TITLE:
Bilateral Middle Fossa Floor Meningiomas Invading the Middle Ear
AUTHORS:
Nuwan T. Meegalla, Malini Suresh Nair, Michele Marie Gandolfi
KEYWORDS:
Conductive Hearing Loss, Multifocal Meningioma, Middle Ear Meningioma
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.13 No.5,
September
11,
2024
ABSTRACT: This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.