Does external auditory canal polyp always refer to chronic ear disease? Case report of expanded jugulotympanic paraganglioma

Abstract

Introduction Identification of external auditory canal (EAC) polyp during otoscopy usually suggests a process of chronic otitis media. However, some rare tumors such as paraganglioma might be identified. Paraganglioma is a tumor that arise from extraadrenal chromaffin cells. It is important to diagnose and treat paragangliomas early, because of potential invasion to temporal bone and surrounding structures leading to life threatening events. A rare case of paraganglioma is disscused in this case report. Case study 52 y/o man complaining of left ear deafness applied for consultation. During otoscopy a huge polyp that occupies all EAC was identified. Hearing threshold in the left ear - 90 dB. No complains of facial nerve dysfunction or vertigo. During polyp excision under general anesthesia an intensive hemorrhage occurred. After hystopathological examination a diagnosis of combination of fibroepithelial polyp and paraganglioma was confirmed. MRI revealed paraganglioma’s size at jugular foramen site as 3.3x3.8x4.0 cm, widely infiltrating superior surface of pyramid. The inferior part of the mass descended by jugular vein to the level of oropharynx. Due to expanded tumor masses it was impossible to differentiate facial and vestibulocochlear nerves, labyrinth was also deformed. Patient was submitted to surgical treatment. The main part of the tumor was removed by retroauricular approach saving integrity of facial nerve. Conclusions EAC polyps may represent different clinical and histological entities, therefore all EAC polyps must undergo hystophalogical examination. If polyp occupies all EAC, it should be removed under general anesthesia.