Two cases of systemic necrotizing angeitis are reported because of their very unusual presenting symptom: serous otitis media responsible for bilateral deafness. After this "invasion phase", typical polyarteritis nodosa developed. Cardiac involvement, with auriculoventricular block, and cranial neuritis were observed in both cases. The few previously published identical cases are reviewed. Specific neurological and cardiac forms of P.A.N. are discussed. It is hypothesized that the cause of this immune complex-mediated disease is infectious.

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