[Osteomas of the middle ear]

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Imaging

Background:

• Osteomas are benign, slow-growing bone tumors often found in the middle ear.
• Etiology remains unclear, but they can lead to functional disorders like hearing loss and otorrhea.
• Surgical intervention is the standard treatment for symptomatic or progressive osteomas.

Observation:

• A patient presented with a 12-year history of left ear discharge, pain, hearing impairment, and tinnitus.
• Otomicroscopy revealed a posterior attic perforation with a polypous formation; Schüller X-ray showed sclerotic changes and absence of pneumocyte cells.
• Surgical exploration identified a biventricular bony formation in the cavum and antrum, associated with cholesteatoma.

Findings:

• A 5x8x8 mm osteoma, including the incus, was surgically removed using a combined transmeatall-mastoid antrum approach.
• The osteoma was classified as a localized type, presenting with progressive hearing loss, recurrent otorrhea, pain, and co-existing cholesteatoma.
• The patient's initial symptoms over 12 years may have been early signs of the osteoma, potentially leading to chronic otitis.

Implications:

• This case highlights the importance of surgical management for symptomatic middle ear osteomas.
• The association with cholesteatoma underscores the need for thorough evaluation and complete tumor removal.
• Accurate diagnosis and timely intervention are crucial for managing functional deficits caused by middle ear osteomas.