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...

Deafness is, unfortunately, not an uncommon sequel of meningococcic meningitis. The deafness is usually bilateral and often complete. Not infrequently it is due to labyrinthitis secondary to an extension of infection from the meninges. The exact channel through which the infection is transmitted to the labyrinth cannot always be determined, nor is the pathologic picture in the early stages of the resultant labyrinthitis definitely known. It is assumed that this extension usually takes place either along preexisting routes, such as the nerve tunnels within the internal auditory meatus and the aquaeductus cochleae, or by way of the blood stream. This report is based on a study of serial sections of temporal bones which showed evidences of early as well as late pathologic changes in the labyrinth secondary to meningococcic meningitis.REPORT OF FOUR CASES OF EARLY CHANGES CASE 1.\p=m-\L.R., a boy aged 2 years, was admitted to the hospital on Jan. 22, 1929, with a history of malaise, fever, convulsions, a purpuric rash and meningeal signs. The duration of the illness was one day. Culture of the blood showed meningococci in all the mediums. The middle ears were normal. The child died on the day of admission. Postmortem examination revealed hemorrhages in the skin, conjunctiva, peritoneum and adrenal glands.Histologic examination of the temporal bone showed hemorrhages and purulent exudate in the internal auditory meatus ; hemorrhages within, and degeneration of, the organ of Corti, and hemorrhages in the stria vascularis and in the saccule. There was partial displacement of the membranous labyrinth in the semicircular canals. CASE 2.\p=m-\J.K., aged 19 months, was admitted to the hospital in a moribund state on March 22, 1929, with a history of fever, cyanosis, vomiting and purpuric rash for three days. Culture of the spinal fluid and of the blood showed meningococci. The middle ears were normal. The child died on the day of admission. Postmortem examination revealed acute purulent meningitis with meningococcemia, and petechiae of the skin, intestines and bladder.Histologic examination of the temporal bone showed purulent exudate with perivascular infiltrations about the main vessel in the internal auditory meatus, purulent From the Otologic Service and the laboratories of the Mount Sinai Hospital.

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