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Published on: July 5, 2021
Skull base meningiomas mimicking otitis media
1Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel. rabia.shihada@b-zion.org.il
Introduction:
Meningiomas are slow-growing, benign tumours originating from the arachnoid villi of the meninges. They account for 13 to 26 per cent of all intracranial neoplasms. Less than 1 per cent of all meningiomas are primary extracranial tumours of the ear and temporal bone. Intracranial meningiomas extending to the middle-ear cleft are uncommon, with fewer than 100 cases reported to date. Presenting symptoms of the latter condition may include hearing loss, tinnitus, dizziness, vertigo and facial palsy. Otitis media with effusion secondary to eustachian tube dysfunction has also been reported.
Aim:
To describe three patients in whom chronic otitis media was the presenting sign of skull base meningioma.
Method:
Case presentations.
Results:
Presentation of clinical and imaging findings as well as management considerations.
Conclusion:
Meningioma involving the middle ear is an extremely rare condition, and is diagnosed by computed tomography in conjunction with magnetic resonance imaging. When biopsy is performed, the histological features, characteristic immunophenotype and ultrastructural analysis are valuable aids to definitive diagnosis. In patients with no neurological symptoms, 'wait and scan' is often the best management option.
Insights
Chronic otitis media can be the initial symptom of a skull base meningioma, a rare tumor. Early diagnosis via imaging is crucial for effective management of this uncommon condition.
Area of Science:
- Neurology
- Otolaryngology
- Oncology
Background:
- Meningiomas are typically benign, slow-growing tumors arising from meningeal cells.
- While most meningiomas are intracranial, a small fraction occur extracranially, particularly in the ear and temporal bone.
- Extension of intracranial meningiomas into the middle ear is rare, with limited documented cases.
Observation:
- This study describes three patients where chronic otitis media was the primary presenting sign of a skull base meningioma.
- Symptoms included hearing loss, tinnitus, vertigo, and facial palsy, mimicking middle ear infections.
- Eustachian tube dysfunction leading to otitis media with effusion was also noted.
Findings:
- Diagnosis relies on advanced imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI).
- Histopathological examination, immunophenotyping, and ultrastructural analysis confirm the diagnosis.
- In asymptomatic patients, a 'wait and scan' approach is often recommended.
Implications:
- Highlights the importance of considering rare diagnoses like meningioma in patients with persistent or unusual ear symptoms.
- Emphasizes the role of multidisciplinary collaboration between neurologists, otolaryngologists, and radiologists.
- Suggests that prompt and accurate diagnosis can lead to better patient outcomes, even with rare conditions.
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