A 16 year-old girl, developed mastoiditis, labyrinthitis and facial paralysis of the right side a month prior to her death of acute myeloic leukemia. She complained of vertigo and had spontaneous nystagmus to the left. Temporal bone study confirmed acute mastoiditis and tympanogenic labyrinthitis. The middle ear mucosa was thick and showed marked leukemic infiltration. Pus filled the middle ear cavity and mastoid air cells as well. Inflammation invaded into the vestibule through the annular ligament.
There was almost no fluid space in the vestibule. It was occupied by granulation tissue. The semicircular canal was filled with coagulum with many histiocytes, granulation tissue and hemorrhage. The utricle was also in the granulation tissue. There was degeneration of sensory epithelia in the macula utriculi and cristae ampullares. The saccular wall was distended and partly disappeared within the granulation tissue. However, the reinforced area of the saccular wall retained its structure. Old hemorrhage occupied the saccule. In the cochlea, scala vestibuli and scala tympani were filled with fibrous tissue. The organ of Corti was well preserved except the basal turn where it was missing. The tectorial membrane was partly detached from the limbus. Many histiocytes were observed scattered within the fibrous scalae. The cochlear duct was filled with coagulum and red cells. The Reissner's membrane was ballooned out. The bleeding in the cochlear duct apparently occurred from partly disintegrated stria vascularis. The internal auditory meatus and cochlear aqueduct were free from pathology. There was a large bony dehiscence in the facial canal, through which the facial nerve was covered by the mucous membrane with marked leukemic infiltration. Hemorrhage was noticed within the facial nerve.
View full abstract