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Osteoma of the middle ear
International Journal of Pediatric Otorhinolaryngology 52 (2000) 193 – 195 www.elsevier.com/locate/ijporl
Case report
Osteoma of the middle ear O8 mer Faruk U8 nal *, Fuat Tosun, Sertac¸ Yetıs¸er, Ahmet Du¨ndar Department of Otolaryngology and Head & Neck Surgery, Gu¨lhane Military Medical Academy, Ankara, Turkey Received 8 September 1999; received in revised form 21 January 2000; accepted 22 January 2000
Abstract Osteomas are benign pedunculated tumours of the lamellar bone, which commonly originates from paranasal sinuses. Within the temporal bone they are seen commonly in the external ear canal. Osteomas originating from the middle ear are very rare. There are only 12 cases reported in the medical literature up to now. Five of those cases caused conductive hearing loss and the others were asymptomatic and diagnosed incidentally. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Osteoma; Middle ear; Conductive hearing loss
1. Introduction Temporal bone osteomas are rarely seen tumours. They most commonly occur in the external ear canal [1]. Sixty cases with non-external ear canal originating temporal bone osteomas were reported [2] and only 12 of those were in the middle ear [3]. Most of the cases with middle ear osteomas were asymptomatic and were diagnosed coincidentally, only five of them caused conductive type hearing loss. In this article, a 14-year-old male patient with
* Corresponding author. Present address: Kug˘u C ¸ ıkmazı B-31/2, Bilkent C ¸ amlık Sitesi, 06530 Ankara, Turkey. Fax: +90-312-3113500. E-mail address: [email protected] (O8 .F. U8 nal)
an osteoma in the middle ear causing conductive hearing loss is presented. 2. Case report A 14-year-old male patient presented to the Department of Otolaryngology of the Gu¨lhane Military Medical Academy with a history of progressive hearing impairment of the left ear. Otolaryngologic examination revealed hypervascularity of the left ear drum. The patient denied tinnitus, trauma, prior surgery, ear infection or vestibular symptoms. Audiologic examination revealed a left sided conductive hearing loss (Table 1). Computerized tomography (CT) scan indicated presence of a bony mass medial to the ear drum filling the middle ear space and involving the ossicles (Fig. 1).
0165-5876/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 5 8 7 6 ( 0 0 ) 0 0 2 8 6 - X
194
O8 .F. U8 nal et al. / Int. J. Pediatr. Otorhinolaryngol. 52 (2000) 193–195
Table 1 Pre-operative hearing levels of the left ear 128 Hz Bone conduction level (dB) Air conduction level (dB)
75
256 Hz 25 75
The patient underwent left exploratory tympanotomy. After elevation of tympano-meatal flap, a rock hard white bony mass was encountered, which was filling the tympanium and extending to the attic (Fig. 2). Atticotomy was done to expose the ossicles which proved that the mass was touching the incudostapedial joint with limitation of ossicular movement. Only a small force was necessary to break the pedicle of the mass to mobilize it. After mobilization, a small cutting burr was used to divide the mass into two pieces to facilitate its removal without harming the flap or the ossicles (Fig. 3). Post operative period was uneventful and post operative CT scan (Fig. 4) and audiologic findings were normal.
512 Hz 15 60
1024 Hz 25 65
2048 Hz 30 70
4096 Hz
80
symptomatic only if it is in direct or indirect relation with the ossicular chain. The most common symptom of an osteoma in the middle ear is conductive hearing loss. Only four cases had a pathological appearance of the tympanic membrane. In two of these cases the osteoma was touching and irritating the ear drum as the case
3. Discussion Thomas, in 1964, was the first to diagnose an osteoma of the middle ear in two siblings, 10 and 6 years of age, and he suggested possible congenital origin of the tumour [4]. Later, in 1966, Ombradanne reported a case with osteoma in the middle ear located on facial canal and stapes causing a conductive type hearing loss [5]. In 1985, Cramers reported a case with an osteoma originating from the promontory and mentioned that labyrinth was exposed while he was trying to break the osteoma with a chisel [6]. Glasscock alluded to Cramer’s case in his article,which presented an osteoma of malleus, and suggested that using a burr to cut the mass would be safer [5]. Other cases with osteoma of the middle ear have been reported [7–11]. When the cases in the literature are reviewed, one can see that even in the middle ear cavity there are several different anatomical places from which an osteoma may originate. The mass is
Fig. 1. Pre-operative CT scan demonstrating solid mass in the middle ear cavity.
Fig. 2. Intra operative view of the middle ear filled with the mass.
O8 .F. U8 nal et al. / Int. J. Pediatr. Otorhinolaryngol. 52 (2000) 193–195
195
sity [3]. Audiological examination is necessary in these patients. With the addition of the case presented here, 6 of the 13 patients with osteomas of the middle ear had conductive hearing loss. Suggested treatment for osteoma in the middle ear is the removal of the mass with an exploratory tympanotomy, with care to avoid damage to the ossicular chain. To avoid possible other complications meticulous work is necessary. In some of the cases, as the case presented, it is necessary to break the large mass into smaller pieces using a burr to facilitate its removal. Fig. 3. Removed osteoma is seen.
