The immotile-cilia syndrome is a congenital disorder characterized by all the cilia in the body being either immotile or showing an abnormal and inefficient beating pattern. Most symptoms come from the ciliated airways (nose, paranasal sinuses, and bronchs) and from the middle ear. Two further symptoms are situs inversus and male sterility. Situs inversus occurs in 50% of the cases and this subgroup is termed the Kartagener's syndrome; it might be due to an inability of the embryonic cilia to shift the heart to the left side and situs laterality seems to be a random process in the immotile-cilia syndrome. Male sterility is caused by the spermatozoa being unable to swim progressively; the sperm tail has the same structure as a cilium. In a few cases only the sperm tail or only the cilia of the body are affected. Female patients have a decreased fertility; most are involuntarily childless. The immotile-cilia syndrome is a heterogeneous disorder in that one out of many different genes may be involved. The different subtypes can be distinguished by an electron microscopic examination which will show defects in either one of a number of the ciliary components.