中耳静脈奇形例

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  • A Case of Venous Malformation of the Middle Ear
  • チュウジ ジョウミャク キケイレイ

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<p>Venous malformations rarely occur in the middle ear, especially at the tympanic opening of the Eustachian tube. A 36-year-old female patient who presented with a several months’ history of a clogged-ear feeling on the left side was referred to us for evaluation. Endoscopic examination showed a dark purple mass occupying the anterior-superior quadrant of the left tympanic membrane. A pure-tone audiogram showed normal hearing. Computed tomography showed an isolated lobulated soft tissue mass extending from the tympanic opening of the Eustachian tube extending to the promontory. There was no evidence of bony erosion in the middle ear. The lesion was visualized as a hyperintensity on T1- and T2-weighted images, and as a contrast-enhancing mass lesion on gadolinium-enhanced magnetic resonance imaging. We performed tumor resection via the postauricular approach. The mass was not adherent and could be removed en bloc. The ossicular chain was intact. Histopathologic examination of the resected specimen identified the lesion as a venous malformation. There was no recurrence until the end of the 2-year follow-up period.</p><p>Venous malformations are benign vascular tumors that account for 44%–64% of all vascular malformations. About 40% of all venous malformations occur in the head and neck region, although venous malformation of the temporal bone is rare. Furthermore, while it is known to occur in the geniculate ganglion, internal and middle ear, chorda tympani, etc., its occurrence at the tympanic opening of the Eustachian tube has never been reported before. Middle ear venous malformations could be asymptomatic or cause a variety of symptoms, including conductive hearing loss, pulsatile tinnitus, bloody otorrhea, otalgia, and otitis media, in order of decreasing frequency. Our patient presented with only a clogged-ear feeling and there was no conductive hearing loss. This could have been a result of the mass being located at the tympanic opening of the Eustachian tube.</p><p>To the best of our knowledge, this is the first documented case of venous malformation arising from the tympanic opening of the Eustachian tube.</p>

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