Cogan's Syndrome

Timothy C. Hain, MD Page last modified: January 5, 2008

Dr. David Cogan. SOURCE: http://vision4.nei.nih.gov/Cogan/dctcCoganBio.jsp

Cogans syndrome is defined as nonsyphilitic interstitial keratitis (an inflammation of the eye) and bilateral audiovestibular deficits (hearing problems and dizziness). It was first described in Morgan and Baumgartner in 1934, and Cogan reported 5 more cases in 1945. Dr. David Cogan was a prolific writer and his name is also on an ocular sign involving ocular deviation under closed eyelids. Only about 100 cases of the Cogans syndrome discussed here have been described in the world literature. This disease primarily affects whites and is believed not to be hereditary.

Signs and Symptoms:

Typical CS is characterized by interstitial keratitis and vestibuloauditory dysfunction.There is generally a brief episode of inflammatory eye disease (interstitial keratitis) followed by bilateral audiovestibular symptoms. The interstitial keratitis usually occurs with sudden onset and is characterized by photophobia, lacrimation, and eye pain. The vestibuloauditory dysfunction is usually bilateral, presenting with tinnitus, sensorineural hearing loss, and acute episodes of vertigo.

The symptoms typically progressively deteriorate within days. While the ESR, WBC, C-reactive protein test may be abnormal and there may be thrombocytosis or anemia, none of these findings are reliable indicators of the disease. A slit-lamp examination is essential. Recent work has suggested that high-resolution MRI and antibodies to inner ear antigens may be helpful. We are dubious about the antibodies, but MRI with a local ear coil seems worth considering, as fibrous material appears to close off the labyrinth in this disease. Cogans children can occur in children, and is particularly difficult to recognize in that situation (Massinger and Keilmann, 2003).

"Atypical" Cogans syndrome is the association of the typical hearing symptoms with other ocular symptoms including scleritis or episcleritis, retinitis, optic neuritis, glaucoma, dry eye, ptosis, etc. (Grasland et al, 2004; Cundiff et al, 2006). The diagnosis of "atypical Cogans", should be considered with much greater skepticism than Cogans with interstitial keratitis, as combining (for example), Meniere's with glaucoma could potentially generate a large number of falsely diagnosed patients. The author's position is that the diagnosis of Cogan's should be referred for patients with the so-called "classic" syndrome.

Treatment

Treatment is with vigorous immune suppression to avoid deafness and visual deterioration.

Other material

A patient with Cogan's syndrome volunteered to put her story on line, and it can be found by clicking here.

See also: Autoimmune Inner Ear Disease

References:

• Cogan DA: Syndrome of nonsyphilitic interstitial keratitis and vestibuloauditory symptoms. Arch Ophthalmol 1945;33:144-9 Cundiff, J., S. Kansal, et al. (2006). "Cogan's syndrome: a cause of progressive hearing deafness." Am J Otolaryngol27(1): 68-70.
• Grasland et al, Typical and atypical Cogan's syndrome: 32 cases and review of the literature. Rheumatology 2004:43:1007-1015.
• Helmchen C, Jager L, Buttner U, Reiser M, Brandt T. Cogans syndrome: High resolution MRI indicators of activity. JVR 8,2,155-167, 1998
• Kundell Sp, HD Ochs: Cogan's syndrome in childhood. J Pediatr 1980;97:96-8
• Massinger C, Keilmann. [Cogan-I-syndrome.A rare differential diagnosis in progressive sensorineural hearing loss.] AHNO 2003 Jan;51(1):66-70 [Article in German]
• Morgan RF, Baumgartner CF, Menier's disease complicated by recurrent interstitial keratitis. Excellent result following cervial ganglionectomy. West J Surg 1934;42:628