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Hearing loss and leukocytosis.

Accepted 1 June 1995 A 79-year-old woman noticed progressive hearing loss and a sensation of pressure in her right ear. Otolaryngologic examination was unremarkable. During the next three months she developed malaise, diaphoresis and intermittent low-grade fever. Physical examination revealed mild bilateral cervical lymphadenopathy and hepatosplenomegaly. Laboratory tests revealed leukocytosis of 120 x 109/1 without anemia or thrombocytopenia. Serum protein and immune electrophoresis were normal. A peripheral blood film revealed the presence of smudge cells and 90% small mature lymphocytes, which were CD2, CD5, CD19, and CD20 positive. An audiogram performed in 2/92 and 8/92 and magnetic resonance imaging (MRI) of the auditory apparatus, demonstrated sensorineural hearing loss, more prominent in the right ear (figures 1 and 2, respectively). Treatment was initiated and a repeat audiogram was performed in 12/92 (figure 1).