rat temporal bone sections demonstrated autoantibodies in the patient's serum specifically targeted against cochlear outer hair cells. No reactivity of the patient's serum was observed with control tissues including kidney, brain, and liver. Western blotting using homogenized rat cochlear tissues showed that the patient's serum reacted with a 25- and 27-kDa protein. No reactivity was observed with heat shock protein 70 in the immunodot blot analysis. The patient's serum did not contain autoantibodies against antinuclear antibodies, double-stranded DNA, antineutrophil cytoplasmic antibodies, basement membrane, reticulin, intestinal mucosa, muscle, collagen, or mitochondria.

CONCLUSION

Observations indicate that this patient suffered sympathetic hearing loss caused by organospecific autoimmunity directed to cochlear outer hair cells.

Pathology and Pathophysiology of Idiopathic Sudden Sensorineural Hearing Loss

BACKGROUND

The cause and pathogenesis of idiopathic sudden sensorineural hearing loss remain unknown. Proposed theories include vascular occlusion, membrane breaks, and viral cochleitis.

AIMS

To describe the temporal bone histopathology in 17 ears (aged 45-94 yr) with idiopathic sudden sensorineural hearing loss in our temporal bone collection and to discuss the implications of the histopathologic findings with respect to the pathophysiology of idiopathic sudden sensorineural hearing loss.

METHODS

Standard light microscopy using hematoxylin and eosin-stained sections was used to assess the otologic abnormalities.

RESULTS

Hearing had recovered in two ears and no histologic correlates were found for the hearing loss in both ears. In the remaining 15 ears, the predominant abnormalities were as follows: 1) loss of hair cells and supporting cells of the organ of Corti (with or without atrophy of the tectorial membrane, stria vascularis, spiral limbus, and cochlear neurons) (13 ears); 2) loss of the tectorial membrane, supporting cells, and stria vascularis (1 ear); and 3) loss of cochlear neurons only (1 ear). Evidence of a possible vascular cause for the idiopathic sudden sensorineural hearing loss was observed in only one ear. No membrane breaks were observed in any ear. Only 1 of the 17 temporal bones was acquired acutely during idiopathic sudden sensorineural hearing loss, and this ear did not demonstrate any leukocytic invasion, hypervascularity, or hemorrhage within the labyrinth, as might be expected with a viral cochleitis.

DISCUSSION

The temporal bone findings do not support the concept of membrane breaks, perilymphatic fistulae, or vascular occlusion as common causes for idiopathic sudden sensorineural hearing loss. The finding in our one case acquired acutely during idiopathic sudden sensorineural hearing loss as well as other clinical and experimental observations do not strongly support the theory of viral cochleitis.

CONCLUSION

We put forth the hypothesis that idiopathic sudden sensorineural hearing loss may be the result of pathologic activation of cellular stress pathways involving nuclear factor-kappaB within the cochlea.

[Sudden bilateral hearing loss disclosing meningeal carcinomatosis]

We report the case of a patient presenting a sudden bilateral hearing loss. Four years before, a bladder carcinoma was resected and a chemotherapy was started. Gadolinium-enhanced magnetic resonance images revealed enhancement of both acoustic nerves. Cerebrospinal fluid analysis showed malignant cells consistent with the initial bladder cancer. Meningeal metastases from bladder carcinoma are extremely rare. Systemic chemotherapy and its low meningeal diffusion may enhance the incidence of this complication. Bilateral hearing loss is a rare initial manifestation of meningeal carcinomatosis.

Histopathology and molecular genetics of hearing loss in the human

Hearing loss is among the most common disabilities of man. It has been estimated that over 70 million individuals in the world are hearing impaired with pure tone averages greater than 55 dB. A genetic etiology is thought to be responsible for over half of early onset hearing loss and at least one third of late onset hearing loss. In this review, examples of the histopathology of the inner ear in known genetic syndromes in the human will be presented in order to provide a structural basis for understanding molecular mechanisms of development and maintenance in the inner ear, and to serve the essential function of validating the applicability of animal genetic models of hearing loss to the human condition.

Otodental syndrome: a case report and genetic considerations

A 5-year-old boy presented with otodental syndrome. His maxillary and mandibular incisors were within normal limits. The premolar/molar areas in all quadrants were occupied by markedly macrodontic teeth showing globular shape. The canines had a similar rounded shape. Two canines and 1 of the other abnormal teeth demonstrated areas of yellow hypoplastic enamel. Radiographs revealed that some of the abnormal teeth had bifurcated pulp chambers and pulp stones. Premolar tooth germs were absent. Audiometry demonstrated that the child had a marked bilateral sensorineural hearing loss for frequencies above 1000 Hz. No other members of the immediate family were clinically affected. The parents of the child were not aware of any similarly affected relatives. Suggestions with respect to possible genetic mechanisms and gene participation in the etiology of this syndrome are offered.

