AM ER IC AN JOUR NA L OF OTOLARY NG OLOG Y –H EA D A N D N E CK ME D I CI NE AN D SUR G E RY 3 5 ( 2 0 14 ) 62 6–6 2 7
Available online at www.sciencedirect.com
ScienceDirect www.elsevier.com/locate/amjoto
Middle Ear Promontory Osteoma Paula Cruz Toro, MD⁎, Àngela Callejo Castillo, MD, Rafael Moya Martínez, MD, Iván Domènech Juan, MD, PHD Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitario Quirón Dexeus, Agrupació Mèdica I Quirúrgica (AMiQ), Barcelona, Spain
ARTI CLE I NFO
A BS TRACT
Article history:
Osteomas are benign lesions of the lamellar bone that within the temporal region are
Received 23 June 2014
common in the external ear canal. Osteomas of the middle ear are extremely rare and until now there are only 14 reported cases. They usually present with conductive hearing loss while others are asymptomatic and diagnosed incidentally. © 2014 Elsevier Inc. All rights reserved.
1.
Introduction
Osteomas of the temporal bone are usually found in the external auditory canal, however its presence in other areas has been reported such as the mastoid region, the squama and the internal auditory canal, being extremely rare the reports in the middle ear. Actually in the medical literature there is a report of 70 cases of temporal bone osteomas originating outside the external canal, being only 14 of these osteomas of the middle ear [1–4].
2.
Case reports
We present a case of a 33 year-old female with history of secretory otitis media in her childhood treated with ear tubes, who complained of hearing loss for the 3 last years, with no other symptoms. Left otoscopy showed an image suggesting a cholesteatoma pearl in the anterior-inferior quadrant of the eardrum and mild unilateral conductive hearing loss in the audiometric tests. CT scan was performed showing an osteoma located on the promontory that contacted with the inner tympanic layer leaving its mark and bulging in the ear drum; there was no evidence of images that suggested cholesteatoma (Figs. 1, 2). The patient was explored with microscopic otoscopy under
local anesthesia, but since her hearing loss was slight, it was decided not to remove the lesion.
3.
Discussion
Temporal bone osteomas occur mostly in young patients, presenting as a single-unilateral lesion. Its etiology is still unknown but it is believed that they originate from the bone capsule’s connective tissue and they are histologically similar to those observed in the external acoustic canal. Usually they present in patients with no history of ear pathology or trauma, with a bear normal otoscopy, being diagnosed incidentally in asymptomatic patients or with associated unilateral progressive conductive hearing loss [1,2]. CT scan is the recommended complementary image as it defines the extent and probable origin of the lesion also detecting any secondary manifestations of the tumor [1–4]. Although in the past surgery was the treatment of choice, nowadays it is controversial as it has been shown that osteomas present an extremely low growing rate, reason why its removal is not indicated. Treatment should be considered only when hearing loss becomes relevant for the patient or, when there are other complications associated. Follow ups with microscopic otoscopy and CT scans are the choice in asymptomatic patients [3,4].
⁎ Corresponding author at: Calle Sabino Arana 5-19, Despacho 1.4. Tel.: +34 663768745; fax: + 34 932178328. E-mail addresses: [email protected], [email protected] (P.C. Toro). http://dx.doi.org/10.1016/j.amjoto.2014.07.005 0196-0709/© 2014 Elsevier Inc. All rights reserved.
AM ER IC AN JOUR NA L OF OTOLARY NG OLOG Y –H EA D A N D N E CK ME D I CI N E AN D SUR G E RY 3 5 ( 2 0 14 ) 62 6–6 2 7
627
Fig. 1 – Coronal section.
Fig. 2 – Axial section.
4.
Conclusion
Osteomas of the middle ear are a rare entity, but should be considered in the differential diagnosis of middle ear masses. They usually present in asymptomatic patients or with conductive hearing loss. CT scan is the confirmatory diagnosis image. Surgical removal is indicated only in moderate–severe hearing loss or in associated complications due to the tumor.
REFERENCES
[1] Unal OF, Tosun F, Yetişer S, Dündar A. Osteoma of the middle ear. Int J Pediatr Otorhinolaryngol 2000;52:193–5. [2] Silver FM, Orobello Jr PW, Mangal A, Pensak ML. Asymptomatic osteomas of the middle ear. Am J Otol 1993;14:189–90. [3] Barbosa VC, Santos MA, Becker HM, Diniz RF. Osteoma of the middle ear. Braz J Otorhinolaryngol 2007;73:719. [4] Greinwald Jr JH, Simko EJ. Diagnosis and management of middle ear osteomas: a case report and literature review. Ear Nose Throat J 1998;77:134–6 [138–9].
