A Rare Case of En Plaque Meningioma Causing an Effusive Chronic Otitis Media

Case Report

Austin Head Neck Oncol. 2018; 2(1): 1005.

A Rare Case of En Plaque Meningioma Causing an Effusive Chronic Otitis Media

Amadei EM* and Cola C

Department of Otorhinolaryngology and Audiology, Infermi Hospital, Rimini, Italy

*Corresponding author: Enrico Maria Amadei, Department of Otorhinolaryngology and Audiology, Infermi Hospital, Rimini, Italy

Received: August 31, 2018; Accepted: September 11, 2018; Published: September 18, 2018

Abstract

In daily practice, every otolaryngologist sees dozens of cases of chronic secretive otitis media. Suspicion must arise when the otitis occurs unilaterally. A rhinopharyngeal pathology will therefore be excluded. An en plaque meningioma can cause an unilateral serous otitis. This diagnosis is exceptional, but it is possible and rarely reported in Literature.

Keywords: En plaque meningioma; chronic monolateral otitis media

Case Description

In this case we have a 64-year-old woman complaining of a right hearing loss for many years. At otomicroscopy we found a right effusive otitis media (Figure 1). With tonal audiometry we found a severe mixed right hearing loss and a left-handed normoacusia (Figure 2). The right tympanogram was flat (type B).

Figure 1: Otomicroscopy: Right tympanic membrane, with epitimpanic bulging and middle chronic effusive otitis.

    

    
    

    

    Figure 1:  Otomicroscopy: Right tympanic membrane, with epitimpanic
bulging and middle chronic effusive otitis.

Figure 2: Tonal Audiometry: A severe mixed right hearing loss and a lefthanded normoacusia.

    

    
    

    

    Figure 2:  Tonal Audiometry: A severe mixed right hearing loss and a lefthanded
normoacusia.

We performed a negative rhinofibroscopy. So after three months of observation and local theraphy with nasal corticosteroid and tubal gymnastics with Otovent, we placed a transtimpanic tube, with good hearing recovery. After six months the tube was expelled spontaneously. One month later secretive otitis has returned.

So we performed first a CT scan, finding a hyperostotic reshaped surface of the middle cranial fossa (Figure 3-4). Finally we executed a MRI, finding an en plaque meningioma with involvement of the bone surrounding the Eustachian tube (Figure 5).

Figure 3: CT left ear: Normal left middle ear.

    

    
    

    

    Figure 3:  CT left ear: Normal left middle ear.

Figure 4: CT right ear: Hyperostotic reshaped right temporal bone (see arrows).

    

    
    

    

    Figure 4:  CT right ear: Hyperostotic reshaped right temporal bone (see
arrows).

Figure 5: MRI: En plaque meningioma of right middle cranial fossa extending to the middle ear with intraosseous expansive lesion.

    

    
    

    

    Figure 5:  MRI: En plaque meningioma of right middle cranial fossa extending
to the middle ear with intraosseous expansive lesion.

Conclusions

An en plaque meningioma should be considered in the differential diagnosis of a chronic monolateral serous otitis media. In this case we would have reached a correct diagnosis in a short time by performing a MRI many years ago. So in case of monolateral chronic otitis, with normal nasopharynx, should we use imaging techniques routinely and without delay?

References

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Citation: Amadei EM and Cola C. A Rare Case of En Plaque Meningioma Causing an Effusive Chronic Otitis Media. Austin Head Neck Oncol. 2018; 2(1): 1005.