Primary Middle Ear Meningioma with Intact Tympanic Membrane: A Case Report and Literature Review

Primary ectopic meningioma of the middle ear is relatively rare in clinical practice. It is often difficult to distinguish it from chronic otitis media or otitis media with effusion due to its similar and atypical clinical symptoms. We report a case of epithelial tympanic ectopic meningioma with the main complaints of otalgia, aural fullness, and hearing loss. It was accidentally discovered during tympanotomy due to the symptoms of recurring refractory secretory otitis media. This article briefly reviews the relevant literature in recent years, summarizes the characteristics of primary ectopic tympanic meningioma with intact tympanic membrane, and emphasizes the diagnosis and treatment strategy of the middle ear mass.

Congenital Cholesteatoma in Adult: Is it Still Possible?

Congenital cholesteatoma is a mass of squamous epithelium located medial to an intact tympanic membrane without previous history of tympanic membrane perforation, otorrhoea or otological surgery. We described a 24 year old gentleman with a left postauricular discharging fistula for 3 years with recent history of gradual hearing loss, tinnitus and recurrent episodes of positional vertigo. Clinical examination noted left postauricular fistula opening and otoscopy showed a whitish mass medial to a bulging intact tympanic membrane. High-resolution computed tomography of temporal bone was suggestive of cholesteatoma. Left modified radical mastoidectomy was done and he recovered with resolution of symptoms. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 96-99

Otitis Externa

Key Points Otitis externa most commonly caused by Pseudomonas aeruginosa or Staphylococcus aureus bacteria.Examination noted to have swelling of ear canal, possible discharge, pain on movement of pinna or tragus.TreatmentFor intact tympanic membrane, can use neomycin, polymyxin B, or trimethoprim sulfate.For non-intact tympanic membrane or tympanostomy tube–associated otorrhea, use fluoroquinolones (eg, ciprofloxacin, ofloxacin).Malignant otitis externa (ie, rapid soft tissue and bone involvement) is characterized by severe pain, copious discharge, and possible facial paralysis and requires admission with imaging and intravenous antibiotics.

Pale Mass behind Intact Tympanic Membrane: An Otologic Puzzle to Solve

Whitish pale looking mass in the middle ear space is a diagnostic challenge not only to a novice otologic surgeon but also for an experienced surgeon. The array of differentials should be known for appropriate site of origin and its true nature. We have discussed a case of pale looking tympanic paraganglioma behind an intact tympanic membrane with few differentials to consider.

Hearing assessment in patients with tympanosclerosis with intact tympanic membrane

<p class="abstract"><strong>Background:</strong> Tympanosclerosis is an irreversible, though not immutable, end result of any unresolved specific or nonspecific inflammatory disease of middle ear characterized by anatomical distortion resulting in functional impairment. The objective of the study was to assess hearing in patients with tympanosclerosis with intact tympanic membrane (TM) and to correlate degree of hearing loss with respect to site of tympanosclerotic patch on TM.</p><p class="abstract"><strong>Methods:</strong> This cross-sectional study was conducted at Bangalore Medical College and Research Institute, Bangalore during study period from November 2016 to May 2018. Thirty patients enrolled for study were subjected to otoendoscopy, pure tone audiometry and tympanometry. Site of tympanosclerotic patch on tympanic membrane and hearing loss were assessed and correlated statistically. </p><p class="abstract"><strong>Results:</strong> Thirty patients (13-males, 17-females), aged 6–73 years (average-39.5 years) who fulfilled inclusion criteria were included. 7 (23.3%) patients had bilaterally affected ears amounting to 37 tympanosclerotic ears. left ear was commonly affected 14 (46.6%). In most patients, tympanosclerosis of tympanic membrane was an incidental finding with patients being otologically asymptomatic. The locations of tympanosclerotic patch on TM were 9 (24.4%) postero-superior, 7 (18.9%) postero-superior and postero-inferior, 7 (18.9%) antero-inferior, 5 (13.5%) postero-inferior, 3 (8.1%) antero-superior, 3 (8.1%) antero-superior and antero-inferior, 2 (5.4%) antero-inferior and postero-inferior and 1 (2.7%) entire pars tensa. Hearing level ranged from 10-46.6 dBHL (normal to moderate) with majority (91.89%) of patients had hearing within 25 dBHL. 43.3% had conductive hearing loss, 2.7% had sensorineural hearing loss and rest had normal hearing. Correlation of site of tympanosclerotic patch on TM with degree of hearing loss was not statistically significant (p=0.058).</p><p class="abstract"><strong>Conclusions:</strong> Variations in the site of tympanosclerotic patch on TM do not affect degree of hearing loss.</p>