Available online at www.sciencedirect.com
ScienceDirect www.elsevier.com/locate/amjoto
Middle Ear Promontory Osteoma Paula Cruz Toro, MD⁎, Àngela Callejo Castillo, MD, Rafael Moya Martínez, MD, Iván Domènech Juan, MD, PHD Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitario Quirón Dexeus, Agrupació Mèdica I Quirúrgica (AMiQ), Barcelona, Spain
ARTI CLE I NFO
A BS TRACT
Article history:
Osteomas are benign lesions of the lamellar bone that within the temporal region are
Received 23 June 2014
common in the external ear canal. Osteomas of the middle ear are extremely rare and until now there are only 14 reported cases. They usually present with conductive hearing loss while others are asymptomatic and diagnosed incidentally. © 2014 Elsevier Inc. All rights reserved.
1.
Introduction
Osteomas of the temporal bone are usually found in the external auditory canal, however its presence in other areas has been reported such as the mastoid region, the squama and the internal auditory canal, being extremely rare the reports in the middle ear. Actually in the medical literature there is a report of 70 cases of temporal bone osteomas originating outside the external canal, being only 14 of these osteomas of the middle ear [1–4].
2.
Case reports
We present a case of a 33 year-old female with history of secretory otitis media in her childhood treated with ear tubes, who complained of hearing loss for the 3 last years, with no other symptoms. Left otoscopy showed an image suggesting a cholesteatoma pearl in the anterior-inferior quadrant of the eardrum and mild unilateral conductive hearing loss in the audiometric tests. CT scan was performed showing an osteoma located on the promontory that contacted with the inner tympanic layer leaving its mark and bulging in the ear drum; there was no evidence of images that suggested cholesteatoma (Figs. 1, 2). The patient was explored with microscopic otoscopy under
local anesthesia, but since her hearing loss was slight, it was decided not to remove the lesion.
3.
Discussion
Temporal bone osteomas occur mostly in young patients, presenting as a single-unilateral lesion. Its etiology is still unknown but it is believed that they originate from the bone capsule’s connective tissue and they are histologically similar to those observed in the external acoustic canal. Usually they present in patients with no history of ear pathology or trauma, with a bear normal otoscopy, being diagnosed incidentally in asymptomatic patients or with associated unilateral progressive conductive hearing loss [1,2]. CT scan is the recommended complementary image as it defines the extent and probable origin of the lesion also detecting any secondary manifestations of the tumor [1–4]. Although in the past surgery was the treatment of choice, nowadays it is controversial as it has been shown that osteomas present an extremely low growing rate, reason why its removal is not indicated. Treatment should be considered only when hearing loss becomes relevant for the patient or, when there are other complications associated. Follow ups with microscopic otoscopy and CT scans are the choice in asymptomatic patients [3,4].
⁎ Corresponding author at: Calle Sabino Arana 5-19, Despacho 1.4. Tel.: +34 663768745; fax: + 34 932178328. E-mail addresses: [email protected], [email protected] (P.C. Toro). http://dx.doi.org/10.1016/j.amjoto.2014.07.005 0196-0709/© 2014 Elsevier Inc. All rights reserved.
AM ER IC AN JOUR NA L OF OTOLARY NG OLOG Y –H EA D A N D N E CK ME D I CI N E AN D SUR G E RY 3 5 ( 2 0 14 ) 62 6–6 2 7
627
Fig. 1 – Coronal section.
Fig. 2 – Axial section.
4.
Conclusion
Osteomas of the middle ear are a rare entity, but should be considered in the differential diagnosis of middle ear masses. They usually present in asymptomatic patients or with conductive hearing loss. CT scan is the confirmatory diagnosis image. Surgical removal is indicated only in moderate–severe hearing loss or in associated complications due to the tumor.
REFERENCES
[1] Unal OF, Tosun F, Yetişer S, Dündar A. Osteoma of the middle ear. Int J Pediatr Otorhinolaryngol 2000;52:193–5. [2] Silver FM, Orobello Jr PW, Mangal A, Pensak ML. Asymptomatic osteomas of the middle ear. Am J Otol 1993;14:189–90. [3] Barbosa VC, Santos MA, Becker HM, Diniz RF. Osteoma of the middle ear. Braz J Otorhinolaryngol 2007;73:719. [4] Greinwald Jr JH, Simko EJ. Diagnosis and management of middle ear osteomas: a case report and literature review. Ear Nose Throat J 1998;77:134–6 [138–9].
