Aural Manifestations of Leukemia

Abstract

In 1856, nine years after Virchow had established leukemia as a definite clinical entity, Vidal made the significant observation that disturbances of hearing were often associated with this disease. While this observation was subsequently confirmed by other investigators, it remained for Politzer 1 in 1884 to lay the groundwork for the present knowledge of the pathologic changes that occur in the ear in leukemia. He was the first to section the temporal bones in a case of myelogenous leukemia and to correlate the clinical with the pathologic observations. There soon followed reports of individual cases with necropsies by Gradenigo,2 Steinbrugge,3 Waggenhauser 4 and others. In 1897 Schwabach 5 reviewed 15 cases, 10 previously reported by others, to which were added 5 of his own. Reports of single cases by the English authors Weber and Lake,6 Finlaysin 7 and Mott8 then appeared in the literature. In 1906 Alexander 9 published a comprehensive monograph on the subject, in which he reviewed 15 personally observed cases. Within the past twenty-five years, however, little has been added to the knowledge of aural involvement in leukemia.The publications within this period have been rather sparse, particularly in this country.10In an endeavor to obtain further information on this subject, the records of all patients with leukemia who were admitted to the Mount Sinai Hospital over a period of five years (1929 to 1933) were reviewed, particular attention being given to the otologie condition in each instance.There were 148 cases of leukemia, which was myelogenous in 97 and lymphatic in 51. Abnor¬ malities of the ear were observed in 25 of the cases, or in 16.8 per cent. The impression gained from the review of the records is that this inci¬ dence of aural involvement is rather low and that the figures probably would have been consider¬ ably higher if a complete otologie examination had been made routinely in each instance. Of passing interest was the observation that ocular changes occurred in 47 cases, or 32.4 per cent, an inci¬ dence almost twice that of aural changes. In evaluating these sets of figures it should be borne in mind that examination of the eyes, including the fundi, was a routine procedure, while exam¬ ination of the ears was not. Of the 25 cases of leukemia with aural changes, 8 were of the lymphatic and 17 of the myeloid type. The age of the patients varied from 5 to 62 years. Twelve patients were male; 13, female.The aural signs and symptoms were referable to the external, the middle and the internal ear, either separately or in combination. The two chief lesions of the external ear were ulcération and hemorrhage of the membranous and the bony canal wall. The tympanomastoid regions were involved in 12 instances, the predominant lesions here being hemorrhage and inflammatory reaction ; the latter varied in intensity from that of mild congestion of the drum membrane to extensive suppuration within the mastoid bone.The internal ear was the site of involvement in From the Laboratories and the Otologic Servic...

XXXII The Temporal Bone in Leukemia Histological Studies

“…At times the destruction of the bone became so extensive that the entire petrous tip was transformed into one big cavity filled with leukemic tissue, or the marrow spaces within the malleus and incus became greatly enlarged with the surrounding bone showing many areas of perivascular osteoclastic destruction (Cases 3, 9,13,14), the so-called spotty osteolysis of Uhlinger." A different type of infiltration was noted within the facial and acoustic nerves.…”

Bilateral Facial Nerve Paralysis Secondary to Acute Myelogenous Leukemia

“…Druss [7], in 1945, was the first otologist to draw attention to the secondary otological complications of leukemia. Paparella et al [8] reviewed 25 patients with leukemia and studied 45 temporal bones.…”

Facial nerve paralysis in acute otomastoiditis as presenting symptom of FAB M2, T8;21 leukemic relapse. Case report and review of the literature

“…Eustachian tube obstruction or infiltration, secondary to leukemic involvement of the nasopharynx, suffusion and/or effusion of the middle ear mucosa, can lead to acute otomastoiditis [31]. Massive bony erosion, deafness and vertigo may develop at a later stage due to progression of the lesion, if untreated [8,9,11,30,36].…”