title: Hypertrophic chronic pachymeningitis associated with chronic otitis media and mastoiditis.
abstract: We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo. Radiological tests of temporal bone revealed soft tissue in the mastoid and tympanic cavities, and T1 weighted MRI revealed prominent Gd enhancement of the middle skull basal meninges. Middle ear inflammation appeared to induce pachymeningitis and to exacerbate associated symptoms, leading to a decline in the patient's overall condition. Bilateral mastoidectomies were effective in improving her general condition. Her hearing improved only on the right side because ossiculoplasty was performed only on that side. Her facial movement progressively improved and pachymeningitis diminished over time. We speculate that removal of the infectious granulation within the middle ears and mastoids ameliorated the acute inflammation. The etiology remains unknown in this case.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Keio University Hospital, 35 Shinanomachi, Shinjuku, Tokyo 160-0082, Japan. skan@sc.itc.keio.ac.jp
authors.forename: Sho
authors.initials: S
authors.lastname: Kanzaki
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Takahisa
authors.initials: T
authors.lastname: Watabe
authors.forename: Kaoru
authors.initials: K
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D004429:Ear Ossicles / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006312:Hearing Loss, Bilateral / Q000209:etiology; D006801:Humans; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000150:complications* / Q000601:surgery; D008581:Meningitis / Q000097:blood / Q000209:etiology*; D010033:Otitis Media / Q000150:complications* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014717:Vertigo / Q000209:etiology
chemical_list: D002097:C-Reactive Protein