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.

Publication History

Publication Date:
23 April 2019 (online)