Abstract
A 47-year-old female patient visited an otolaryngologist complaining of earache and hearing loss on the right side and was diagnosed as having tympanitis and treated accordingly. Since there was no improvement in the hearing loss and she had also started experiencing dysphagia in addition, she consulted a neurosurgeon. Imaging revealed a large cerebellopontine angle tumor. She was referred to us for the evaluation of her hearing and swallowing functions, and our initial examination revealed a tumor protruding from the right eardrum. Biopsy revealed that it was a meningioma. Under general anesthesia, we performed a craniotomy and removed the tumor. Pathological examination revealed the same findings as of the meningioma protruding from the middle ear.
Previous reports on the pathway of intracranial meningioma to the middle ear have been inconclusive, suggesting that the pathway can only be estimated based on the clinical symptoms and imaging, and no definite pathway has been established yet objectively. We were able to demonstrate, using 3D contrast-enhanced MRI, that the cerebellopontine angle tumor probably emerged from the cranium through the jugular sinus and extended to the middle ear via the auditory tube.
