Sudden Deafness with Serosanguinous Middle Ear Effusions in a Patient with Rheumatoid Arthritis

Investigations: Hb, 95%; WBe 6200 mm': differential count normal; platelets 250,000 mm'. Hess'test negative; RA (latex) test posiuve: R3 test negative; antinuclear factor negative; B-I-C/ I-A globulin 200mg./ 100ml. Immunoglobulins: IgG = I660mg./ 100mi., IgM = 64mg.j 100mi., IgA = 200mg:/100ml. LE cells X3 negative. Coornb's test negative; ASO ntre 50 u/rnl: WR and VORL negative; blood cultures, Brucella antibodies, MSU and throat swabs were all negative. Electrolytes and blood urea normal; SGOT, SGPT, LOH and creatinine kinase were not raised. Serum albumin 3.6g./100ml; ウ セ イ オ ュ globulin 3.2g./100 ml; electrophoresis セ ィ N ッ キ ・ 、 so.me Increase in gamma globulins. X-rays: chest, JOInts and Internal auditory meati were normal. ECG showed slow atrial fibrillation. s セ ョ ッ カ ゥ セ Q analysis: Clear. low viscosity fluid, 8000 cellsr rnm ', 80% polymorphs. No crystals detected, RO latex and セnf were negative, culture was sterile, B-I-C/ I-A globulin 63mm./100ml. (normal 120-168mg./IOOml.). IgG 1413 mg./ 100mi., IgM 25mg./ 100ml., IgA 105mg./100ml. Temporal artery biopsy and muscle (right thigh) biopsy were normal. On a.dmission to hospital the patient was receiving indomethacin 100mg. per day and 1-2 g. aspirin per day. The serum uric acid level was more than 12mg./IOOml. but fell rapidly to 5.6mg./IOOml. on discontinuing the salicylates. Bilateral myringotomy and paracentesis were performed, F1g.1a. AUdiogram showing bilateral conductive deafness. Bone conduction is better than air conduction. 100 .0 .0 fluid in both middle ears. There were signs of conductive deafness with a bilateral negative Rinne's test, and audiograms confirmed this (Fig. la).