Occult infratemporal fossa neurofibroma presenting with persistent unilateral tinnitus and middle ear effusion: More than meets the eye

• Published in: American journal of otolaryngology Vol. 38; no. 2; pp. 251 - 253
• Main Authors: Carlstrom, Lucas P., Van Abel, Kathryn M., Carlson, Matthew L., Moore, Eric J., Stokken, Janalee K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017; Elsevier Limited
• Subjects: Aural fullness; Benign; Case reports; Diagnosis, Differential; Diagnostic systems; Ear; Effusion; Endoscopic medial maxillectomy; Endoscopy; Equalization; Female; Hearing loss; Hearing Loss, Conductive - surgery; Humans; Infratemporal fossa tumor; Lesions; Magnetic Resonance Imaging; Mandibular Neoplasms - diagnostic imaging; Mandibular Neoplasms - surgery; Middle Aged; Middle ear; Neurofibroma; Neurofibroma - diagnostic imaging; Neurofibroma - surgery; Occlusion; Otitis Media with Effusion - surgery; Otolaryngology; Pterygopalatine Fossa - diagnostic imaging; Pterygopalatine Fossa - surgery; Surgery; Tinnitus; Tinnitus - surgery; Tumors; Infratemporal fossa tumor; Tinnitus; Aural fullness; Endoscopic medial maxillectomy; Neurofibroma
• ISSN: 0196-0709; 1532-818X; 1532-818X
• DOI: 10.1016/j.amjoto.2016.11.015

Herein, we present the case of a previously healthy 54year-old female who developed several weeks of unilateral tinnitus and aural fullness. She subsequently underwent unilateral pressure equalization tube placement at an outside institution after exam demonstrated a middle ear effusion, conductive hearing loss and normal nasopharyngoscopy. Ultimately, an MRI revealed an occult mass in the infratemporal fossa (ITF), which was successfully removed via an endoscopic transnasal ITF approach. Following resection of a histopathologically confirmed benign neurofibroma, she reported complete resolution of her symptoms. The antiquated diagnostic algorithm of unilateral effusion suggests that normal nasopharyngscopy successfully “rules out” a causative neoplastic process; however, Eustachian tube occlusion by occult skull base lesions may be missed without further investigation. This case highlights the need for additional radiological investigation of unexplained unilateral persistent middle ear effusion in the setting of normal nasopharyngoscopy.