Osteomas of the middle ear

Abstract

INTRODUCTION Osteomas of the middle ear are small, single, usually unilateral, peduncular growths, off-white in color, with smooth or multilobular surface, asymptomatic or causing functional disorders (progressive hearing loss, pathological appearance of the eardrum, vertigo and otorrhea), of unclear or unknown etiology. Fleury described three types of osteomas: massive, diffuse atticoantral and localized type. The therapy is surgical. Small and asymptomatic ones are followed-up. Cremers suggests surgical intervention in cases of progressive growth and increased hearing loss. Case description Discharge and pain in the left ear started twelve years ago, accompanied by impaired hearing and tinnitus. Four months ago the symptoms aggravated and discharge and pain increased. Otomicroscopic findings revealed: perforation in the posterior attic and a prominent polypous, clustered bright red formation. Sch?ller X-ray showed total absence of pneumocyte cells, with distinct sclerotic changes. Retroauricular access showed a biventricular bony formation in the cavum and partly in the antrum. A cholesteatoma extended from the cavum into the antrum, above the osteatoma. The bony formation was separated transmeatally from the grip in the posterior attic using a chisel, partially removing the bone wall of the exterior aural tube, removing it completely through the mastoid antrum. The removed bony mass, sized 5 x 8 x 8 mm, included also the incus. DISCUSSION Osteoma was discovered accidentally. Regarding clinical features, it belonged to the second group, due to progressive hearing loss, recurrent episodes of otorrhea, pain, biventricular shape and association with cholesteatoma. It was removed using a combined method. It was not possible to establish when the osteoma exactly started generating. It is possible that the initial complaints twelve years ago were the first signs of illness, and chronic otitis may have occurred as a consequence of the tumor.