Retromaxillary mass as cause of unilateral tympanic effusion

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.

 

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Dr. med. Sophia Lodes

HNO-Klinik der Universitätsklinik Tübingen,

Elfriede-Aulhorn-Straße 5, 72076

Tübingen

eMail: [e-mail]

Publikationsverlauf

Publikationsdatum:
23. April 2019 (online)