An Inverted Papilloma of the Middle Ear

Introduction:

We report the occurrence of an inverted papilloma (IP) in the petrous bone after endonasal surgery.

Case report:

A 68-year-old female patient reported nasal obstruction and rhinorrhoea on her left nose.

Endoscopic examination and CT-scans revealed her left nasal cavity to be filled with a tumor mass.

The tumor was surgically removed completely by endonasal-endoscopic sinus surgery. Histological examination led to the finding of an IP. The unusually large openings of the tuba auditiva were intraoperatively free and far located from the IP. After 8 weeks the patient noticed a progressive hearing loss on her left side. A conductive hearing loss of 40db concerning all frequencies and a dedifferentiation of the left eardrum could be verified. CT-scans revealed the left mastoid and tympanum to be completely obstructed. Explorative tympanoscopy confirmed IP within the petrous bone. A left typanomastoidectomy was performed consecutively with the aim of tumor removal. Discussion in the interdisciplinary tumor conference led to the recommendation of adjuvant radiotherapy because of severe dysplasia. The patient refused this therapy and preferred to present periodically to follow-up examinations.

Conclusion:

IP is a rare tumor entity representing about 0.5 to 4% of all nasal tumors. Localization in the petrous bone is associated with a higher risk of malignancy (up to 60%) than the endonasal localization (up to 15%). The tumor may infiltrate the middle ear via the tuba auditiva. There exist few case reports on IP of the middle ear. It is characterized by a locally destructive growth and a tendency towards malignant transformation, which represents a challenge to treat by the attending ENT and other specialists.

Publication History

Publication Date:
18 April 2018 (online)