title: Mastoiditis and facial paralysis as initial manifestations of temporal bone systemic diseases - the significance of the histopathological examination.
abstract: Several systemic diseases, including granulomatous and infectious processes, tumors, bone disorders, collagen-vascular and other autoimmune diseases may involve the middle ear and temporal bone. These diseases are difficult to diagnose when symptoms mimic acute otomastoiditis.
  
  
  METHODS
  The present report describes our experience with three such cases initially misdiagnosed. Their predominating symptoms were otological with mastoiditis, hearing loss, and subsequently facial nerve palsy. The cases were considered an emergency and the patients underwent tympanomastoidectomy, under the suspicion of otitis media with cholesteatoma, in order to remove a possible abscess and to decompress the facial nerve. The common features were the presence of severe granulation tissue filling the mastoid cavity and middle ear during surgery, without cholesteatoma. The definitive diagnoses was made by means of biopsy of the granulation tissue from the middle ear, revealing granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) in one case, middle ear tuberculosis and diffuse large B-cell lymphoma respectively. After specific associated therapy facial nerve functions improved, and atypical inflammatory states of the ear resolved.
  
  
  CONCLUSIONS
  As a group, systemic diseases of the middle ear and temporal bone are uncommon, but aggressive lesions. After analyzing these cases and reviewing the literature, we would like to stress upon the importance of microscopic examination of the affected tissue, required for an accurate diagnosis and effective treatment.
authors.affiliation: Department of Otorhinolaryngology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; almacjro@yahoo.com.
authors.forename: Alma Aurelia
authors.initials: AA
authors.lastname: Maniu
authors.forename: Oana
authors.initials: O
authors.lastname: Harabagiu
authors.forename: Laura Otilia
authors.initials: LO
authors.lastname: Damian
authors.forename: Eugen HoraŢiu
authors.initials: EH
authors.lastname: Ştefănescu
authors.forename: Bogdan Marius
authors.initials: BM
authors.lastname: FănuŢă
authors.forename: Andreea
authors.initials: A
authors.lastname: Cătană
authors.forename: Carmen Aurelia
authors.initials: CA
authors.lastname: Mogoantă
mesh_terms: D001706:Biopsy; D002675:Child, Preschool; D004423:Ear / Q000473:pathology / Q000601:surgery; D005158:Facial Paralysis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008417:Mastoiditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D038781:Otoscopy; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed