Symptoms: Middle Ear Effusion and Eustachian Tube… : The Hearing Journal – LWW Journals
A 39-year-old male patient presented to the clinic with a history of left-sided hearing loss, ear fullness, and tinnitus. In 2009, an outside otolaryngologist placed pressure equalization (PE) tubes for ear effusion twice, and the patient was placed on steroids and antibiotics, but had no improvement. In 2014, he had serial aspirations of the middle ear with immediate relief. In addition, he reported left-sided ear pain and dizziness. He had no history of previous ear infections …….
A 39-year-old male patient presented to the clinic with a history of left-sided hearing loss, ear fullness, and tinnitus. In 2009, an outside otolaryngologist placed pressure equalization (PE) tubes for ear effusion twice, and the patient was placed on steroids and antibiotics, but had no improvement. In 2014, he had serial aspirations of the middle ear with immediate relief. In addition, he reported left-sided ear pain and dizziness. He had no history of previous ear infections but had a car accident with head trauma 15 years prior. Microscopic examination of the left ear showed evidence of middle ear effusion. The right side was normal. The patient had had an MRI previously ordered which the patient brought in and was read as normal. (See Figure 1.)
Axial (horizontal) T1 post-gadolinium MPR MRI of the internal auditory canals showing fluid in the mastoid. Clinical Consultation, middle ear effusion, eustachian tube dysfunction, eustachian tube, MRI, aneurysm, petrous internal carotid artery.
Figure 2:
Coronal (vertical parallel to the face) T1 post gadolinium MRI of the IAC showing a dilated carotid artery on the left (right side of image) compared to the right (left side of image). Clinical Consultation, middle ear effusion, eustachian tube dysfunction, eustachian tube, MRI, aneurysm, petrous internal carotid artery.
Figure 3:
Axial CT of temporal bones showing a possible lesion in the area in the left petrous apex that appears to be a dilated carotid artery. Clinical Consultation, middle ear effusion, eustachian tube dysfunction, eustachian tube, MRI, aneurysm, petrous internal carotid artery.
Figure 4:
Coronal source images of the MR arteriography (MRA) of the neck showing the carotid artery anatomy with a possible aneurysm on the patient’s left (Right side of image). Clinical Consultation, middle ear effusion, eustachian tube dysfunction, eustachian tube, MRI, aneurysm, petrous internal carotid artery.
Figure 5:
Composite MR arteriography (MRA) of the neck showing the carotid artery anatomy with a definite aneurysm on the patient’s left (right side of image). Clinical Consultation, middle ear effusion, eustachian tube dysfunction, eustachian tube, MRI, aneurysm, petrous internal carotid artery.
Diagnosis: Aneurysm of the Petrous Internal Carotid Artery
In adults, a unilateral middle ear effusion, with no history of Eustachian tube dysfunction (ETD), warrants a complete head and neck examination, audiogram, and imaging on the part of the clinician. Most commonly, ETD is due to upper respiratory infections, allergic rhinitis, and gastroesophageal reflux (usually underrecognized). Worrisome conditions that can also cause ETD include nasopharyngeal masses (from benign tumors such as sinonasal polyps to malignancies such as nasopharyngeal carcinoma or clival chordoma) occluding the Eustachian tube. Wegener’s granulomatosis should be considered in adult patients with chronic serous otitis media or acute otitis media. …….
