右S状洞血栓症と左後頭蓋窩進展を伴った両側真珠腫性中耳炎例

抄録

A 45-year-old man presented with right otorrhea, headache, fever and nausea. Audiogram showed moderately conductive hearing loss in the right ear and total deafness in the left ear. In addition, complete left hemifacial palsy and a hard mass in the right lateral neck were observed. CT revealed that a soft tissue density in the middle ear, bone destruction in the tegmen tympani, erosion of the sinus plate with air bubbles in the lateral sinus in the right ear; destruction of the petrous bone including the cochlea, superior semicircular canal and internal auditory canal in the left ear. MRI depicted a thrombus in the right transverse sinus, lateral sinus and internal jugular vein and a large cholesteatoma mass invading the left petrous bone and extending to the left cellebro-pontine angle. The treatment of the right ear consisted of internal jugular vein ligation with incision of the lateral sinus for drainage of abscess, modified radical mastoidectomy for eradication of cholesteatoma and staged tympanoplasty for preservastion of hearing. Seventy days after the right ear surgery, the patient underwent the left ear surgery, which consisted of combined transmastoid / subtemporal presigmoid approach. Postoperative hearing in the right ear was improved and no recurrent cholesteatoma was depicted on imaging study in both ears for 11 months.