A 66-year-old female patient presented with a unilateral mixed hearing loss for several months. Otoscopy of the right ear revealed a white-colored sclerotic plaque under an intact and thickened tympanic membrane. The ear canal was without any pathologic finding. The provisional differential diagnosis was middle ear cholesteatoma. The patient's history did not reveal any significant predisposing factors for gout such as diuretic or aspirin usage, trauma, or acute illness. Our patient did not show any typical gouty symptoms such as severe joint pain, swelling, tenderness, or joint erythema. There were no clinical or laboratory signs of hyperuricemia.Clinical examination contained otoscopy by ear microscopy, pure-tone audiography, and tympanometry. Moreover, high-resolution computerized tomography of the temporal bone was done (Fig. 1). We performed a tympanoscopy of the patient's right ear in general anesthesia and removed semolina puddingYlike middle ear mass. Histopathology identified negatively birefringent crystals by light and polarized microscopy. Preoperative and postoperative pure-tone audiograms were examined after healing in a follow-up period of 3 months. Serologic analysis of urate was done according to a standard protocol. A musculoskeletal survey was performed by an orthopedic consultant. Because of the lack of any major joint symptoms, a joint fluid analysis (the gold standard for the diagnosis of gout) could not be obtained.The patient showed a combined hearing deafness with a conductive loss of 20 dB and normal tympanometry. Computed tomography of the petrous bone displayed a partial opacification of the middle ear with an almostnormal mastoid. During operation, we removed the middle ear masses that seemed semolina-like. The ossicular chain, chorda tympani, and tympanic membrane remained intact. Gout tophi were revealed on histopathologic examination by the identification of negatively birefringent monosodium urate crystals in the tophi by polarized Address correspondence and reprint requests to FIG. 1. Computerized tomography of the temporal bone showing a partly opacified middle ear. FIG. 2. Amorphous deposits within the tympanic membrane and subepithelial tissue. Needle-like deposits are also displaced within a fibrous stroma. Little inflammation is present. HE-staining, Â200.

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