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The enzymatic changes in tertiary nasal syphilis were studied in 5 patients. The cholinesterase was increased in the subepithelium, around the glands and blood vessels, denoting parasympathetic hyperactivity. Acid phosphatase was increased in the epithelium, stromal histiocytes, around the glands and ducts, indicating increased phagocytotic activity. Alkaline phosphatase was increased in the capillary endothelium and periglandular stroma, denoting marked vascular changes. Succinic dehydrogenase, alkaline phosphatase, alpha esterase and PAS-alcian blue were diminished in the epithelium and glands, denoting diminished secretory activity, hence a diminished natural defence mechanism of the nasal mucosa. When serological tests are inconclusive, these findings become an important adjuvant to a final diagnosis.

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Urbach-Wiethe disease is a rare disorder, inherited in an autosomal recessive fashion. In this work we have studied the clinical data in six patients with well-established UWD. The histopathological and histochemical findings are discussed. Unless the otolaryngologist has a knowledge of the disease, the diagnosis can be missed.