Symptom: Serous Middle Ear Effusion and Hearing Loss : The Hearing Journal – LWW Journals
A 61-year-old male patient presented to the clinic with a history of recurrent upper respiratory infections, chronic ear fullness, and right-sided otalgia. An outside otolaryngologist had recommended pressure equalizer (PE) tubes, which were placed three years ago. Once his tube came out, the fullness in the ear returned, necessitating replacement a year later. When he had the tube in place, he had drainage from his ear intermittently. In addition, he reported headaches, blurry v…….
A 61-year-old male patient presented to the clinic with a history of recurrent upper respiratory infections, chronic ear fullness, and right-sided otalgia. An outside otolaryngologist had recommended pressure equalizer (PE) tubes, which were placed three years ago. Once his tube came out, the fullness in the ear returned, necessitating replacement a year later. When he had the tube in place, he had drainage from his ear intermittently. In addition, he reported headaches, blurry vision, and pulsing right eye pain. He has no history of previous ear issues as a child or adult. Physical examination demonstrates a serous middle ear effusion (Fig. 1). The left side was normal. Audiogram demonstrated mixed mild to moderately severe hearing loss on the right and mild high-frequency sensorineural hearing loss on the left.
Otoscopic image of the patient’s right ear. Audiology, serous middle ear effusion.
Figure 2:
Axial (horizontal) T1 pre-contrast MRI of the brain demonstrating a hyperintense (bright) mass of the right petrous apex that is brighter than the surrounding brain and anterior to the right IAC. Audiology, serous middle ear effusion.
Figure 3:
Axial (horizontal) T2-weighted MRI image demonstrating that the mass remains bright on T2. Audiology, serous middle ear effusion.
Figure 4:
Axial (horizontal) CT image showing the right petrous apex mass with erosion of the right eustachian tube. Note the normal appearance of the left eustachian tube. Audiology, serous middle ear effusion.
Figure 5:
Axial (horizontal) CT image demonstrating the right petrous apex mass with erosion of the bony carotid canal. Note the normal appearance of the left carotid canal. Audiology, serous middle ear effusion.
Table 1:
Petrous Apex Lesions.
DIAGNOSIS: PETROUS APEX CHOLESTEROL GRANULOMA
Unilateral serous middle ear effusion, especially in adults, requires further investigation and workup. Though unilateral serous middle ear effusion can be caused by Eustachian tube function, the patient had no history of Eustachian tube function prior to three years ago. The first step in workup of unilateral serous effusion is to perform nasopharyngoscopy to evaluate for a nasopharyngeal mass occluding the Eustachian tube. Nasopharyngeal masses can range from benign sinonasal polyps or tumors to malignancies such as nasopharyngeal carcinoma or clival chordoma. If no mass is identified, and the patient has no history of Eustachian tube dysfunction, recent upper respiratory infection, or allergic rhinitis/significant reflux, an MRI or CT scan should be obtained for further evaluation. Lastly, if this is nondiagnostic, blood tests such as ANCA should be obtained to evaluate for an underlying autoimmune etiology, including granulomatosis with polyangiitis (aka Wegener’s granulomatosis), which can cause inflammatory serous otitis media. In our patient, a petrous apex lesion was discovered on …….
