Chronic Serous Otitis Media with Effusion in Patients with “En Plaque” Meningiomas

To present a series of patients with “en plaque” meningioma involving the middle ear, subsequently developing chronic serous otitis media with effusion, review this unusual presentation and its most common clinical manifestations as well as imaging features and management.

Methods: This is a single-center, retrospective study of cases involving the association of these two conditions. A review of medical records, images and operative reports and videos was conducted. Patients included for review presented signs and symptoms suggestive of CSOM and neuroimaging studies showing “en plaque meningioma” involving the middle ear or mastoid and/or with effusion.

Results: Five cases were identified, of which four were in female patients, ages ranging from 45 to 70 years (average: 56 years).

All patients had a long history of hypoacusia, aural fullness, and three also referred tinnitus. Despite different medical treatments, symptoms persisted at discharge. Delay between symptom onset, diagnosis of meningioma and referral to our center was at least 2 years.

CT scans and MRIs showed evidence of sphenotemporal hyperostosis and middle ear or mastoid air cell involvement in all cases. MRI was the study of choice for definition of extension.

Management prior to referral included unsuccessful middle ear procedures such as VTs, mastoidectomy, and exploratory myringotomy. Three patients underwent neurosurgical decompression due to major orbit or intracranial extension and significant neurological symptoms.

Histology confirmed WHO grade I meningioma in four operated patients. Two were referred for adjuvant radiotherapy/GKS, and one for hormone therapy.

Conclusion: En plaque meningiomas presenting middle ear or mastoid involvement may cause atypical or persistent CSOM, not resolving after tympanostomy and tube placement. CT scan and MRI will aid in diagnosis. Surgery may be considered for histologic confirmation as well as decompression of neural structures. However, total resection is difficult and often achieved at the expense of significant morbidity, neurological deficit or risk of CSF leak. Remnants should be monitored closely, and postoperative radiotherapy may be indicated in some histology types. Conservative management and imaging during follow-up are often the best alternative for small or medium size, asymptomatic lesions.

Tomographic evidence of occupation of both the mastoid surgical cavity (*) and the tympanic cavity (arrow; [Fig. 1]).

On MRI the mastoid component is hyperintense in T2 (thick arrow) and does not show contrast enhancement (hollow arrowhead). Tympanic component is isointense on T2 (dotted arrow) with intense enhancement (arrowhead). Images compatible with mastoid effusion and tympanic tumor invasion.

Fig. 1 Axial CT (A) and MRI-weighted sections in T2 (B), T1 (C) and T1 with gadolinium (D). Coronal slices of CT (E, I) and MRI weighted at T2 (F, J), T1 (G, K) and T1 with gadolinium (H, L).

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023