Case report - unclear auditory tube dysfunction

Introduction The tympanic cavity is ventilated and drained via the auditory tube into the nasopharynx. In case of chronic tubal dysfunction a pathology in the nasopharynx has to be excluded.

Anamnesis A 33-year-old patient presented to the hospital for the first time with an auditory tube dysfunction and recurrent tympanic effusion from the left ear with request for balloon eustachian tuboplasty and reinsertion of a ventilation tube (VT). A VT inserted elsewhere 5 years ago had fallen out shortly before. More than 10 years ago a benign tumour of the left parotid gland (PG) was surgically removed via a transoral approach abroad.

Diagnostics In the clinical examination the oro- and nasopharynx appeared free from pathological findings. Audiometry revealed a conductive hearing loss with a flat tympanogram in the left ear. Ultrasound imaging of the neck showed two small, hypoechoic, homogeneous, sharply defined tumours in the latero-caudal part of the left PG. Due to the unclear previous operation an MRI of the neck with contrast medium was conducted. It showed a large tumour growing from the deep lobe of the left PG. The tumour reached up to the nasopharynx and compressed the auditory tube.

Therapy To improve hearing a VT was inserted on the left side under local anesthesia. In the further course we performed a transcervical total parotidectomy with extirpation of the paranaso- and paraoropharyngeal tumour masses under facial nerve monitoring and intubation anesthesia. The histological examination revealed a pleomorphic adenoma. Conclusion: Nasopharyngeal endoscopy without pathological findings combined with chronic, therapy-resistant, unilateral tubal dysfunction should result in extended imaging to rule out a deeper pathology.

Poster-PDF A-1509.pdf

Publication History

Article published online:
13 May 2021