title: Otological manifestations of thalassaemia intermedia: evidence of temporal bone involvement and report of a unique cholesteatoma-like lesion.
abstract: Thalassaemia intermedia should be considered in any chronically anaemic patient presenting from the Middle East with hearing impairment. We report here three Saudi siblings with thalassaemia intermedia and features of severe bone marrow expansion, particularly invading the temporal bone. They were seen first for their otological problems before they had access to proper haematological evaluation. One member was admitted for surgical exploration of a cholesteatoma, which was then found to be marrow expansion of the temporal bone. Screening of the family revealed two more anaemic siblings with thalassaemia intermedia. Audiological examination of all the family members showed that only the two affected members had a high frequency sensori-neural hearing loss. Bone marrow expansion into the temporal bone is a rare feature of thalassaemia intermedia. Cholesteatoma-like lesion has not been previously described. It has to be considered in all cases of symptomatic thalassaemia intermedia manifesting with cavitation and lytic lesions in the mastoid system. The likelihood that sensorineural hearing loss may complicate the thalassaemias is raised and the possible mechanism for such involvement discussed. The proper management for different otological manifestations of the thalassaemias is suggested. These cases would suggest a more extensive involvement of the temporal bone in the thalassaemias than has been previously recognized. Further large scale studies are required to illuminate the subject.
authors.affiliation: Department of Clinical and Laboratory Haematology, King Saud University Medical College, Abha, Kingdom of Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Sheikha
authors.forename: M
authors.initials: M
authors.lastname: Kameswaran
authors.forename: B C
authors.initials: BC
authors.lastname: Okafor
authors.forename: A A
authors.initials: AA
authors.lastname: al-Saigh
mesh_terms: D000293:Adolescent; D000328:Adult; D001847:Bone Diseases / Q000000981:diagnostic imaging; D002648:Child; D002781:Cholesteatoma / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology*; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006411:Hematopoiesis, Extramedullary / Q000502:physiology; D006801:Humans; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging; D013701:Temporal Bone / Q000000981:diagnostic imaging; D013789:Thalassemia / Q000150:complications*; D014057:Tomography, X-Ray Computed