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Histopathological section of middle ear osteoma showing the bone covering of cuboidal ciliated epithelium with a thin band of intervening fibrous tissue (stained with hematoxylin and eosin).
Source publication
Introduction
Facial nerve weakness is most commonly due to Bell’s palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction.
Case presentation
We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observ...
Citations
... Consequently, the facial nerve is impacted[4].Careful and thoughtful observation is the key to discerning subtle signs of weakness in the muscles supplied by the motor portion [5]. Evaluation of the severity and progression of facial nerve weakness is crucial and requires a reliable quantitative grading scale. ...
Osteomas of the jaw are rare, benign, asymptomatic, slow-growing, and progressive osteogenic neoplasms, primarily located in the angle of the mandible. These neoplasms can grow to enormous sizes and exert constant pressure over the nerve, leading to nerve weakness, affecting its function, and causing cosmetic problems. The facial nerve is associated with different facial expressions, and its involvement in large neoplasms is highly uncommon and requires early recognition and intervention to prevent permanent damage. This study aims to document a rare clinical presentation associated with asymmetry in a patient's smile due to unilateral weakness of the marginal mandibular branch of the facial nerve. The evaluation of the improvement in the patient's smile was done using the Sunnybrook Facial Grading System to guide us in observing the healing process of the nerve after osteoma removal.
... Consequently, the facial nerve is impacted[4].Careful and thoughtful observation is the key to discerning subtle signs of weakness in the muscles supplied by the motor portion [5]. Evaluation of the severity and progression of facial nerve weakness is crucial and requires a reliable quantitative grading scale. ...
This study aims to document a rare clinical presentation associated with asymmetry in a patient's smile due to unilateral weakness of the marginal mandibular branch of the facial nerve. The evaluation of the improvement in the patient's smile was done using the Sunnybrook Facial Grading System to guide us in observing the healing process of the nerve after osteoma removal.
... Temporal bone osteomas are benign tumors typically found in the external auditory canal. Their occurrence within the middle ear is rare, though not unprecedented, with 39 cases documented since 1964 [1][2][3][4][5][6]. The etiology of middle ear osteomas is unclear. ...
... Middle ear osteoma has been shown to most commonly arise from the promontory [8]. While there have been several instances of an osteoma assimilating the malleus or incus, there have only been four cases involving the stapes [3,6,8,10,11], and there has never been a case before assimilating all three ossicles. To our knowledge, this is the first case reported to have assimilated all three ossicles. ...
We present a case report of a middle ear osteoma presenting as gradual unilateral conductive hearing loss in a healthy 32-year-old lady. The decision for treatment was influenced by the relatively small burden of the disease, and the size and location of the osteoma, which made the decision for surgical excision prohibitively difficult.
Taking patient wishes and circumstances into account, the decision was made for a bone conduction hearing implant in conjunction with close follow-up.
... We found that only 9 other cases have been reported since Yoon et. al. published their findings in 2014 [17][18][19][20][21][22], and reported the 46 th case of MEO (Table 1). Unfortunately, we were unable to obtain the full text of one paper in which 2 cases of MEO were reported. ...
... However, others advocate that even asymptomatic cases should be treated surgically, as treatment becomes difficult, and risks increase along with the tumor volume [7]. Curtis et al. [20] reported a case of surgically treated MEO with facial palsy at House-Brackmann grade IV. They reported that the facial palsy improved just up to grade II after surgery [20]. ...
... Curtis et al. [20] reported a case of surgically treated MEO with facial palsy at House-Brackmann grade IV. They reported that the facial palsy improved just up to grade II after surgery [20]. Chang et al. [37] reported that conductive hearing loss persisted, despite successful removal of the MEO and reconstruction of the ossicular chain, and stated that this was due to obliteration and loss of flexibility of the round window [37,38]. ...
Middle ear osteoma is an extremely rare benign tumor of the middle ear. Due to its very slow growth rate and benign nature, osteoma of the middle ear can be found incidentally without causing any symptoms. The most common clinical signs are conductive hearing loss, the sense of fullness in the ear, tinnitus, and otorrhea. Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss. When the mass becomes very large, and symptoms caused by the tumor increase, treatment also becomes difficult. In this paper, we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube. We also present a review of the pertinent literature.
... Реже встречаются выделения из среднего уха (при блоке тимпанального устья слуховой трубы) . Также в литературе описаны больные данным заболеванием с прогрессирующей кондуктивной тугоухостью в сочетании с периферическим парезом лицевого нерва и симптомом Тулио [8] и случаи асимптоматического течения [9,10] . ...
