Presentation
Ear pain, blockage and right sided tinnitus for 6 months. Pulsatile mass on otoscopic examination.
Patient Data
Soft tissue mass abutting intact cochlear promontory extending into the middle ear cavity (including the prussak space) causing external bulging of the tympanic membrane and encasement of the middle ear ossicles without erosion/destruction.
Mass enhances on post contrast study.
Extension into the aditus ad antrum, mastoid antrum, mastoid air cells and eustachian tube.
The mass also lies adjacent to the facial nerve anterior genu and tympanic portions with widening of the mastoid segment of the facial canal.
The round window and round window niche are opacified.
The floor of the middle ear cavity is intact with no evidence of dehiscence of the lateral wall of the carotid canal.
Reactive bone sclerosis of the mastoid and tympanic temporal bone is also noted most likely due to chronic obstruction.
The scutum is preserved.
No permeative bone destruction is seen.
Case Discussion
A right sided middle ear soft tissue mass in the middle ear cavity adjacent to the cochlear promontory encasing but not destroying the ossicles, not blunting the scutum
Findings are strongly supportive of a right tympanic paraganglioma
The main differential was cholesteatoma but unlikely as the scutum is preserved
Unfortunately further clinical or imaging follow-up is not available for this case as an alternate geographical area was sought for further steps.
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