Patient With Hearing Loss and a Middle Ear Mass

Neutel, Kjell; Mes, Steven W.; Merkus, Paul

doi:10.1001/jamaoto.2022.2589

Cited by 2 publications

(7 citation statements)

References 12 publications

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“…Notably, in this case, as well as in most reported cases of tophaceous gout in the middle ear, patients exhibited normal serum uric acid levels. Furthermore, no cases indicated previous gout manifestations in other joints [1][2][3][4].…”

Section: Discussionmentioning

confidence: 97%

“…Audiometry serves to quantify the extent of conductive hearing loss. High-resolution computed tomography (HRCT) generally depicts a heterogeneous partially calcified mass within the middle ear, with a distinct radiological appearance as seen in previously reported cases [1][2][3][4]. A semolina-like mass has been used as a descriptive term.…”

Section: Discussionmentioning

confidence: 98%

“…Diagnosing tophaceous gout affecting the middle ear demands a comprehensive approach that involves audiometry, imaging, and intraoperative correlation with macroscopic inspection of the mass. When there is a discrepancy between the imaging and intraoperative findings, histopathology can ultimately confirm or exclude the diagnosis by evaluating for the presence of monosodium urate crystals [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Gout (monosodium urate crystal deposition disease) is an inflammatory arthropathy and ranks among the primary causes of monoarthritis, primarily affecting peripheral joints such as the great toe or the knee [1]. Manifestations in the head and neck region have rarely been reported, affecting the sternoclavicular, temporomandibular, and cricoarytenoid joints, as well as the larynx, nose, pinna, and middle ear [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Tophaceous Gout of the Middle Ear

Waumans,

Desloovere,

Devos

2024

Journal of the Belgian Society of Radiology

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Tophaceous gout can rarely present in the middle ear as a mass-like lesion, causing conductive hearing loss. Noncontrast high-resolution computed tomography (HRCT) of the temporal bone plays a significant role in the diagnosis. Awareness of this condition among radiologists is important since it presents a distinctive appearance on HRCT. We present a case of tophaceous gout of the middle ear diagnosed with photon-counting computed tomography (PCCT).Teaching point: The presence of a partially calcified mass with a semolina-like appearance within the middle ear is highly suggestive of tophaceous gout, even in the presence of normal serum uric acid levels.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tophaceous Gout of the Middle Ear

Waumans,

Desloovere,

Devos

2024

Journal of the Belgian Society of Radiology

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“…Upon review of previously reported cases of middle ear tophi, none presented with a history of gout, pseudogout, or previous ear surgery (6)(7)(8). Middle ear tophi have been more frequently reported in patients older than 55 years old with the primary clinical manifestation being a simple progressive conductive hearing loss (7).…”

Section: Discussionmentioning

confidence: 99%

Middle Ear Tophi: A Case Series of Two Unusual Lesions and a Report of Facial Weakness and Review of the Literature

Akella,

Ghezavati,

Siddiqui

et al. 2024

Otol Neurotol

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Objective Tophaceous lesions of the middle ear from calcium pyrophosphate deposition disease (CPPD, or pseudogout) and gout are infrequently reported. Recognizing its characteristic findings will allow clinicians to accurately narrow the differential diagnosis of bony-appearing middle ear lesions and improve management. Patients Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history. Interventions Surgical excision of tophaceous middle ear lesions. Main Outcome Measure Improvements in facial weakness and conductive hearing loss. Results The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively. Conclusion Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.

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Patient With Hearing Loss and a Middle Ear Mass

Abstract: A 65-year-old patient with a history of myocardial infarction, sleep apnea, Meniere disease, and congenital cataract presents with left-sided hearing loss during the past 6 months without evident cause. What is your diagnosis?

Cited by 2 publications

References 12 publications

Tophaceous Gout of the Middle Ear

Tophaceous Gout of the Middle Ear

Middle Ear Tophi: A Case Series of Two Unusual Lesions and a Report of Facial Weakness and Review of the Literature

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