References
Fig. 4. Control CT scan showing no residual tumor in the middle ear.
presented here. One of the other patients had cholesteatoma [7] and the other had an adenoma together with an osteoma, changing the appearance of tympanic membrane [9]. Diagnosis of the osteoma in the middle ear was suggested by CT scan of temporal bone, which showed a well circumscribed mass with high den-
.
[1] H.H. Ramadan, Osteoma of the malleus, Am. J. Otol. 15 (1994) 807 – 809. [2] S. Ito, H. Tanaka, M. Hirano, Osteoma of the middle ear, J. Laryngol. Otol. 104 (1990) 803 – 806. [3] E.H. Harley, R.G. Berkowitz, Osteoma of the middle ear, Ann. Otol. Rhinol. Laryngol. 106 (1997) 714 – 715. [4] R. Thomas, Familial osteoma of the middle ear, J. Laryngol. Otol. 78 (1964) 805 – 807. [5] M.E. Glasscock, K.X. McKennan, S.C. Levine, Osteoma of the middle ear: a case report, Otolaryngol. Head Neck Surg. 97 (1987) 64 – 65. [6] C.W. Cremers, Osteoma of the middle ear, J. Laryngol. Otol. 99 (1985) 383 – 386. [7] T. Yamasoba, T. Harada, T. Okuno, Y. Nomura, Osteoma of the middle ear: report of a case, Arch. Otolaryngol. Head Neck Surg. 116 (1990) 1214 – 1216. [8] F.M. Silver, P.W. Orobello, A. Mangal, M.L. Pensak, Asymptomatic osteomas of the middle ear, Am. J. Otol. 14 (1993) 189 – 190. [9] K.R. McDonald, J.T. Vrabec, Synchronous middle ear osteoma and adenoma, Ear Nose Throat J. 76 (1993) 866 – 869. [10] H. Muraoka, A. Tsunoda, M. Kojima, H. Tokano, A. Komatsuzaki, Three dimensional imaging of ENT diseases with helical computed tomography, J. Laryngol. Otol. 110 (1996) 604 – 608. [11] Y. Orita, K. Nishizaki, H. Akagi, T. Ogawa, Y. Masuda, Osteoma with cholesteatoma in the external ear canal, Int. J. Pediatr. Otorhinolaryngol. 43 (1998) 289 – 293.
Case report
Osteoma of the middle ear O8 mer Faruk U8 nal *, Fuat Tosun, Sertac¸ Yetıs¸er, Ahmet Du¨ndar Department of Otolaryngology and Head & Neck Surgery, Gu¨lhane Military Medical Academy, Ankara, Turkey Received 8 September 1999; received in revised form 21 January 2000; accepted 22 January 2000
Abstract Osteomas are benign pedunculated tumours of the lamellar bone, which commonly originates from paranasal sinuses. Within the temporal bone they are seen commonly in the external ear canal. Osteomas originating from the middle ear are very rare. There are only 12 cases reported in the medical literature up to now. Five of those cases caused conductive hearing loss and the others were asymptomatic and diagnosed incidentally. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Osteoma; Middle ear; Conductive hearing loss
1. Introduction Temporal bone osteomas are rarely seen tumours. They most commonly occur in the external ear canal [1]. Sixty cases with non-external ear canal originating temporal bone osteomas were reported [2] and only 12 of those were in the middle ear [3]. Most of the cases with middle ear osteomas were asymptomatic and were diagnosed coincidentally, only five of them caused conductive type hearing loss. In this article, a 14-year-old male patient with
* Corresponding author. Present address: Kug˘u C ¸ ıkmazı B-31/2, Bilkent C ¸ amlık Sitesi, 06530 Ankara, Turkey. Fax: +90-312-3113500. E-mail address: [email protected] (O8 .F. U8 nal)
an osteoma in the middle ear causing conductive hearing loss is presented. 2. Case report A 14-year-old male patient presented to the Department of Otolaryngology of the Gu¨lhane Military Medical Academy with a history of progressive hearing impairment of the left ear. Otolaryngologic examination revealed hypervascularity of the left ear drum. The patient denied tinnitus, trauma, prior surgery, ear infection or vestibular symptoms. Audiologic examination revealed a left sided conductive hearing loss (Table 1). Computerized tomography (CT) scan indicated presence of a bony mass medial to the ear drum filling the middle ear space and involving the ossicles (Fig. 1).