[Bilateral progressive hearing loss as the first manifestation of metastatic carcinoma of the head of the pancreas. Case report]

We report the history of a patient who presented first with a progressive unilateral hearing loss and later with a bilateral deafness and an unilateral facial nerve palsy as first and only symptoms of a pancreatic adenocarcinoma. By means of magnetic resonance tomography tumor-suspect lesions in both internal auditory canals were detected. Referring to the results of further examinations these intracanalicular lesions are most probably due to rarely seen bilateral metastasis of a pancreatic adenocarcinoma in the temporal bone. In addition to this rarely diagnosed localisation of metastasis it is rather uncommon that this kind of primary malignoma had not been detected because of gastrointestinal symptoms or extracranial metastasis.

[The Susac syndrome--a retinocochleocerebral angiopathy]

INTRODUCTION

There has been a series of case reports of otherwise healthy patients suffering from microangiopathy of the brain, retina and cochlea. Most patients were young women presenting clinically with a subacute encephalopathy, branch retina artery occlusions, and hearing loss. In 1994 the name "Susac syndrome" has been proposed for this disease entity.

METHOD

Case report and review of 64 published cases, identified through MEDLINE are given.

CASE REPORT

We describe a 32-year-old otherwise healthy woman presenting with a subacute encephalopathy, multiple branch retinal artery occlusions and bilateral hearing loss. MRI of the brain revealed multiple small white and grey matter lesions without contrast enhancement. CSF protein was elevated, oligoclonal bands were negative. Immunological laboratory parameters, microbiology, virology, coagulation studies, SEP, AEP, VEP and cerebral DSA were normal.

REVIEW OF THE LITERATURE

Of 64 identified patients 58 were women. The mean age of the patients was 30 years. 60 patients (94%) had arterial occlusions, which were bilateral in 39%. 48 patients reported hearing loss, 37 patients (58%) had a global encephalopathy, but other neurologic manifestations were common.

CONCLUSION

This rare syndrome has a strong young female preponderance. MRI of the brain often shows lesions suggestive of multiple sclerosis. Fluorescein angiography may show arteriolar wall hyperfluorescence. Patients can be identified at an early stage with a careful history and physical examination. Early treatment with corticosteroids is often associated with a good prognosis. Cyclophosphamide and antiplatelet drugs may be added in complicated cases.

Inner ear abnormalities in Kabuki make-up syndrome: report of three cases

Three patients, a female and two males, 28, 15, and 14 years of age, with Kabuki make-up syndrome (KMS) were studied for middle and inner ear abnormalities by using CT scanning of the petrous bones. All three patients had bilateral dysplasia of the inner ear, i.e., hypodysplasia of the cochlea, vestibule, and semicircular canals (so-called Mondini dysplasia), whereas their middle ears had no abnormalities. Audiometry demonstrated a sharp decrease in hearing of the high tone range, bilateral in one and unilateral in another, while the third patient was noncooperative. In view of these findings, it would be advisable to study each individual with KMS and hearing impairment for possible inner ear abnormalities.

[Disseminated intravascular coagulation in a patient with polyarteritis nodosa and bilateral hypoacusis]

We describe the case of a 44-years-old female patient with a panarteritis nodosa preceded by a rapid progressive bilateral deafness after an acute otitis media. Once on treatment with steroids and cyclophosphamide, she developed a disseminated intravascular coagulation, with a fatal evolution not justifiable by a different cause apart from her main disease.

Cogan's syndrome: clinical significance of antibodies against the inner ear and cornea

The aim of this study was to evaluate the pathological significance of antibodies against cornea and inner ear tissue in the development of audiovestibular and ocular symptoms in patients with Cogan's syndrome (CS). We analysed the serum of 5 CS patients for binding of IgM and IgG to fresh cryosections of rat labyrinth (semicircular canals, ampulla, utricle, saccule) and cornea by indirect immunofluorescence (IF). The predominant pattern of anti-corneal IgM was staining of the superficial cell layer of the non-keratinizing squamous epithelium. IgM against cornea was found in 3 patients, all of whom had bilateral inflammatory eye signs at the start of the disease. However, IgM was also detected in the chronic stage of the disease when no clinical signs of eye involvement were apparent. The study includes the first follow-up examination of anti-corneal IgM and IgG antibodies during a complete episode of active CS. During the first episode of CS in 1 patient, anti-corneal IgM became detectable 1 week after the onset of interstitial keratitis and 3 weeks after the onset of audiovestibular symptoms. It increased over several weeks and then fell to very low levels. However, at no time was anti-corneal IgG found. In the course of follow-up examinations, the serum of 4 patients intermittently contained low titre IgG antibodies against inner ear labyrinthine tissue, but without any clear correlation with the active stages of CS. In addition, high-resolution MRI (HR-MRI) of the inner ear was performed in the acute and chronic stages of CS to evaluate the activity of CS. In the acute stage, HR-MRI revealed abnormal MRI signals in the vestibule, semicircular canals, vestibular nerve, or cochlea. In the chronic stage, patients showed narrowing or occlusion of semicircular canals and the cochlea on the 3D-CISS images, but no high signal lesions (T1) and no enhancement. Antibodies against cornea or labyrinthine tissue were not consistently detected in CS and the level of organ-specific antibodies did not correlate with the activity of the disease.

