Introduction:
An 88-year-old patient was fist referred in 08.2017 with encreasing hearingloss of
the left side and tympanic effusion since four weeks. Findings of the ear microscopy
were a dull and immobile left tympanic membrane with serous middle ear effusion on
the left side. Audiometry revieled a pantonal combined hearing loss of 10 – 20 dB.
With history of improvement under decongestant measures, conservative therapy was
intensified. After 13 month the patient was re-referred with a new persistent tympanic
effusion and progressive hearing loss on the left ear.
Methods:
The ENT examination revealed a left-sided tympanic effusion with a non-thickened and
intact eardrum. Endoscopically, the eustachian tube entrance was swollen compared
to the opposite side. Audiometry showed a progressive combined, severe hearing loss
on the left with a pantonal conductive hearing loss of 20 – 30 dB.
Results:
A subsequent MRI and CT of the head revealed a mass in the left pterygopalatina fossa,
which reached the middle fossa. In a transmaxillary biopsy showed a low grade spindle
cell proliferation with numerous psammoma bodies, most likely corresponding to a meningioma.
The diagnosis of meningotheliomatous meningioma, WHO grade I was made.
As there were no symptoms under tympanic drainage, the decision was in favor of a
wait and scan strategy.
Conclusion:
This case emphasizes that in adult patients with persitent unilateral tympanic effusion
and without an organic correlate in the nasopharynx an imaging study should be performed
to clarify the diagnosis.
