[Tympanic paraganglioma mimicking cholesteatoma: about a case]

Tympanic paragangliomas are common benign tumors of the middle ear, made up of neuroendocrine cells dispersed along the major vascular axes of the head, the neck and the vertebral column. The revealing symptoms are hearing loss and a pulsatile tinnitus. Otoscopy often shows pulsatile retrotympanic reddish mass. MRI and somatostatin analogue scintigraphy (OctreoScan) are the imaging modality of choice. OctreoScan allows physicians to detect other tumor locations. The dosage of urinary methoxyl derivatives is determined, complemented by the screening of other components of multiple endocrine neoplasias (MEN). Biopsy is contraindicated because of the risk of hemorrhage. Surgery is the treatment of choice. We report the case of F. A., a 75-year old patient, admitted with tympanic paraganglioma revealed by hearing loss in his right ear (occurred 4 years before) associated with pulsatile tinnitus concomitant with the heart beating in his ear. He underwnt otoscopy showing retrotympanic reddish pulsatile mass in his right ear (A). (B) MRI of the brain showed total involvement of the middle ear and of the mastoid cells, without identifiable tumoral process, with distinct hyperintensity on diffusion-weighted imaging and strong contrast-enhancement. MEN assessment was without abnormalities, including 24h methoxyl derivatives, parathyroid hormone and calcitonin. The diagnosis of paraganglioma was retained because of the strong contrast-enhancement. OctreoScan was indicated before surgery.