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Typical Cogan's syndrome is a rare disease of young adults consisting of flares of interstitial keratitis and sudden onset of Ménière-like attacks (nausea, vomiting, tinnitus, vertigo and hearing loss). Life-threatening aortic insufficiency develops in 10% of reported cases. Atypical Cogan's syndrome (audiovestibular dysfunction with other types of inflammatory eye disease) is associated with vasculitis in 20% of cases and has a less favourable prognosis than typical Cogan's syndrome.

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BACKGROUND: Although there are a number of reports concerned with the role of immunity in the sudden onset of progressive sensorineural hearing loss, there are few references dealing with the involvement of immune-mediated mechanisms in sudden deafness. OBJECTIVES: To study the phenotype of peripheral blood lymphocytes in a group of patients with sudden deafness by use of 3-color flow cytometry. DESIGN: The study was carried out prior to the start of steroid therapy. Fourteen patients underwent a follow-up study once steroid therapy had been completed. Prospective analysis, case-control. SETTING: Tertiary case referral center, ambulatory and hospitalized care. PATIENTS: Twenty-two patients (13 men and 9 women; mean age, 45.3 years) were compared with 14 healthy control subjects (9 men and 5 women; mean age, 36 years). Patients were divided in 2 groups according to their response to steroid therapy. RESULTS: Decreased numbers of both CD4+ helper cells (38.4% vs 45.5%; P = .04) and CD8+ cytotoxic cells (17.5% vs 22.3%; P = .02) were observed in patients and compared with those in the control subjects, as well as reduced numbers of CD4+CD45RA+ cells (14.4% vs 29.3%; P = .01) and CD8+CD45RA+ naive cells (18.2% vs 25.4%; P = .04). In the group of patients with a good response to steroid therapy (group 1), a tendency toward normalization of the CD4+ (pretreatment, 38.6%; posttreatment, 44.6%), CD4+CD45RA+ (pretreatment, 15.2%; posttreatment, 21.7%), and CD4+CD45RO+ (pretreatment, 21.1%; posttreatment, 18.2%) cell counts was observed, with a slight decrease in the CD8+ population (pretreatment, 18%; posttreatment, 15.7%). However, in patients with a poorer response (group 2), while there were increases in the CD4+ (pretreatment, 38%, posttreatment, 50%) and CD4+CD45RA+ (pretreatment, 12.8%; posttreatment, 16.7%) cell counts after steroid therapy, there was a significant increment in the CD4+CD45RO+ memory cell count (pretreatment, 14.1%; posttreatment, 28.5%) and low CD8+CD45RA+ counts (pretreatment, 14.6%; posttreatment, 15.5%). No differences were observed in the numbers of B or natural killer cells or in the presence of activation antigens CD25 and HLA-DR when pretreatment and posttreatment levels were compared. CONCLUSION: These results demonstrate significant abnormalities in the subpopulations of lymphocytes in patients with sudden hearing loss, suggesting the existence of immune-mediated responses in the inner ear as possible etiopathogenic factors in this entity.

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The value of imaging methods for the diagnosis of different forms of chronic otitis media is debated, in spite of widespread use. A retrospective study was made of 50 patients who underwent tympanoplasty, with or without mastoidectomy, in our department. Otoscopic, radiological, and computed tomographic findings were analyzed and correlated statistically with surgical findings. Attic perforation was associated significantly with presence of cholesteatoma. Computed tomography was inadequate for differentiating forms of chronic otitis media.

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Seventy (70) dissections of temporal bones of grown-up guinea pigs were done by the AA. in order to get a suitable approach to obtain inner ear studies, aiming at a morphological investigation.

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Since 1989 we have been using on a regular basis in our department endoscopic technics applied to fosas and paranasal sinuses. A methodological study of the first 100 cases of this type of surgery is presented. The indications, results, and complications of the surgical technique are analyzed. The cases included: sinusitis, nasosinusal polyposis, endoscopy of malignant tumors, epistaxis, various inflammatory processes, and plastic endonasal reparations. It is concluded that nasosinusal endoscopic surgery is an advantageous technique in the treatment of general nasosinusal conditions.

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Fibrous dysplasia is a rare disease which occasionally affects the temporal bone. In its monostotic form, only 27 cases have been reported until today. We present a case of monostotic fibrous dysplasia of the temporal bone coincident with a cholesteatoma of the EAC, operated on by mean of a modified radical mastoidectomy, with good results.

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Closure of nasal septal perforations represents a difficulty for the rhinologist. Several surgical techniques have been reported in this end. In the present paper we describe a chondro-perichondral-mucosal rotation flap, which has completely resolved 70% of our perforations and partially in the remainder 30%.

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A number of intra and postoperative accidents in close cavity surgery when using nitrous oxide have been reported. In order to check the influence of nitrous oxide anesthesia in tympanic surgery, 38 patients were operated on by the usual techniques in middle ear surgery. Half the patients received continuous nitrous oxide inhalation throughout the procedure while, in the remaining cases, the anesthetic gas was suspended 30 minutes before applying the tympanic graft. Audiological differences in both groups, as controlled at 6 and 12 months, were negligible.

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