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Soft tissue middle ear mass
G Model
ARTICLE IN PRESS
ANORL-413; No. of Pages 2
European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
Available online at
ScienceDirect www.sciencedirect.com
What is your diagnosis?
Soft tissue middle ear mass G. Barrett a,∗ , B. Rock b , M. Prior c a
MRCS, Department of ENT Head and Neck Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, United Kingdom FRCR, Department of Radiology, Royal Cornwall Hospital NHS Trust, Penventinnie Ln, Truro, Cornwall TR1 3LJ, United Kingdom c FRCS, Department of ENT Head and Neck Surgery, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom b
1. Description A 70-year-old gentleman was seen with right-sided sensorineural hearing loss but no other otological symptoms. On otoscopy, a polypoid mass was visualized in the right middle ear behind an intact and healthy tympanic membrane. A computed tomography scan showed a soft tissue mass within the right mesotympanum measuring 6.6 mm in maximum axial dimension, extending into the region of the round window niche. Following this, magnetic resonance imaging (MRI) was obtained including T2 axial (Fig. 1a) and gadolinium enhanced T1 coronal (Fig. 1b) formats.
Fig. 1. a: T2 axial MRI of the internal acoustic meati; b: gadolinium enhanced T1 coronal MRI. The arrow points to the round window.
2. Question
What is your diagnosis?
∗ Corresponding author. E-mail address: [email protected] (G. Barrett). http://dx.doi.org/10.1016/j.anorl.2014.09.003 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Barrett G, et al. Soft tissue middle ear mass. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2014.09.003
G Model ANORL-413; No. of Pages 2
ARTICLE IN PRESS G. Barrett et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
2
3. Answer
References
The MRI demonstrated avid enhancement of a right-sided vestibular schwannoma traversing the cochlea, vestibule and round window (arrow) into the middle ear cleft. No other abnormalities were detected. Vestibular schwannomas are benign tumors of the Schwann cells typically affecting the superior vestibular nerve. An annual growth rate of 1–2 mm is expected, but up to 75% of tumors show no growth [1]. Lateral expansion into the middle ear through breach of the otic capsule and round window is a rare finding [2]. These tumors may also originate from the inner ear [3], and the Kennedy classification system addresses this type [4].
[1] Nikolopoulos TP, Fortnum H, O’Donoghue G, Baguley D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010;31:478–85. [2] Ebmeyer J, Gehl HB, Upile T, Sudhoff HH. Vestibular schwannoma presenting as a white middle ear mass behind an intact tympanic membrane. Otol Neurotol 2011;32(5):e32–3. [3] Van Abel KM, Carlson ML, Link MJ, Neff BA, Beatty CW, Lohse CM, et al. Primary inner ear schwannomas: a case series and systematic review of the literature. Laryngoscope 2013;123:1957–66. [4] Kennedy RJ, Shelton C, Salzman KL, Davidson HC, Harnsberger HR. Intralabyrinthine schwannomas: diagnosis, management, and a new classification system. Otol Neurotol 2004;25:160–7.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
Please cite this article in press as: Barrett G, et al. Soft tissue middle ear mass. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2014.09.003
ARTICLE IN PRESS
ANORL-413; No. of Pages 2
European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
Available online at
ScienceDirect www.sciencedirect.com
What is your diagnosis?
Soft tissue middle ear mass G. Barrett a,∗ , B. Rock b , M. Prior c a
MRCS, Department of ENT Head and Neck Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, United Kingdom FRCR, Department of Radiology, Royal Cornwall Hospital NHS Trust, Penventinnie Ln, Truro, Cornwall TR1 3LJ, United Kingdom c FRCS, Department of ENT Head and Neck Surgery, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom b
1. Description A 70-year-old gentleman was seen with right-sided sensorineural hearing loss but no other otological symptoms. On otoscopy, a polypoid mass was visualized in the right middle ear behind an intact and healthy tympanic membrane. A computed tomography scan showed a soft tissue mass within the right mesotympanum measuring 6.6 mm in maximum axial dimension, extending into the region of the round window niche. Following this, magnetic resonance imaging (MRI) was obtained including T2 axial (Fig. 1a) and gadolinium enhanced T1 coronal (Fig. 1b) formats.
Fig. 1. a: T2 axial MRI of the internal acoustic meati; b: gadolinium enhanced T1 coronal MRI. The arrow points to the round window.
2. Question
What is your diagnosis?
∗ Corresponding author. E-mail address: [email protected] (G. Barrett). http://dx.doi.org/10.1016/j.anorl.2014.09.003 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Barrett G, et al. Soft tissue middle ear mass. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2014.09.003
G Model ANORL-413; No. of Pages 2
ARTICLE IN PRESS G. Barrett et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
2
3. Answer
References
The MRI demonstrated avid enhancement of a right-sided vestibular schwannoma traversing the cochlea, vestibule and round window (arrow) into the middle ear cleft. No other abnormalities were detected. Vestibular schwannomas are benign tumors of the Schwann cells typically affecting the superior vestibular nerve. An annual growth rate of 1–2 mm is expected, but up to 75% of tumors show no growth [1]. Lateral expansion into the middle ear through breach of the otic capsule and round window is a rare finding [2]. These tumors may also originate from the inner ear [3], and the Kennedy classification system addresses this type [4].
[1] Nikolopoulos TP, Fortnum H, O’Donoghue G, Baguley D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010;31:478–85. [2] Ebmeyer J, Gehl HB, Upile T, Sudhoff HH. Vestibular schwannoma presenting as a white middle ear mass behind an intact tympanic membrane. Otol Neurotol 2011;32(5):e32–3. [3] Van Abel KM, Carlson ML, Link MJ, Neff BA, Beatty CW, Lohse CM, et al. Primary inner ear schwannomas: a case series and systematic review of the literature. Laryngoscope 2013;123:1957–66. [4] Kennedy RJ, Shelton C, Salzman KL, Davidson HC, Harnsberger HR. Intralabyrinthine schwannomas: diagnosis, management, and a new classification system. Otol Neurotol 2004;25:160–7.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
Please cite this article in press as: Barrett G, et al. Soft tissue middle ear mass. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2014.09.003