The short literary review of frequency of occurrence, complaints, results of diagnostics and surgical treatment of patients about osteomine is presented to a drum cavity in article. Two own cases of clinical inspection and surgical treatment of patients about osteomine of a drum cavity are described.
... 4 We reviewed MEDLINE database and only three other cases reported since then. 2,5,6 Including the patient in this study there were 25 males and 15 females with a male predominance 1.67:1. The age of patients ranging from 5 year old to 57 years old with mean age of 29.3. ...
... It has been reported that middle ear osteomas may present with other manifestations such as vestibular manifestations, facial palsy, mixed hearing loss, Tullio phenomenon, otorrhea, discharge and tinnitus. 3,[6][7][8] CT scan is the recommended complementary image as it defines the extent and probable origin of the lesion also detecting any secondary manifestations of the tumor. 2 The promontory is the most commonly involved site, followed by incus, pyramidal process, and the anterolateral wall of the epitympanum. 3 Middle ear osteoma should be considered in the differential diagnosis of any bony growth originating in the middle ear, such as fenestral otospongiosis, ossifying hemangiomas, osteoid osteomas, benign osteoblastoma, ossifying fibroma, fibrous dysplasia, osteochondroma, chondroma, calcified meningioma, isolated eosinophilic granuloma, giant cell tumor and malignant lesions such as osteosarcoma and osteoblastic metastasis. ...
... However in patients with significant conductive hearing loss or when there are other complications associated, surgical removal is preferred. 3,6 ...
... The main differential diagnosis is exostosis. However, exostoses, which occur only in the external auditory canal, are non-tumoral multiple, bilateral, broad-based elevations of the tympanic bone in response to repeated exposure to cold water, whereas osteomas [8] are solitary, unilateral, pedunculated tumors of unknown origin that may invade the middle ear. ...
... Only three other cases of MEOs in contact with the stapes have been reported to date [4,8,9] .The one reported by Curtis et al. illustrates the difficulties of treating such cases [4] . The patient was suffering from a mild conductive low-frequency hearing loss and facial nerve weakness. ...
Osteomas of the middle ear are rare benign tumors. Their consequences and symptoms are due to their specific location, such as the promontory or the epitympanum and their contact with the facial nerve, the semicircular canal, the ossicles, and the oval or round windows. We report a very unusual case of middle ear osteoma (MEO) in a 23-year-old male patient causing a right mixed hearing loss by contacting and overwhelming the incus and stapes. The lesion was also closely attached to the tympanic portion of the fallopian canal. Since the stapes was not clearly visible behind the lesion, careful observation was preferred to surgery owing to the high risk of inner ear damage and facial palsy with removal of the lesion. MEOs are rarely situated at this critical site. Regular clinical and computerized tomography monitoring is warranted to check their growth. This case also supports the etiological theory of chronic middle ear inflammation causing osteomas.
... Lesions arising from temporal bones are considered rare occurrence (8). Osteomas of external auditory canal are rare, but still most common tumors of temporal bones (8). ...
Osteoma is benign tumor composed of well- differentiated matured osseous tissue. Its presence in mandible and paranasal sinuses is common, yet appearance in external auditory canal is rare. We present a case of a 26- year- old male complaining of hearing loss and pain in the affected ear. Pathohistological analysis of surgically removed tissue revealed tumor consisted of mature trabecular bone, which represents benign lesion without tendency of metastasis.
Middle ear osteoma Temporal bone osteoma Computed tomography Conductive hearing loss Middle ear lesion a b s t r a c t Osteoma of the middle ear (MEO) is a rarity. Due to the benign nature and slow growth rate, MEO are often occasionally found by chance. Possible unspecific clinical symptoms may be conductive hearing loss, tinnitus, effusion, and a sense of fullness. If the osteoma is small and not visible in the otoscopic inspection, it may be confused with other conductive hearing loss etiologies, such as otosclerosis. Nevertheless, one should be aware of this rare but important differential diagnosis of middle ear lesions. This article presents an MEO case causing conductive hearing loss and outlines the diagnostic approach with computed to-mography.
The middle ear osteoma is a benign, infrequent, slow-growing tumor. This lesion is frequently asymptomatic and its diagnosis is usually accidental, as the case presented here. We present a case of a 26-year-old man who consulted for odynophagia and right ear pain in the context of an upper airway infection. By otoscopy in the left ear, we observed a whitish retrotympanic lesion that was compatible with a middle ear osteoma. To manage symptomatic patients with middle ear osteomas, surgery is the treatment of first choice. Nevertheless, for asymptomatic patients, follow up is recommended.
