The Auditory Manifestations of Leukemia

The otological complications of leukemia are common, but rarely are they given much consideration in discussions of the clinical aspects of leukemia. During the past several years the frequency with which deafness, tinnitus, and vertigo have developed in many of our patients has prompted us to investigate the incidence and type of involvement which occurs in this disorder. The aural manifestations of leukemia are of considerable historical interest. The first case of leukemia ever described was that of a 44-year-old female who was admitted to a hospital because of an abdominal tumor and deafness of 6 months' duration in the year 1844.9 The tumor proved to be an enlarged spleen, and blood studies at autopsy by Donne showed an excessive leukocytosis. Only twelve years later Vidalr reported deafness in a case of leukemia and was able to find 3 more in a total of 32 cases of leukemia. In 1906 Alexander' pointed out that the probable etiology of the first case of Meniere's syndrome was acute leukemia. The case was that of a young girl who developed sudden deafness, severe vertigo, and vomiting, which was followed by death five days later. In Meniere's first report on the autopsy findings' he stated that a red plastic material filled the entire labyrinth, but in a later report' he said that the red substance was found only in the semi-circular canals without demonstrable abnormalities of the vestibule and cochlea. Alexander believed that the red plastic material was blood which had remained following sudden hemorrhage into the labyrinth as a complication of leukemia. He felt that the Meniere's syndrome must have developed as a terminal complication of a fatal process, since death could not have resulted from the syndrome per se. More recently, Alexander's interpretation of Meniere's case has been challenged.' Much of the early medical literature on leukemia described the aural symptoms and pathological changes which developed as complications of leukemia. Between the time of Vidal's report and the turn of the cen-