Otological findings in idiopathic hyperphosphatasia

A 17-year-old male patient was admitted because of progressive hearing loss since the age of six. His former blood and radiology investigation had revealed idiopathic hyperphosphatasia. On ENT examination bilateral thickened tympanic membranes with severe mixed-type hearing loss was diagnosed. Computerized tomography (CT) demonstrated expansion of the calvarial bones, including the temporal bones, except for the otic capsule. Middle-ear exploration revealed thickened middle-ear mucosa and a stone hard, immobile bony mass instead of the normal ossicular chain at the posterior superior part of the mesotympanum. No ossicular reconstruction could be attempted and the patient was rehabilitated with a hearing aid.

[Effect of Fucong tablets and its ingredients on ototoxicity of gentamycin in guinea pigs]

OBJECTIVE

To assess the antagonistic effect of Fucong Tablet (FCT) and its ingredients on ototoxicity of gentamycin in guinea pigs.

METHODS

The guinea pigs were given gentamycin 80 mg/kg intramuscularly once daily for 20 days and FCT or its ingredients separately oral taken for 20 days. The auditory brain stem evoked response (ABR) threshold, vascular stria blood circulation condition, outer hair-cell count and cochlear ultrastructure of guinea pigs were observed before and after treatment to assess the antagonistic effect and protective effect of FCT on cochlear structure.

RESULTS

FCT and its ingredients of tonifying Kidney, replenishing Qi and blood, promoting blood circulation could lower the impairment ratio of outer hair-cell induced by gentamycin (P < 0.05), protect morphosis and function of cochlea and lower the elevated ABR threshold (P < 0.05).

CONCLUSIONS

FCT and its ingredients could reduce the toxic damage on ear induced by gentamycin effectively.

Sudden bilateral hearing loss due to gastric carcinoma and its histological evidence

Six temporal bones and a brain tissue sample removed at autopsy from four patients with bilateral sudden hearing loss related to gastric adenocarcinoma were histologically studied. The pathological remains suggest that the sudden hearing loss of these patients may have occurred via one of two different mechanisms: (1) metastasis to the internal auditory meatus damaging the auditory nerve or (2) inner ear haemorrhage damaging Corti's organ. These two mechanisms may cause bilateral sudden deafness in patients with gastric adenocarcinoma.

Usher syndrome. A temporal bone report

The bilateral temporal bones of a deceased 84-year-old man who had been suffering from Usher syndrome were examined using light microscopy. Histopathologic examination disclosed degeneration of the organ of Corti that was most profound in the basal turn, degeneration of cochlear neurons in all of the turns, and severe loss of spiral ganglia in both cochleas. Endolymphatic hydrops of unknown cause and a functionally unimportant pit malformation in the macular utricle were observed in the right cochlea. We compared the aforementioned findings with temporal bone reports cited in the literature.

Ciliary beat frequency of nasal and middle ear mucosa in children with otitis media with effusion

Impaired mucociliary function of respiratory tract mucosa is associated with secretory otitis media in some well recognized syndromes. Ciliary activity per se may now be assessed directly by determination of ciliary beat frequency by a photoelectric technique. 49 children with otitis media with effusion undergoing surgical treatment were studied. Middle ear mucosa and nasal epithelial cells were obtained by biopsy and cytological brushings respectively at the time of surgery (myringotomy +/- grommet insertion under general anaesthesia). From these samples mean nasal ciliary beat frequency was 11.0 Hz and mean middle ear ciliary beat frequency was 11.2 Hz. A positive correlation exists between mean ciliary beat frequency of nasal and middle ear samples from individual patients. A comparison of mean ciliary beat frequency between children who were effusion positive and effusion negative at the time of surgery revealed no statistically significant difference. In addition, no difference existed between those children with recurrent otitis media with effusion and newly presenting cases. No prima facie evidence exists of impaired ciliary function in this population of children with otitis media with effusion.

