PMC5021455_01
(a) View of the right tympanic membrane and lesion (arrow) utilizing the operating microscope. (b) Intraoperative view of the lesion (long arrow) within the lifted tympanic membrane (asterisk) and the underlying malleus (short arrow) (images courtesy of Dr. Abraham Jacob, MD).
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Otoscopy revealed a diffusely thickened right tympanic membrane and a white, spherical mass involving the pars flaccida and most proximal portions of the malleus manubrium (Figure 1).
(a) Axial bone windowed temporal bone CT scan showing a 3-4 mm hyperdense lesion (arrow); the middle ear is aerated. (b) Coronal bone windowed temporal bone CT scan showing a 3-4 mm lesion lateral to the neck of the malleus (arrow). The scutum (lateral wall of epitympanum) is free of bone erosion (images courtesy of Banner University Medical Center).
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A high-resolution temporal bone CT scan was then obtained and confirmed the presence of a 3-4 mm lesion involving the upper eardrum and proximal malleus (Figure 2).
(a) Hematoxylin and eosin stained light microscopy obtained from the right ear mass (10x). Fibrous infiltrate, hyaline degeneration, and calcification (arrow) without presence of squamous epithelium are seen. (b) 20x view with black arrows demonstrating giant cell reaction (images courtesy of Sarah Tang, PSF).
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After discussing risks, benefits, alternatives, and reasonable expectations for informed consent, the patient elected to undergo surgery, and final pathology was consistent with tympanosclerosis, without evidence of cholesteatoma (Figure 3).