0165-5876/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 5 8 7 6 ( 0 0 ) 0 0 2 8 6 - X
194
O8 .F. U8 nal et al. / Int. J. Pediatr. Otorhinolaryngol. 52 (2000) 193–195
Table 1 Pre-operative hearing levels of the left ear 128 Hz Bone conduction level (dB) Air conduction level (dB)
75
256 Hz 25 75
The patient underwent left exploratory tympanotomy. After elevation of tympano-meatal flap, a rock hard white bony mass was encountered, which was filling the tympanium and extending to the attic (Fig. 2). Atticotomy was done to expose the ossicles which proved that the mass was touching the incudostapedial joint with limitation of ossicular movement. Only a small force was necessary to break the pedicle of the mass to mobilize it. After mobilization, a small cutting burr was used to divide the mass into two pieces to facilitate its removal without harming the flap or the ossicles (Fig. 3). Post operative period was uneventful and post operative CT scan (Fig. 4) and audiologic findings were normal.
512 Hz 15 60
1024 Hz 25 65
2048 Hz 30 70
4096 Hz
80
symptomatic only if it is in direct or indirect relation with the ossicular chain. The most common symptom of an osteoma in the middle ear is conductive hearing loss. Only four cases had a pathological appearance of the tympanic membrane. In two of these cases the osteoma was touching and irritating the ear drum as the case
3. Discussion Thomas, in 1964, was the first to diagnose an osteoma of the middle ear in two siblings, 10 and 6 years of age, and he suggested possible congenital origin of the tumour [4]. Later, in 1966, Ombradanne reported a case with osteoma in the middle ear located on facial canal and stapes causing a conductive type hearing loss [5]. In 1985, Cramers reported a case with an osteoma originating from the promontory and mentioned that labyrinth was exposed while he was trying to break the osteoma with a chisel [6]. Glasscock alluded to Cramer’s case in his article,which presented an osteoma of malleus, and suggested that using a burr to cut the mass would be safer [5]. Other cases with osteoma of the middle ear have been reported [7–11]. When the cases in the literature are reviewed, one can see that even in the middle ear cavity there are several different anatomical places from which an osteoma may originate. The mass is
Fig. 1. Pre-operative CT scan demonstrating solid mass in the middle ear cavity.
Fig. 2. Intra operative view of the middle ear filled with the mass.
O8 .F. U8 nal et al. / Int. J. Pediatr. Otorhinolaryngol. 52 (2000) 193–195
195
sity [3]. Audiological examination is necessary in these patients. With the addition of the case presented here, 6 of the 13 patients with osteomas of the middle ear had conductive hearing loss. Suggested treatment for osteoma in the middle ear is the removal of the mass with an exploratory tympanotomy, with care to avoid damage to the ossicular chain. To avoid possible other complications meticulous work is necessary. In some of the cases, as the case presented, it is necessary to break the large mass into smaller pieces using a burr to facilitate its removal. Fig. 3. Removed osteoma is seen.
References
Fig. 4. Control CT scan showing no residual tumor in the middle ear.
presented here. One of the other patients had cholesteatoma [7] and the other had an adenoma together with an osteoma, changing the appearance of tympanic membrane [9]. Diagnosis of the osteoma in the middle ear was suggested by CT scan of temporal bone, which showed a well circumscribed mass with high den-
.
[1] H.H. Ramadan, Osteoma of the malleus, Am. J. Otol. 15 (1994) 807 – 809. [2] S. Ito, H. Tanaka, M. Hirano, Osteoma of the middle ear, J. Laryngol. Otol. 104 (1990) 803 – 806. [3] E.H. Harley, R.G. Berkowitz, Osteoma of the middle ear, Ann. Otol. Rhinol. Laryngol. 106 (1997) 714 – 715. [4] R. Thomas, Familial osteoma of the middle ear, J. Laryngol. Otol. 78 (1964) 805 – 807. [5] M.E. Glasscock, K.X. McKennan, S.C. Levine, Osteoma of the middle ear: a case report, Otolaryngol. Head Neck Surg. 97 (1987) 64 – 65. [6] C.W. Cremers, Osteoma of the middle ear, J. Laryngol. Otol. 99 (1985) 383 – 386. [7] T. Yamasoba, T. Harada, T. Okuno, Y. Nomura, Osteoma of the middle ear: report of a case, Arch. Otolaryngol. Head Neck Surg. 116 (1990) 1214 – 1216. [8] F.M. Silver, P.W. Orobello, A. Mangal, M.L. Pensak, Asymptomatic osteomas of the middle ear, Am. J. Otol. 14 (1993) 189 – 190. [9] K.R. McDonald, J.T. Vrabec, Synchronous middle ear osteoma and adenoma, Ear Nose Throat J. 76 (1993) 866 – 869. [10] H. Muraoka, A. Tsunoda, M. Kojima, H. Tokano, A. Komatsuzaki, Three dimensional imaging of ENT diseases with helical computed tomography, J. Laryngol. Otol. 110 (1996) 604 – 608. [11] Y. Orita, K. Nishizaki, H. Akagi, T. Ogawa, Y. Masuda, Osteoma with cholesteatoma in the external ear canal, Int. J. Pediatr. Otorhinolaryngol. 43 (1998) 289 – 293.