Norries disease

A 2-month-old male infant was found to have Norrie's disease. The clinical presentation and detailed histological features diagnostic of the disease are discussed. This is the first authentic, histologically proven case of Norrie's disease from India. The absence of hearing loss and mental retardation at the time of presentation at the early stage of infancy and the fact that the case was sporadic do not detract from the diagnosis. However the child at the age of one year developed hearing loss.

Epstein syndrome: oral lesions in a patient with nephropathy, deafness and thrombocytopenia

Epstein syndrome is a rare dominantly inherited disorder in which the main features are nephritis, deafness and macrothrombocytopathic thrombocytopenia. A case with oral haemorrhage and purpuric lesions is reported. This appears to be the first report of this syndrome in the dental literature.

Longitudinal followup of patients with Menière's disease

The etiology, pathophysiology, and natural history of Menière's syndrome are poorly understood. The reported studies have had inadequate followup or insufficient numbers of patients to allow conclusions about the natural history. Our study group was 119 patients who had the classic symptom complex of episodic vertigo, tinnitus, and hearing loss in the year 1970. After initial review of these charts, follow-up information was obtained by questionnaire, telephone interview, chart review, or repeat examination, when possible, both in 1983 and in 1988, for a total followup of 18 years. In the patients with followups of at least 14 years, vertiginous episodes had disappeared completely in 50% of patients and somewhat resolved in 28%; hearing was absent in 48% and worse in 21%. Surprisingly, 43% of patients underwent surgery at some point for control of vertigo. Bilateral disease was present initially in 13% and developed subsequently in 45% of patients. Other areas reviewed included the efficacy of long-term medical treatment, frequency and severity of vertiginous attacks, and contralateral ear symptoms.

Vitiligo with primary hypothyroidism and hypoacusis: a case report

A 48-year-old female patient with vitiligo developed primary hypothyroidism and hypoacusis. The signs and symptoms of hypothyroidism improved with thyroid hormone replacement therapy but hypoacusis did not. The coexistence of vitiligo and thyroid disease is uncommon and the additional association of hypoacusis is very rare. There may be a common autoimmune pathogenesis for the three disorders. Vitiligo may be a diagnostically useful sign which suggests the presence of multiple autoimmune diseases.

Temporal bone showing polyarteritis nodosa, otosclerosis, and occult neuroma

The clinical and general histopathologic manifestations of systemic vasculitis of the polyarteritis nodosa type are well known. Although hearing loss associated with polyarteritis nodosa has been reported, only two temporal bone studies are available. The findings in a 60-year-old man with well-documented hearing loss who had rheumatoid arthritis, polyarteritis nodosa, and otosclerosis are presented. Polyarteritis nodosa extensively involved the subarcuate arteries and arteries of the facial canal. There were decreased nerve fibers to and sensory cells in the crista of the semicircular canals and macula of the utricle and saccule. Focal and diffuse atrophy of the stria vascularis and decreased cellularity in the spiral prominence and ligament were present. There was a loss of outer hair cells. Otosclerosis involved the left and right oval window niches (bilateral stapedectomy had been performed). There was a small Antoni type A neuroma of the superior division of the vestibular nerve on the left.

Bilateral otitis media and hearing loss in an adult

Bilateral otitis media, an uncommon entity in adults, may represent the initial manifestation of a life-threatening systemic disease. Prompt recognition and treatment of the underlying disease is needed to preserve auditory function and prevent involvement of other organ systems. We present the case of a thirty-four-year-old male with bilateral serous otitis media and progressive hearing loss, which was refractory to antimicrobial therapy and middle ear drainage. A mastoid biopsy revealed necrotizing granulomatous inflammation. The differential diagnosis and probable cause of this unusual finding are discussed.

Frontometaphyseal dysplasia: symptoms and possible mode of inheritance

Frontometaphyseal dysplasia is a rare syndrome of which only 20 cases have been described thus far. In this paper we report a 46-year-old man who showed a medium degree of manifestation of the disorder. The variable expressivity in both sexes, as derived from the careful study of reported symptoms in all known cases, was discussed. On the basis of the published pedigrees and additional information from our case, the possible mode of inheritance was debated.

Salicylate ototoxicity in the chinchilla: a behavioral and electron microscope study

Normal audiograms were obtained from a group of behaviorally conditioned chinchillas. Following this the animals were injected with sodium salicylate. Temporary hearing losses were measured 1 1/2 hours after treatment. Animals were anesthetized and blood samples taken to determine salicylate levels. The animals were then decapitated and the temporal bones were examined by SEM and TEM. No morphological correlate was seen for temporary hearing losses which were generally in the neighborhood of 30-40 dB.